advance topics coagulation

Which of the following is NOT true concerning von Willebrand disease?

"treat with factor VIII concentrate not with cryoprecipitate, cryo does not contain vWF"

Which of the following is true concerning von Willebrand disease?

autosomal dominant, affecting males and females equally

cryo does not contain vWF

results in platelet adhesion defect and abnormal PFA test

often results in deficiency of factor VIII

A 22 year old female was seen in the ER with evidence of bleeding following a spider bite. Lab results show:Blood smear: schistocytesPlatelet count: 50,000/mm3PT: 20 secondsaPTT: 60 secondsd-dimer: positiveThe most likely diagnosis is:

Secondary fibrinolysis

The INR is calculated INR=(patient result PT/mean of reference range)ISI.

What is "INR"?

What is "ISI"

International Normalized Ratio.

ISI = International Sensitivity Index

Which of the following is NOT true concerning Factor V Leiden?

resists action of PC & PS

is a genetic mutation

is confirmed by activated PC test

is a mutation at position 20210

"is a mutation at position 20210"

Which of the following is true concerning Factor V Leiden?

resists action of PC & PS

is a genetic mutation

is confirmed by activated PC test

Abnormal platelet aggregation with ristocetin is seen in what condition(s)?

A. Aspirin Therapy

B. Von willebrand disease

C. Glanzmann thrombasthenia

D. Bernard-Soulier disease

E. B & D

F. A &D

A. Aspirin Therapy

D. Bernard-Soulier disease

B. Von Willebrand disease

C. Glanzmann thrombasthenia

F. A&D

E. B & D (Von Willebrand disease & Bernard-Soulier disease)

How long will the effect of aspirin last on the bleeding time?

1-5 days

3-6 days

10-14 days

7-10 days

Aspirin irreversibly inhibits COX-1 in platelets → ↓ thromboxane A₂ → impaired platelet aggregation.

Platelets cannot synthesize new enzymes (no nucleus), so the effect lasts for the entire lifespan of the platelet.

🩸 Platelet lifespan = 7–10 days

The bleeding time is used to measure:

Platelet function

fibrinolysis

intrinsic pathway

extrinsic pathway

common pathway

Platelet function

platelet function and intrinsic and extrinsic coagulation systems

What factors are included in the contact group?

II, VII, IX, X

I, V, VII, IX

XI, XII, PK, HMWK

I, V, VIII, XIII

XI, XII, PK, HMWK

Abnormal platelet aggregation with all reagents, normal platelet number and normal platelet morphology are seen in: ?????????????

Bernard-Soulier Syndrome

von Willebrand disease

Glanzmann thrombasthenia

Immune Thrombocytopenia Purpura

Bernard-Soulier Syndrome

If one performs an PTT on a patient on high dose warfarin therapy, we would expect that the result would be:

prolonged because of fibrinogen split products

increased because of factor VII defieciency

Normal because warfarin effects the PT only

prolonged because of other multiple factor deficiencies

prolonged because of other multiple factor deficiencies

D:↑ because of other multiple factor deficienciesThe prothrombin time is used to monitor warfarin therapy, but warfarin results in deficiencies of Factors II, VII, IX, and X. "D" is correct because Factors II, IX, and X are also measured by the aPTT.

3 major fibrinolytic drugs "clotbusters" are:

AntiThrombin, Streptokinase, tPA

Serine Protease, tPA, Streptokinase

Streptokinase, Urokinase, Protease

tPA, Urokinase, Streptokinase

Streptokinase, Urokinase, and Alteplase (tPA – tissue plasminogen activator)

Match the platelet inhibitor to its description:

Plavix

Aspirin

Glycoprotein IIb/IIIa receptor inhibitor

clopidogrel) → ADP (P2Y12) receptor inhibitor👉 Blocks ADP-mediated platelet activation and aggregation

aspirin destroys cyclo oxygenase to inhibit release reaction

glycoprotein Blocks fibrinogen binding site on platelets👉 Prevents final common step of platelet aggregation (platelet-platelet crosslinking)

Which of the following would be seen in a factor VIII inhibitor?

PT- prolonged, PTT- normal, normal plasma does not correct

PT- normal, PTT- prolonged, normal plasma does not correct

PT- normal, PTT prolonged, normal plasma corrects

PT- Prolonged, PTT normal, normal plasma corrects

PT – normal, PTT – prolonged, normal plasma does not correct

PT: Normal (extrinsic pathway is intact) PathologyOutlines.com.

aPTT: Prolonged (intrinsic pathway affected) PathologyOutlines.com.

Mixing study: When normal plasma is added in a 1:1 ratio, the prolonged aPTT does not correct because the inhibitor is present in the patient’s plasma and neutralizes any added factor VIII The

Heparin sulfate binds to ____________ on the endothelial cells to inactivate the activated serine proteases.

Protein C

Antiheparin II

Antithrombin

Protein S

Antithrombin

What test measures Factor I, only?

bleeding time

Prothrombin Time

Fibrinogen assay

aPTT

fibrinogen assay

What anticoagulant is used in the test tube for coagulation tests?

CaCl2

Na Citrate

Heparin Sulfate

K sulfate

Sodium citrate (Na citrate)

A 4 year old male has a prolonged aPTT. When mixing studies are performed aPTT results are still prolonged. Which of the following is most likely?

Inhibitor or other anticoagulant

Hemophilia A

Hemophilia B

Systemic Lupus Erythematosus

inhibitor or other anticoagulant (

match

ADP acts on platelets

Factor VIII

GP Ib

GP IIb/IIIa

bindings the links platelets

GP Ib + vWF = adhesion

GP IIb/IIIa + fibrinogen = aggregation

ADP = platelet activation

vWF carries Factor VIII

Reptilase time is similar to thrombin time, but is not inhibited by?

Coumandin

Warfarin

Heparin

Aspirin

Heparin

What factors are measured by the prothrombin time?

all factors except VII & XIII

I, II, V, VII, X

VIII & V

I, II, V, VII, X

Factor I – Fibrinogen (common pathway)

Factor II – Prothrombin (common pathway)

Factor V – Proaccelerin (common pathway)

Factor VII – Proconvertin (extrinsic pathway)

Factor X – Stuart–Prower factor (common pathway)

when plasmin cleaves fibrin in clot this process is called _______ and results in _______.

Fibrinolysis, D-dimers

Fibrinolytic, inhibitors

Fibrinogenolysis, X, Y, D & E fragments

thrombosis, inhibitors

Fibrinolysis, D-dimers

What factors are in the fibrinogen group?

I, V, VIII, XIII

I, V, VII, IX

XI, XII, PK, HMWK

II, VII, IX, X

I, V, VIII, XIII

Factor I – Fibrinogen (the precursor protein itself) Quizlet

Factor II – Prothrombin (converted to thrombin, which cleaves fibrinogen to fibrin) The Merck Manuals

Factor XIII – Fibrin stabilizing factor (cross-links fibrin monomers to strengthen the clot)

Which of the following concerning platelet adhesion is INCORRECT?

requires von Willebrand factor

glycoprotein Ib binds to exposed collagen

results in the secretion of ADP from the platelet

results in the secretion of prothrombin

results in the secretion of prothrombin

Which of the following concerning platelet adhesion is correct

requires von Willebrand factor

glycoprotein Ib binds to exposed collagen

results in the secretion of ADP from the platelet

What is the therapeutic goal for the INR?

2.0-3.5

1-2

4-6

3-4.5

2.0-3.5

A rapidly dissolving clot in the clot retraction test is an indication of:

decreased factor VIII activity

Increased fibrinolysis as in DIC

platelet dysfunction as in Glanzmann's thrombasthenia

lack of XIII

lack of Factor XIII

What clotting factor is deficient in Hemophilia B?

VIII

X

XI

IX

IX

What is the reference range for the prothrombin time?

Less than 13 seconds

less than 100 seconds

20-40 seconds

40-60 seconds

Less than 13 seconds

Match the inhibitor to to screening test and/or confirmation test

aPTT mixing studies

Low concentration phospholipid reagents (DRVVT)

Platelet neutralization techniques

Mixing = factor problem

dRVVT = lupus detection

Platelet neutralization = lupus confirmation

What reagents are used in the aPTT test?

Thromboplastin & CaCl2

activator, platelet phospholipid, & CaCl2

activator, platelet phospholipid, & CaCl₂

Which of the following is NOT true concerning Protein C (PC)?

lack of PC results in abnormal bleeding

inactivates Factor VIII

requires protein S

inactivates Factor V & VIII

lack of PC results in abnormal bleeding

In the fibrinolytic system plasminogen in converted to ________ which breaks down the clot.

thrombin

Phosphlipid

plasmin

Calcium

plasmin

Which of the following can affect coagulation and aggregation results on instruments that use optic (optical density) measurement analyzers, but are not affected to mechanical measurement analyzers,

clot

Hemolysis

incorrect ratio of blood to anticoagulant

Lipemia

Lipemia

What factors are measures by the PTT?

VIII, IX, X, XI, XII, XIII

I, II, V, VII, X

VII

all factors except VII & XIII

VIII, IX, X, XI, XII, XIII

Factor VIII (Antihaemophilic factor A) – intrinsic pathway

Factor IX (Antihaemophilic factor B, Christmas factor) – intrinsic pathway

Factor XI (Plasma thromboplastin antecedent, Hemophilia C) – intrinsic pathway

Factor XII (Hageman factor) – intrinsic pathway

Factor X (Stuart–Prower factor) – common pathway

Factor V (Proaccelerin, labile factor) – common pathway

Factor II (Prothrombin) – common pathway

Factor I (Fibrinogen) – common pathway

What test is not affected by heparin and is therefore a good test to use for patients on heparin to assess clotting of fibrinogen?

thrombin time

aPTT

Stepven time

Reptilase Time

Reptilase Time

What test is used to detect factor XIII deficiency?

5 M urea test

APTT

Thrombin

Prothrombin time

5 M urea test

Match the oral plasma protein anticoagulants to their description:

Dabiatran

Rivaroxaban

Warfarin

Dabigatran = “direct thrombin”

Rivaroxaban = “Factor Xa blocker”

Warfarin = “vitamin K dependent factors”

Which of the following is NOT true concerning Antithrombin?

Vitamin K dependant

activated by heparan sulfate on the endothelial cell

activated by heparin as therapeutic drug

Produced by the liver

Vitamin K dependent

What is the average life span of platelets?

50-100 days

20-40 days

9-12 days

110-120 days

9-12 days

Which of the following would be seen in primary fibrinolysis, thus differentiating it from DIC (secondary fibrinolysis)?

Decreased platelet count, schitocytes, abnormal PT, abnormal aPTT, positive FDP, positive d-dimer

Normal platelet count, normal RBC morphology, abnormal PT & PTT, Positive FDP, negative d-dimer

Normal platelet count, schitocytes, abnormal PT, abnormal aPTT, negative FDP, positive d-dimer

Decreased platelet count, normal RBC morphology, normal PT, abnormal aPTT, positive FDP, negative d-dimer

Normal platelet count, normal RBC morphology, abnormal PT & PTT, Positive FDP, negative d-dimer

Activated protein C and its cofactor Protein S (when bound to it receptor/activator thrombomodulin) inactivates Factors?

VIII & V

X & V

I & II

VII

VIII & V

What factors are included in the prothrombin group?

XI, II, PK, HMWK

I, V, VII, IX

I, V, VIII, XIII

II, VII, IX, X

II, VII, IX, X

Platelets are produced from what cell?

Drepanocyte

Hepatocyte

Megakaryocyte

Lymphocyte

Megakaryocyte

Which of the following is NOT true concerning Protein S (PS)?

Vitamin K dependan

requires antithrombin as a cofactor

lack of protein S results in venous clotting

measure bound & free PS because only free is funcional

requires antithrombin as a cofactor

What is the ratio of blood to anticoagulant for coagulation tests?

1:10

10:1

1:9

9:1

9:1

What is the reference range for the aPTT?

less than 100 seconds

20-40 seconds

Less than 13 seconds

40-60 seconds

20-40 seconds

What test measures Vitamin K dependent factors?

Thrombin Time

aPTT

Prothrombin Time

Fibrinogen

Prothrombin Time

Is the factor consumed during the clot or not?

V

XIII

VIII

I

IX

VII

II

X

I, V, VIII, XIII

V ✔️ consumed

VIII ✔️ consumed

I (fibrinogen) ✔️ consumed (converted to fibrin)

II (prothrombin) ✔️ consumed (converted to thrombin)

What effect will heparin have on the thrombin time?

It will have no effect

It will decrease the thrombin time

It will increase the thrombin Time

It will increase the thrombin time

What % of platelets is retained in the spleen?

10%

30%

75%

70%

30%

Platelet aggregation studies should not be run on what problem sample?

Hemolyzed

Turbid

Lipemic

hemolized

D-dimer latex test is negative in which condition?

Deep vein thrombosis

Primary fibrinolysis

All of these

Pulmonary embolism

DIC

Deep vein thrombosis

What test is used to monitor oral anticoagulant (warfarin, coumarin, dicoumarol)?

bleeding time

Thrombin Time

Prothrombin Time

aPTT

Protombin time

What test is used to measure heparin therapy?

aPTT

Prothrombin Time

Fibrinogen assay

Bleeding time

aPTT (activated partial thromboplastin time)

Match parenteral anticoagulants to their description:

Low Molecular Weight Heparin

Heparin

LMWH = Xa inhibitor (more specific)

Heparin = IIa + Xa inhibitor (broader effect)

What test measures the intrinsic and common pathways?

Thrombin Time

Fibrinogen

aPTT

Prothrombin Time

aPTT (activated Partial Thromboplastin Time)

What factors are dependent of Vitamin K?

II, VII, IX, X

XI, II, PK, HMWK

I, V, VIII, XIII

I, V, VII, IX

II, VII, IX, X

What reagents are used in prothrombin time?

activator, platelet phospholipid & CaCl2

Tissue thromboplastin & CaCl2

Tissue thromboplastin & CaCl2

Match the factor to the protein type:

Factor VII

HMWK

Factor XIII

Factor V

Factor XI

Factor I

Factor XII

Factor VIII

Factor IX

PK

Factor II

Factor X

Fibrinogen group (final/common clot formation)

Factor I → Fibrinogen

Factor V → Labile factor (prothrombinase cofactor)

Factor VIII → Anti-hemophilic factor A

Factor XIII → Fibrin-stabilizing factor

What clotting factor is deficient in Hemophilia A?

VII

IX

VIII

V

VIII

The reference range for platelets in the peripheral blood is:

1,000-5,000/uL

50,000-100,000uL

100,000-200,000/uL

150,000-400,000/uL

150,000-400,000/µL

Which of the following is not true concerning Hemophilia C?

Common among Askenazi Jews

Would have an abnormal PTT

Does not show clinical symptoms of bleeding

Deficiency in factor XI

Would have an abnormal PTT