MMSC423 Exam 2 Study Materials - Flashcards on Hematology and Coagulation

What is meant by the term primary fibrinolysis?

plasmin is formed in the presence of coagulation

plasmin is formed in the absence of coagulation

thrombin is formed in the absence of coagulation

formation of thrombin but absence of plasmin

plasmin is formed in the absence of coagulation

What reagent is required when performing a specific factor assay?

factor deficient plasma

platelet agonist

vitamin K

barium sulfate

platelet agonist

What strongly immunogenic antigen is associated with isoimmune neonatal thrombocytopenia?

PL A1

P

D

Csa

PL A1

In this test, sodium citrate whole blood is placed inside of an analyzer and exposed to cartridges containing either collagen/epinephrine or collagen/ADP to assess platelet aggregating ability

Prothrombin Time

PFA-100

APC resistance

Bleeding Time

PFA-100

Calculate the INR given the following results: patient PT = 12.5 seconds, control = 11.6 seconds, ISI = 2.1

3.0

1.2

1.7

2.0

1.2

The LMWHs are more efficient in binding factor ----------- than binding FIIa.

FXIIa

FXa

FVa

FVIIa

FXa

In this type of coagulation methodology, a stationary electrode and moving electrode conduct electrical current when the fibrin clot is formed

optical

chromogenic

electromechanical

nephelometry

electromechanical

Which of the following is used to reverse the effects of heparin?

Coumadin

Aspirin

Vitamin K

protamine sulfate

protamine sulfate

In which disease state might you expect percent transmittance to be decreased in platelet aggregation studies with ADP?

von Willebrand's disease

Hemophilia A

Hemophilia B

Glanzmann's Thrombasthenia

Glanzmann's Thrombasthenia

What is the longest time a prothrombin time can be performed after collection if stored at 2-4 degrees Celsius or room temperature?

4 hours

8 hours

12 hours

24 hours

24 hours

Which of the following is paramount to unfractionated heparin's efficacy as a anticoagulant?

prothrombin

fibrinogen

antithrombin

prekallikrein

antithrombin

What is effective in reversing the effects of warfarin?

vitamin K

heparin

Coumadin

protamine sulfate

vitamin K

Which of the following tests is increased in a patient with severe hemophilia A?

Thrombin Time

APTT

Factor VIII assay

PT

APTT

What is the significance behind the "Gray Platelet Syndrome" name?

- patients present with moderate thrombocytosis

- large platelets appear gray on Wright Stained blood smears

- red blood cells appear gray on Wright stained blood smears

- patients present with hemarthrosis

large platelets appear gray on Wright Stained blood smears

Why is Calcium chloride added after the FXII activator in the APTT?

- activator is added first to activate FXII and calcium is added second to activate FX

- activator is added first to activate FXII, calcium is added second to activate FXI

You Answered

- activator is added first to activate FXII, calcium is added second to activate FVII

- activator is added first to activate FXII, calcium is added second to activate FIX

activator is added first to activate FXII, calcium is added second to activate FIX

Which coagulation factor is the first to decrease when a patient is placed on oral anticoagulant (Coumadin) therapy?

II

X

VII

IX

VII

In this phenomenon platelets surround segmented neutrophils necessitating a redraw of the CBC (complete blood cell count) into a sodium citrate tube

post transfusion purpura

Gray Platelet Syndrome

platelet satellitosis

Chediak-Higashi

platelet satellitosis

Which of the following is associated with Primary Fibrinolysis but not uncompensated DIC?

increased APTT

normal D-dimer

increased PT

low fibrinogen

normal D-dimer

All of the following are associated with Hermansky-Pudlak syndrome, except:

albinism

prolonged bleeding

presence of dense granules

absence of dense granules

presence of dense granules

Which of the following is characterized as a disease of aggregation?

Bernard-Soulier syndrome

Glansmann's Thrombasthenia

von Willebrands Disease

Gray Platelet syndrome

Glansmann's Thrombasthenia

In this test, percent transmittance and PRP (platelet rich plasma) is employed as well as platelet agonists such as ADP

bleeding time

TEG

PFA 100

platelet aggregation

platelet aggregation

How does the Reptilase time differ from the thrombin time?

the Reptilase time is decreased in hypofibrinogenemia

the reptilase time utilizes patient serum

the Reptilase time is not affected by heparin

the Reptilase time is increased in hypofibrinogenemia

the Reptilase time is not affected by heparin

All of the following is true regarding ITP (idiopathic thrombocytopenia purpura), except:

plasma from an ITP patient can elicit a state of ITP if that

plasma is transfused into a non-diseased patient

the lifespan of platelets is shortened

IgG antibodies bind to platelets and destroy them

IgM antibodies bind to platelets and destroy them

IgM antibodies bind to platelets and destroy them

What is the blood to anticoagulant ratio in coagulation samples?

1:5

9:1

5:1

1:9

9:1

A Prothrombin Time and APTT was tested on a 51-yr old male with Hemophilia A. The Prothrombin time was 12.7 seconds and APTT was 50 seconds. A mixing study was performed with normal plasma and absorbed plasma and the APTT was repeated using a 1:1 mix of patient plasma and normal plasma, and a 1:1 mix of patient plasma and absorbed plasma. The APTT tests did not correct. What can be concluded from the mixing study?

the 1:1 mix was not potent enough

patient likely has an inhibitor to FVII

patient likely has an inhibitor to FVIII

patient is on Coumadin

patient likely has an inhibitor to FVIII

All of the following is associated with Wiskott-Aldrich syndrome, except:

normal platelet aggregation

susceptibility to recurrent infections

X-linked disorder

decreased platelet aggregation

normal platelet aggregation

What are the normal values (in seconds) for the prothrombin time test?

12.6 to 14.6 seconds

10.1 to 13.3 seconds

25 to 35 seconds

2 to 9 minutes

12.6 to 14.6 seconds

In Bernard-Soulier syndrome there is absence of

GPIV

GPIIb/IIIa

GPV

GPIb

GPIb

What purpose would a splenectomy serve in treatment of ITP (idiopathic thrombocytopenia purpura)?

removes circulating immunoglobulin from circulation

enhances cellular sequestration

up regulates the RES system

removal of primary site of platelet destruction and antibody production

removal of primary site of platelet destruction and antibody production

How would you interpret an APTT of 51 seconds?

result is prolonged

result is decreased

result is normal

two answers are correct

result is prolonged

In a factor II deficiency, which of the following would occur?

both PT and APTT would be normal

both the PT and APTT would be decreased

PT normal, APTT increased

PT increased and APTT increased

PT increased and APTT increased

A female patient, 45 yrs old, comes into the Emergency Room complaining of bruises on their forearm and epistaxis. Lab results showed a PT of 16 seconds, APTT of 30 seconds, platelet count of 140,000/µL, and hemoglobin of 14.4 g/dL. A mixing study was done to try and correct the PT with both aged serum and adsorbed plasma. With aged serum in the mixing study with patient plasma, the PT was 11 seconds; however with adsorbed plasma it was 16 seconds. What could be the factor deficiency?

FX

FV

FVIII

FVII

FVII

Post-transfusion purpura is precipitated by transfusion in a recipient who

who has formed an antibody to a red cell antigen

who has formed an antigen to a platelet antibody

who has formed an antibody to an antigen they express

has formed an antibody to a platelet antigen

has formed an antibody to a platelet antigen

Which of the following describes Low Molecular Weight Heparin?

polysaccharide chains of 3000 to 30,000 Daltons

polysaccharide chains of 10,000 to 20,000 Daltons

polysaccharide chains of 4500 to 5000 daltons

polysaccharide chains of 5000 to 15,000 Daltons

polysaccharide chains of 4500 to 5000 daltons

What is the cause of TTP (thrombotic thrombocytopenia purpura)?

hemolysis, elevated liver enzymes, low platelets

Shiga-toxin producing E. coli

IgG autoantibody

deficiency of ADAMTS-13

deficiency of ADAMTS-13

What factors can be assessed by the Prothrombin Time Test?

FVII, I, II, V, and X

FXIII

FXII, XI, IX, FVIII, I, II, V, X

FVII, XI, IX, VIII

FVII, I, II, V, and X

This dense granule deficiency disorder is associated with pancytopenia and giant lysosomal granules in white cells

Wiskott-Aldrich

TAR syndrome

Chediak-Higashi

Hermansky-Pudlak

Chediak-Higashi

DDAVP is an effective treatment for

vWD type 1

dysfibrinogenemia

heparin overdose

ITP

vWD type 1

In this disease, the amount of sodium citrate added to collection tube must be modified due to a high hematocrit and low plasma level

von Willebrand's disease

Bernard-Soulier Syndrome

Polycythemia Vera

Hemophilia A

Polycythemia Vera

Which immunoglobulin is implicated in HIT (Heparin induced thrombocytopenia)?

IgG

IgD

IgA

IgM

IgG

This anticoagulant is most often used in coagulation testing

EDTA

sodium heparin

sodium fluoride

sodium citrate

sodium citrate

What type of vWD gives a strong response to low-dose ristocetin-induced platelet aggregation?

2b

2n

1

2a

2b

The extrinsic pathway of coagulation is monitored by the:

activated partial thromboplastin time

thrombin time

Styphen time

prothrombin time

prothrombin time

A patient presents with a PT of 17 seconds, APTT of 31 seconds, and TT of 16 seconds. What factor deficiency is most likely?

Factor I

FVIII

Factor VII

FX

Factor VII

This test assesses the simultaneous measurement of platelet aggregation and secretion of ATP

PFA 100

platelet lumiaggregometry

TEG

Reptilase time

platelet lumiaggregometry

A patient with symptoms of thrombosis is tested for Activated Protein C-resistance (APC-R). When testing patient plasma and normal pooled plasma for the APC-R ratio, it came out to be 0.5. What can be concluded from the ratio?

patient is positive for APC-R

patient is negative for APC-R

patient is on Coumadin

patient is on heparin

patient is positive for APC-R

A specimen for a PT and APTT is delivered to the hematology laboratory. However, after it is centrifuged it appeared hemolyzed. What is the best course of action?

have the patient redrawn

run the PT but not the APTT

run the APTT but not the PT

run the PT and APTT test

have the patient redrawn

Regarding a hemostasis laboratory QA program, the delta check is a:

analytical component

not part of QA program

post-analytical component

pre-analytical component

post-analytical component

The DRVVT is utilized as a test for Lupus Anticoagulant based upon the ability of the Lupus Anticoagulant to bind:

phospholipids

FXIII

fibrin

red cells

phospholipids

A 51- yr old man presents with deep vein thrombosis (DVT) of the great saphenous vein, swelling, and pain. For the past 15 years he has worked as a bank teller. His complete blood count (CBC) is normal but APTT is 37-seconds. PT and INR are normal. Family history includes acute myocardial infarction in his father and a daughter that has had two miscarriages. Protein C levels were normal and bleeding time is 5.5 minutes. The patient was treated initially with unfractionated heparin and is now on oral anticoagulant therapy which raies his PT and INR to therapeutic levels. Which of the following are possible in this patient?

A.Prothrombin G20210A

B. DIC

C. vWD type I

D. Bernand-Soulier

Prothrombin G20210A

A prolonged PT, prolonged APTT, prolonged TT, undetectable fibrinogen by the Clauss method would be seen in:

A. Afibrinogenemia

B. Hypofibrinogenemia

C. hyperfibrinogenemia

D.Hemophilia A

Afibrinogenemia

in this sex-linked recessive disorder, a common clinical finding is hemathroses, normal platelet count, normal RIPA (Ristocetin induced platelet aggregation), normal PT, prolonged APTT, and normal bleeding time.

A. DIC

B. Factor X Deficiency

C. Hemophilia A

D. ITP

Hemophilia A

in this type of vWD, the platelt count is normal, PTT is prolonged, VWF antigen is very low or absent, RIPA is absent. and all vWF multimers are absent.

A. Type 1

B. Type 2b

C. Type 2A

D. Type 3

Type 3

Which of the following is recognized as viable treatment for TTP (thrombotic thombocytopenic Purpura)?

A. Plasma Exchange

B. Platelet Transfusion

C. Cyropercipitate

D. all answers are correct

Plasma Exchange

all of the following may be seen in Hemolytic Uremic Syndrome, except:

A. Increased serum creatine

B. Decreased reticulocyte count

C. Hematuria

D. Proteinuria

Decreased reticulocyte count

all of the following are associated with HELLP syndrome, except:

A. Absence of schistocytes

B. Anemia

C. Proteinuria

D. increased lactate dehydrogenase

Absence of schistocytes

in this rare autosonmal recessive disorder, patients are missing the radius bone and present with an elevated white blood cell count and decreased platelet count.

A. Gray platelet syndrome

B. Hermansky-Pudlak Syndrome

C. TAR syndrome

D. Bernard-Soulier

TAR syndrome

in this syndrome, patients platelets are lacking dense granules and present with oculocutaneous albinism with bleeding diathesis often resulting in bleeding fums and epistaxis as well as excessive bleeding following surgery/

A. Bernard- Soulier

B. Hermansky-Pudlak Syndrome

C. Glanzmann's Thrombasthemia

D.Gray Platelet Syndrome

Hermansky-Pudlak Syndrome

Which TEG parameter would let the clinician know a platelet transfusion is indicated?

A. Decreased R time

B. Decreased MA

C. Decreased K time

D. increased LY30

Decreased MA

in this autosomal recessive disorder, clot retraction is abnormal, there is a deficiency of platelet membrane glycoprotein IIb/IIIa which leads to the absence of aggregation with natural platelet agonists, like ADP.

A. Bernard- Soulier

B. Gray Platelet syndrome

C. TAR syndrome

D. Glanzmanns Thrombasthenia

Glanzmanns Thrombasthenia

which of the following disorders is characterized by lack of alpha granules in platelets?

A. Hemophilia A

B. Gray Platelet Syndrome

C. Bernard Soulier

D. Factor V Leiden

Gray Platelet Syndrome

What is considered normal range in the bleeding time (BT) test?

A. 2-9 minutes

B. 5-10 minutes

C. 10-15 minutes

D. 4-6 minutes

2-9 minutes

this test measures the time required for the platelet plug to occlude the aperture using standard platelet agonists. like ADP and collagen.

A. Prothrombin time

B. Reptilase time

C. PFA-100

D. Thrombin time

PFA-100

when running TEG, what reagent would be employed in the test system for a patient on unfractionated heparin?

A. Heparinase

B. Vitamin K

C. Warfarin

D.aspirin

Heparinase

all of the following coagulation factors are measured in the Prothrombin Time test, except:

A.FXIII

B. VII

C. I

D. X

FXIII

when calculating the INR, what does ISI stand for?

A. International Sensitivity Index

B. International Specificity Index

C. International Survelliance Index

D. International Solubility Index

International Sensitivity Index

all the following factors are measured by the APTT, except:

A. FVII

B. FXII

C. FXI

D. FX

FVII

the screening test for Factor V Leiden involved adding a standard amount of activated protein C for both patient plasma and normal plasma. This test is based upon the:

A. PT

B. APTT

APTT

which test is elevated in uncompensated DIC (Disseminated Intravascular Coagulation)?

A. Fibrinogen

B. Protein C

C. D Dimer

D. Protein S

D Dimer

Light transmittance is increased in platelet aggregation studies where the platelet agonist employed is ADP.

A. True

B.False

True

Patients who has a deficiency of GPIb have a disorder of adhesion.

A. True

B. False

True

Oral anticoagulation, eg. Warfarin, is associated with:

A. Vitamin K

B. Vitamin D

C. Vitamin A

D. Vitamin C

Vitamin K

which of the following is decreased in uncompensated DIC?

A. fibrinogen

B. PT

C. PTT

D. D-dimer

Fibrinogen

Bethesda titers are used for:

A. quantitating inhibtors of coagulation factors (VII, VIII)

B. identifying vitamin k deficiency

C. ascertain both aggulating abilites

D. quantitate the number of units of blood

quantitating inhibtors of coagulation factors (VII, VIII)

DDAVP is an effective treatment for:

A.heparin overdose

B. dysfibrinogenemia

C. vWD type 1

D. vWD type 2b

vWD type 1

what would mixing studies reveal in a patient with an inhibitor to Factor VIII?

A. APTT would not correct with normal plasma

B.APTT would not correct with absorbed plasma

C. APTT would not correct with absorbed plasma or normal plasma

D. APTT would correct with both normal and absorbed plama

APTT would not correct with absorbed plasma or normal plasma

which of the following tests is increased in a patients with severe Hemophilia A?

A.PT

B. PTT

C. Thrombin time

D.Factor VIII assay

PTT

A patient presents with a PT of 17 seconds, PTT of 31 seconds, and a TT of 16 seconds. What factor deficiency is most likely?

A. Factor I

B. Factor VIII

C. Factor X

D. Factor VII

Factor VII

What subtype of vWD gives a positive response (increased aggregation) to low-dose ristocetin-induced platelet aggregation (concentration of ristocetin is .6 U/mL)?

A. 2b

B. 2a

C. 1

D. 3

2b

what molecule does unfractionated heparin bind to in precipitating its anticoagulation effect?

A. Thrombomodulin

B. vWF

C. Antithrombin

D. fibrinogen

Antithrombin

what efficacy would IVIG serve in treatment of ITP (idiopathic thrombocytopenia purpura)?

A. keep IgG coated platelets in circulation

B. binds to Rh positive red blood cell

C. Depression antibody formation

D. binds to CD22 inhibiting product

keep IgG coated platelets in circulation

which of the following is characterized as a disorder of aggregation?

A.Glanzmann's Thrombasthenia

B. vWD

C. Bernard-Soulier syndrome

D. Gray platelet syndrome

Glanzmann's Thrombasthenia

female patient. 45 yr old comes into the ER complaining of bruises on their forearm and epistasis. Lab results showed a PT of 16 seconds, APTT of 30 seconds, platelet cound of 140,000/uL, amd hemoglobin of 14.4g/dL. A mixing study was done to try and correct the PT with both normal plasma and absorbed plasma. With normal plasma mixed with patient plasma, the PT was 11 seconds, however with absorbed plasma and patient plasma, the PT was 16 seconds. What could be the factor deficiency?

A. FVII

B. FVIII

C. FX

D. FV

FVII

this abnormal RBC can be found in a patient with DIC.

A. target cell

B. Schistocyte

C. sickle cell

D. stomatocyte

Schistocyte

what is the target of the anticoagulant mechism of unfractionated heparin?

A. thrombin synthesis

B. thrombin inhibition

C. plasmin synthesis

D. plasmin inhibition

thrombin inhibition

Calculate the INR given the following results: patient PT=12.5 seconds, normal control=11.6 seconds, ISI=2.1

1.17

The LMWHs are more efficient in binding factor___ than bindnig factor IIa.

A. FXa

B. FXIIA

C. FVa

D. FVIIa

FXa

which immunoglobin is implicted in HIT?

A. IgM

B. IgD

C. IgG

D. IgA

IgG

which coagulation factor level is the first to decrease, having the shortest half life, when a patient is placed on oral anticoagulat therapy (eg. Warfarin)?

A. VII

B. X

C. IX

D. II

VII

which is the blood to anticoagulat ratio in coagulation samples?

A. 9:1

B. 1:9

C. 5:1

D. 1:5

9:1

what test is usually employed in detecting the prescence of Lupus Anticoagulate where an IgG or IgM immunoglobin targets phospholipids?

A. Activated Protein C Resistance

B. Thrombin time

C. Dilute russels viper venom test

D. Lumiaggregometry

Dilute russels viper venom test

which of the following tests would be unaffected by the presence of heparin in patient plasma?

A. replitase time

B. thrombin time

C. APTT

D. TEG

replitase time

the extrinsic pathway of coagulation is monitored by the:

A. Thrombin Time

B. Activated Partial Thromboplastin

C. Replitase time

D. Prothrombin Time

Prothrombin Time

what anticoagulant is used to collect patient blood specimens in coagulation/hemostasis testing, like the PT and APTT?

A. Sodium Citrate

B. EDTA

C. Sodium Heparin

D. Sodium Flouride

Sodium Citrate

What course of action should be followed in the event of platelet satellitosis (platelets surround segments neutrophils) on the peripheral blood smear.

A. have patient blood redraw using sodium citrate

B. have patient redraw using EDTA

C.have patient redrawn using lithium aluminum

D. nothing should be done

have patient blood redraw using sodium citrate

what enzyme is suppressed by Warfarin preventing gamma carboxylation of the vitamin k dependent factors?

A.cyclooxygenase

B. vitamin k epoxide reductase

C. thromboaxane synthetase

D. prostacyclin synthetase

vitamin k epoxide reductase