Unit 13 Fibrinolysis, Thrombosis Risk Factors, and Coagulation Instrumentation

What converts plasminogen to plasmin and protein C to activated protein C?

• thrombin

• factor III

• plasminogen

• plasmin

thrombin

Endothelial cells secrete ___________________ that activates plasminogen, forming plasmin.

• Thrombomodulin

• Factor XIIa

• Tissue plasminogen activator (tPA)

• Plasmin

tissue plasminogen activator (TPA)

__________ digests fibrinogen and fibrin, producing fibrin degradation products (FDP).

• Thrombin

• Plasminogen

• Plasmin

• Factor XIIIa

plasmin

Urinary tract cells secrete __________ which is also a plasminogen activator.

• Streptokinase

• Urokinase

• Tissue plasminogen activator (tPA)

• Factor XIIa

urokinase

What specimen to you used for coagulation studies?

• sodium heparin (green top)

• EDTA (lavender top)

• SST (gold top)

• sodium citrate (light blue top)

sodium citrate (light blue top)

Sodium citrate tubes used for coagulation studies should contain ____% sodium citrate and have a ratio of ______ for whole blood to sodium citrate

3.2%

9:1

A citrated blood specimen for coagulation studies is collected from a polycythemic patient. The anticoagulant should be:

• the standard volume

• reduced in volume

• changed to EDTA

• changed to oxalate

reduced in volume (polycythemia causes decreased plasma so you need to decrease volume to have correct ratio of anticoagulant)

Which results would be expected for the PT and APTT in a patient with polycythemia:

• both prolonged

• both shortened

• normal PT, prolonged APTT

• both normal

both prolonged

What test is used to monitor the extrinsic pathway/anticoagulant therapies?

• Activated Partial Thromboplastin Time (APTT)

• Thrombin Time (TT)

• Fibrinogen assay

• Prothrombin Time (PT)

Prothrombin time (PT)

The prothrombin time test requires that the patient's citrated plasma be combined with:

• platelet lipids

• thromboplastin

• calcium and platelet lipids

• calcium chloride and thromboplastin

calcium chloride and thromboplastin

PT measures what factor deficiencies?

• I, II, V, VIII, and XIII

• I, II, V, VII, and X

• II, V, VII, IX, and X

• II, VII, IX, and X

I, II, V, VII, and X (extrinsic + common)

The PT test is most sensitive for which factor deficiency?

• factor I

• factor II

• factor V

• factor VII

factor VII

Which of the following factors typically shows an increase in liver disease:

• Factor VII

• Factor VIII

• Factor IX

• Factor X

Factor VIII

How do you calculate the INR for a PT?

INR = (PT / normal PT) ^ ISI

What test is used to monitor the intrinsic pathway/heparin therapy?

• Activated Partial Thromboplastin Time (aPTT)

• Thrombin Time (TT)

• Fibrinogen assay

• Prothrombin Time (PT)

aPTT

In the APTT test, the patient's plasma is mixed with:

• ADP and calcium

• tissue thromboplastin and collagen

• phospholipids and calcium

• tissue thromboplastin and calcium

phospholipids and calcium

The APTT is sensitive to a deficiency of:

• Factor VII

• Factor X

• PF3

• Calcium

Factor X

aPTT measures what factor deficiencies?

• factors I, II, V, VII, VIII, XI, and XII

• factors I, II, V, VII, VIII, IX, X, XI, and XII

• factors I, II, V, VIII, IX, X, XI, and XII

• factors I, II, V, VIII, XI, XII, and XIII

factors I, II, V, VIII, IX, X, XI, and XII (intrinic + common)

What test is used to assess clotting time of patient before and during surgeries?

• Prothrombin Time (PT)

• Activated Partial Thromboplastin Time (aPTT)

• Activated Clotting Time (ACT)

• Bleeding Time

activated clotting time (ACT)

What test measures the availability of functional fibrinogen?

• Thrombin Time (TT)

• Fibrinogen Assay (Clauss method)

• Prothrombin Time (PT)

• Activated Partial Thromboplastin Time (aPTT)

thrombin time (TT)

What test measures the integrity of platelet function?

• Prothrombin Time (PT)

• Activated Partial Thromboplastin Time (aPTT)

• Bleeding Time

• Thrombin Time (TT)

bleeding time

What must be present for heparin to function as an anticoagulant?

• Protein C

• Antithrombin

• Factor VIII

• Fibrinogen

antithrombin

Which of the following proteins is the primary inhibitor of the fibrinolytic system:

• protein C

• protein S

• alpha2 antiplasmin

• alpha2 macroglobulin

alpha2 antiplasmin

What 2 SERPINs inactivate factors Va and VIIIa?

• Antithrombin and alpha-1 antitrypsin

• Activated Protein C and Protein S

• Plasminogen activator inhibitor-1 and antithrombin

• Protein C and antithrombin

activated protein C and protein S

All of the following are characteristics of protein C except:

• vitamin K-dependent zymogen

• activated by thrombin

• inhibits cofactors Va and VIIIa

• activity is inhibited by protein S

activity is inhibited by protein S (protein S enhances)

What is the most common risk factor for inherited thrombosis among whites?
Prothrombin G20210A mutation

• Factor V Leiden mutation

• MTHFR mutation

• Activated Protein C resistance (APCR)

activated protein C resistance (APCR)

What gene mutation is commonly seen in people with activated protein C resistance (APCR)?

• Prothrombin G20210A mutation

• Factor V Leiden mutation

• MTHFR mutation

• Protein C gene mutation

Factor V Leiden mutation

What is the second most common risk factor in whites for inherited thrombosis?

• Factor V Leiden mutation

• Prothrombin G20210 mutation

• MTHFR mutation

• Protein S deficiency

prothrombin G20210 mutation

What inhibitor can cause increased aPTT results due to antiphospholipid antibodies and increases risk of thrombosis?

• Factor VIII inhibitor

• Lupus Anticoagulant (LAC)

• Antithrombin deficiency

• Protein C inhibitor

Lupus anticoagulant (LAC)

What other antibody is found alongside phospholipid antibodies in lupus anticoagulant (LAC)?

• Anti-β2 glycoprotein I

• Anti-cardiolipin

• Anti-dsDNA

• Rheumatoid factor

anti-cardiolipin

Aliquots of plasma with a prolonged PT and prolonged APTT are mixed using various ratios of patient plasma and normal plasma. All samples are incubated at 37C and tested at 10, 30, and 60-minute intervals. The PT and APTT results on all of the mixtures are corrected. The results would indicate the presence of:

• circulating anticoagulant

• factor deficiency

• contaminated reagent

• antibodies

factor deficiency (normal results after mixing in normal serum means the patient was lacking factors that are in the normal plasma)

Which of the following is characteristic of platelet disorders:

• deep muscle hemorrhages

• retroperitoneal hemorrhages

• mucous membrane hemorrhages

• severely prolonged clotting times

mucous membrane hemorrhages

Which of the following statements concerning vitamin K is NOT true:

• there are two sources of vitamin K; vegetable and bacterial

• vitamin K converts precursor molecules into functional coagulation factors

• heparin inhibits the action of vitamin K

• vitamin K is fat soluble

heparin inhibits the action of vitamin K (heparin enhances antithrombin III to inhibit thrombin)

A patient with a prolonged PT is given intravenous vitamin K. The PT corrects to normal after 24 hours. What clinical condition most likely caused these results:

• liver disease

• Factor X deficiency

• fibrinogen deficiency

• obstructive jaundice

obstructive jaundice (causes impaired absorption of fat-soluble vitamins like K)

Which of the following lab procedures is most helpful in differentiating severe liver disease and accompanying secondary fibrinolysis from disseminated intravascular coagulation:

• presence of fibrin split products

• increased APTT

• Factor VIII activity

• fibrinogen level

factor VIII activity

The most potent plasminogen activator in the contact phase of coagulation is:

• kallikrein

• streptokinase

• Factor XIIa

• fibrinogen

kallikrein

A hemophiliac male and a normal female can produce a:

• female carrier

• male carrier

• male hemophiliac

• normal female

female carrier

A mixing study that remains uncorrected is indicative of:

• Factor deficiency

• Presence of an inhibitor

• Contaminated reagent

• Vitamin K deficiency

presence of an inhibitor

A prolonged aPTT due to a factor XI deficiency is seen in:

• Hemophilia A

• Rosenthal syndrome

• Von Willebrand disease

• Bernard-Soulier syndrome

Rosenthal syndrome

Which of the following factor deficiencies is associated with either no bleeding or only a minor bleeding tendency, even after trauma or surgery:

• Factor X

• Factor XII

• Factor XIII

• Factor V

factor XII

A factor deficiency that has a normal PT, aPTT, and TT that can still cause risk of bleeding is due to a deficiency in factor:

• VII

• VIII

• XI

• XIII

XIII

What factors are affected by liver disease?

vitamin K dependent (II, VII, IX, X)

What factors are affected by nephrotic syndrome?

vitamin K dependent (II, VII, IX, X) and XII

A test used to monitor streptokinase therapy is:

• reptilase time

• fibrin split products

• staphylococcal clumping test

• thrombin generation time

fibrin split products

Which of the following is necessary for activation of vitamin K-dependent coagulation factors:

• antithrombin III

• calcium

• carboxy residues

• arachidonic acid

calcium

Which coagulation factor deficiency is associated with a prolonged prothrombin and Stypven time:

• Factor III

• Factor VII

• Factor X

• Factor XI

factor X (Stypven is used specifically for factor X)

Which of the following is the most common cause of an abnormality in hemostasis:

• decreased plasma fibrinogen level

• decreased Factor VIII level

• decreased Factor IX level

• quantitative abnormality of platelets

quantitative abnormality of platelets

Acute disseminated intravascular coagulation (DIC) is characterized by:

• hypofibrinogenemia

• thrombocytosis

• negative D-dimer

• Factor V deficiency

hypopofibrinogenemia

A patient develops severe unexpected bleeding following four transfusions. The following test results were obtained: PT and APTT prolonged, platelets are 50 X 103/uL, fibrinogen level is 30 mg/dL, and fibrin split products increased. Given these results, which of the following blood products should be recommended to the physician for this patient?

• platelets

• Factor VIII

• Cryoprecipitate

• Fresh frozen plasma

Cryoprecipitate

Which statement about the fibrin degradation product (FDP) test is false:

• detects early degradation products

• elevated in DIC

• evaluates the fibrinolytic system

• detects late degradation products

detects early degradation products