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Hematology

The etiology of chronic lymphocytic leukemia (CLL) is

a. Due to radiation
b. Due to a retrovirus
c. A familial disease
d. Unknown

answer is
d

A 22-year-old man comes to the emergency room of


your hospital because he has a diffuse, erythematous
rash involving nearly all of his body. His total WBC
count is greater than 100,000 cells/mm3. He also
complains of bone pain, severe irritability, weakness,
fatigue, nausea and vomiting, constipation,
photophobia, and polyuria. His electrocardiogram
(ECG) shows shortening of the QT interval,
prolongation of the PR interval, and nonspecific T
wave changes. The most likely cause of his symptoms

a. Hypercalcemia
b. Hypocalcemia
c. Hypophosphatemia
d. Hyperkalemia

answer is
a
Which of the following factors complexes with factor
VIII, which is activated to factor VIIIa when released
from the complex

a. Factor XIII
b. High molecular weight kininogen
c. Von Willebrand factor (vWF)
d. Thromboplastin
e. Plasminogen

answer is
c

Which of the following factors depends on platelets


for synthesis

a. Factor II (prothrombin
b. Factor VII (proconvertin
c. Protein S
d. Factor XIII (fibrin-stabilizing factor
e. Factor X (Stuart-Prower factor

answer is
d
Which of the following causes of anemia is associated
with microcytosis

a. Folic acid deficiency


b. Therapy with zidovudine (AZT
c. Hypothyroidism
d. Alcohol
e. Thalassemia

answer is
e

Which of the following causes of an elevated


hemoglobin concentration in the blood is
characterized by a LOW level of erythropoietin in the
blood

a. Chronic tobacco smoking


b. Dwelling at high altitudes, such as in the Andes
c. Erythrocytosis associated with renal tumors
d. Primary polycythemia (polycythemia vera
e. Erythrocytosis secondary to chronic pulmonary
insufficiency

answer is
d

Which of the following causes a leukocytosis without


an increase in the number of circulating
polymorphonuclear neutrophil leukocytes
a. Acute infection
b. Release of epinephrine
c. Tissue necrosis
d. Myelocytic leukemia
e. Collagen vascular disease

answer is
b

In a typical case of iron deficiency, which of the


following molecular forms that contains or can bind to
iron increases in the patient’ s serum

a. Hemoglobin
b. Ferritin
c. Hemosiderin
d. Myoglobin
e. Transferrin

answer is
e

Which of the following disorders is associated with


thrombocytosis

a. Disseminated intravascular coagulation


b. A plastic anemia
c. Postsplenectomy
d. Hypersplenism
e. Prosthetic valves
answer is
c

A 47-year-old man walks into the emergency room


because of feeling very weak, tired, short of breath,
and dizzy. He has numbness and tingling of his
fingers. He appears pale and sallow. On examination,
his heart rate is 132. His sclerae and nailbeds are
pale. His heart is enlarged and he has dependent
edema of his ankles. Laboratory findings include a
negative Coombs’ test and a hemoglobin of 4 g/dL.
The likely diagnosis is

a. Traumatic hemolytic anemia


b. Autoimmune anemia
c. Blood loss
d. Pernicious anemia
e. Iron-deficiency anemia

answer is
d

Most drugs induce thrombocytopenia by which


mechanism

a. Marrow-depressing effect
b. Directly cytotoxic of platelets
c. Depress megakaryoctye production
d. Immune response in which the platelet is damaged
by complement activation
e. Impair megakaryoctye production

answer is
d

Which of the following statements related to


circulating erythrocytes (red cells) is untrue

a. The nuclei of the precursor cells to erythrocytes


are extruded from their cells shortly before the red
cells leave the bone marrow. Consequently, the
presence of nucleated red cells in the peripheral
blood should be regarded as abnormal and may
indicate an underlying disease state.
b. In a thin blood smear stained with Romanowsky’ s
stain (such as Wright’ s stain), the youngest cells
(reticulocytes) can be recognized by a blue coloration
(basophilia) as different from most of the red cells
present.
c. The average diameter of erythrocytes is about 8
µm; consequently, they cannot
flow through the smaller capillaries that have a
diameter of 2 to 4 µm.
d. The protein of hemoglobin, which is the principal
constituent of the red cell
contents, is in tetrameric form, with two α and two β
subunits.
e. The iron atom of the hemoglobin molecule, which is
essential to its function of carrying oxygen, is an
intrinsic part of the heme complex attached to each
sub-unit of protein

answer is
c

Which of the following statements concerning the


relationship of the neutrophil polymorphonuclear
leukocyte (PMN) to infection with bacterial pathogens
is incorrect

a. The principal functions of the PMN are expressed in


the tissues and not usually in the bloodstream, which
is simply the transport path of the cells to their
required site of action.
b. The cytoplasmic granules of PMN are essentially
inert, but metabolically have only vegetative role in
maintaining cell viability.
c. When the cell numbers of PMN are reduced
significantly , the probability of severe bacterial
infection can be greatly increased.
d. The average duration of the period of circulation of
PMN after entering the bloodstream is about 6 to 8 h.
e. An increasing need for PMN produced by infection
is met in part by large numbers of immature cells
(especially band cells) being released from the
marrow pool into the bloodstream

answer is
b

Which pathologic cells in a stained blood film have


appearances very similar to those of normal mature
white cells or their precursors
a. Chronic lymphocytic leukemia (B cell type
b. Chronic myelocytic leukemia
c. Lymphoblastic leukemia
d. Hodgkin’ s disease
e. Non-Hodgkin’ s disease

answer is
b

On karyotyping, a well-defined chromosomal


abnormality is pathognomonic of which condition

a. Chronic lymphocytic leukemia (B cell type


b. Chronic myelocytic leukemia
c. Lymphoblastic leukemia
d. Hodgkin’ s disease
e. Non-Hodgkin’ s disease

answer is
b

Which condition customarily terminates by transition


to a blast cell phase with similarities to acute
leukemia

a. Chronic lymphocytic leukemia (B cell type


b. Chronic myelocytic leukemia
c. Lymphoblastic leukemia
d. Hodgkin’ s disease
e. Non-Hodgkin’ s disease

answer is
b

The principal complication of which condition is


susceptibility to infection

a. Chronic lymphocytic leukemia (B cell type


b. Chronic myelocytic leukemia
c. Lymphoblastic leukemia
d. Hodgkin’ s disease
e. Non-Hodgkin’ s disease

answer is
a

Which disorder presents mainly as a localized new


mass or group of superficial lymph nodes

a. Chronic lymphocytic leukemia (B cell type


b. Chronic myelocytic leukemia
c. Lymphoblastic leukemia
d. Hodgkin’ s disease
e. Non-Hodgkin’ s disease

answer is
d
Which mechanism is responsible for
thrombocytopenia in vitamin B12 deficiency

a. Decreased production
b. Maldistribution
c. Accelerated destruction
d. Decreased survival
e. Inherited

answer is
a

Another:

MCQs
………………………………………

1. Major hematopeotic embryo:


A. lymph nodes
B. Bone marrow
C. liver
D. spleen
E. Yolk sac

2. All can cause Iron deficiency anemia EXCEPT:


A. Menorrhagia
B. bleeding from GIT
C. Pregnancy.
D. Transcoblamin 1 deficiency

3. 1ry site of folate absorption is:


A. both
B. neither
C. Duodenum
D. Proximal jejunum.

4. Which of the following test is most helpful in diagnosis of thalassemia :


A. serum iron and iron binding capacity
B. bone marrow iron stain
C. hemoglobin electrophoresis

5. all can be associated with Sickle Cell Anemia EXCEPT:


A. vasoocclusive cresis
B. infection
C. Aplastic cresis
D. organ damage
E. chest Syndrome
F. bleeding disease

6. Anemia characterized by increase RBCs production is:


A. chronic renal failure
B. Anemia of chronic disease
C. Fanconi's Anemia
D. Hereditary Spherocytosis

7. All of the following common finding in Acute Lymphocytic leukemia EXCEPT:


A. epistaxis
B. fever
C. marked elevation in WBCs
D. Gum hypertrophy

8. In Acute myelocytic leukemia all of the following correct EXCEPT :


A. Bone marrow examination is essential diagnosis
B. it is worse prognosis than chronic myeloid leukemia
C. more common in adult
D. Philadelphia +ve chromosome

9. the Philadelphia chromosome observed in which one of the following leukemia:


A. chronic myeloid leukemia
B. Acute Lymphocytic Leukemia
C. Neither
D. Both

10. Diagnostic criteria of 2ry polycythemia all of the following EXCEPT:


A. smoking
B. renal cyst
C. a high altitude
D. D.M

11. Haemophilia A ( factor IIIV deficiency) EXCEPT:


A. All males with defective gene have hemophilia
B. 50% of daughter's of hemophilic man are diseased
C. 50% of daughter's of hemophilic man are carrier
D. It is Autosomal dominant inheritance

12. Thrombocytopenia can be all of the following EXCEPT:


A. ITP
B. ALL
C. AML
D. Essential thrombocytopenia

13. R factor for venous thrombosis include all EXCEPT:


A. immobilization
B. Estrogen therapy
C. Anti thrombin III deficiency
D. Exercise

14. which can cause thrombosis:


A. liver disease
B. thrombocytopenia
C. Anti phospholipid Syndrome

15. Blood Transfusion for all EXCEPT:


A. Hepatitis B & C virus
B. HIV
C. Syphilis
D. Hepatitis A virus

16. The packed RBCs are stored at :


A. 20 degree Centigrade
B. 30 degree Centigrade
C. 37 degree Centigrade
D. 4 degree Centigrade
(note: platelets at room temperature=25)

17. Vitamin K dependent coagulation Factors may include all EXCEPT:


A. Factor 2
B. Factor 7
C. Factor 9
D. Factor 11

18. All of the following features of Multiple Myeloma EXCEPT:


A. Pathological fracture
B. Increase plasma abnormal cells in bone marrow
C. Increase peak serum of monoclonal protein in electrophoresis
D. Increase Hemoglobin level

19. Hodgkin's Disease the most common histological subtype is:


A. Lymphocytic predominant
B. Mixed Cellularity
C. Lymphocyte depleted
D. Nodular sclerosing

20. In which of the following Hematological disorders the polymerase chain reaction
is helpful:
A. Megaloblastic anemia
B. Hemolytic anemia
C. Iron deficiency anemia
D. Hemolytic malignancy

All the last answers are correct

Non Specific Esterase(NSE) is seen in which type of leukaemia:


a.) AML 3
b.) AML 0
c.) ALL
d.) All of the above

Highest peroxidase activity is seen in


A- Myeloblast
B- Promyelocyte
C- Lymphoblast
D- Monocyte
E- Reed Sternberg cell

120- Glycophorein positive cells are seen especially in


A- AML-M1
B- AML-M2
C- AML-M3
D- AML-6
E- Non of the above

Fibrin/Fibrinogen split products may cause prolongation of the aPTT due to:

A. Inhibition of platelet aggregation

B. Inhibition of fibrin crosslinking by factors XIIIa

C. Inhibition of thrombin mediated conversion of fibrinogen to fibrin

D. Conversion of plasminogen to plasmin


2. Both the aPTT and PT would be expected to be prolonged with:

A. Deficiency of factors X, V, II or I

B. Deficiency of factors X, V, II or XIII

C. Deficiency of factors XII, XI, IX, VIII, or IV

D. Deficiency of factors III or VII

E. Deficiency of HWMK (High molecular weight kininogen) or Prekallikrein


3. Which of the following would be increased with deficiency(ies) of factors XI, IX, or
VIII:
A. aPTT (activated partial thromboplastin time)

B. PT (prothrombin time)

C. Ivey bleeding time

D. Platelet count

ATYPICAL CELLS OF INFECTIOS MONONUCLEIOSISIS IS


A. KILLER CELL
B. NK CELL
C. CD 8
D. MONOCYTE

Which of the following cells share a common progenotor cells with macrophages?

A-astrocytes.
B-epedendymal cells.
C-microglia
Dmullers fibers
E- oligodendrocytes.

poor prognosis for AML is..?


a. t(8;25)
b. t(15,17)
c. inv(16)
d. inv(3)

sezary syndrome in included under


a. B cell leukemia
b. T cell leukemia
c. lymphoma
d. genodermatosis

in mycosis fungoides proliferation of which cells is seen..?


a. T helper cells
b. T suppressor cells
c. plasma cells
d. B-cells

highest LAP score is seen in ?


a. CML
b. polycythemia vera
c. PNH
d. MDS

osmotic fragility increased in..?


a. thalassemia
b. SCD
c. chronic lead poisoning
d. hereditary spherocytosis

ESR raised in ?
a. SCD
b. multiple myeloma
c. angina petoris
d. thalassemia

ALP is raised in.......?


a. multiple myeloma
b. osteoporosis
c. hypoparathyroidism
d. hodgkin's disease.

true abt metastatic calcification is


a. serum ca normal
b. occurs in dead tissue
c. occurs in damaged heart valves
d. calcification starts in mitochondria.

multiple myeloma shows which calcification?

Dystrophic
Metastatic

which vitamin protects cells from free radical injury


a. vit A
b. vit C
c. vit E
d. vit K

iron is present as cofactor in all of these except


a. peroxidase
b. catalase
c. carbonic anhydrase
d. cytochrome C

ladder pattern of DNA electrophoresis in apoptosis is due to enzyme ?


a. DNAse
b. caspase
c. endonuclease
d. exonuclease.

)NON SPECIFIC ESTERASE POSITIVE IS SEEN IN WHICH OF FOLLOWING


SUBCLASSES OF AML?
A)M0
B)M3
C)M6
D)M2

type 4 or delayed HS reaction occurs in which disease


a. GBS
b. graves disease
c. acute glomerulonephritis --------ans
d. pemphigus vulgaris

primary granules of neutrophil includes A/E


a. alkaline phosphatase
b. myeloperoxidase
c. acid hydrolyses
d. elastases.

cytokines that affect leukocyte movement are called


a. interleukins
b. chemokines
c. lymphokines
d. monokines

thromboxaneA2 produced by
a. neutrophils
b. macrophage
c. endothelium
d. platelets

mediators involved in vasodilation are A/E


a. PGE1
b. IL-1
c. anaphylatoxin
d. TXA2

exudation of plasma and leukocytes in acute inlammation is from the


a. venules
b. capillaries
c. arterioles
d. arterioles and capillaries

pernicious anemia is associated with A/E


a. increased serum gastrin
b. increased serum autoantibodies
c. increased serum vit B12
d. decreased gastric acid secretion

L.E. cell is a
a. lymphocyte
b. neutrophil
c. basophil
d. eosinophil

if both parents are sickle cell anaemia patients then the likelyhood of offsprings
having the disease is
a. 25%
b. 50%
c. 75%
d. 100%

ANNGIOTENSINOGEN SECRETED BY
KIDNEY
LIVER
LUNGS
SPLEEN
Basophilic leucocytosis occurs in?
Aml
All
Cml
Cll

Factor V is required for growth of :

1. Haemophillus
2. Staphylococci
3. Neisseria
4. All of above

The globin structure of the major hemoglobin found in human adults is:
A- α2 β2
B- α2 γ2
C- α2 δ2
D- α2 ε2
E- ζ2 ε2

2- Tear drop cells are found at increasing number in all of the following cases,
EXCEPT:
A- Thalassemias.
B- Myelofibrosis.
C- BM tumors.
D- Extramedullary hemopoiesis.
E- None of the above

3- Spherocytes can be seen in cases with:


A- Thalassemias
B- Sickle cell anemia
C- Severe burns.
D- Abetalipoproteinemia.
E- PNH

4- In Hb electrophoresis at alkaline pH, all of the following statements are true,


EXCEPT:
A- HbA is faster than HbF and HbA2.
B- HbC have the same mobility as HbA2.
C- HbH is a fast moving Hb, while Hb Bart's is a slow moving Hb.
D- Hb S and Hb D, and Hb G have the same electrophoretic mobility.
E- Hb Lepore is slower than HbA

--The hematologic disease which is expected to be highly seen in spring season is:
A- Glucose 6 phosphate dehydrogenase deficiency.
B- Hereditary pyropoikilocytosis.
C- Hereditary stomatocytosis.
D- Spur cell anemia.
E- All of the above diseases can be seen in spring at the same rate.

6- In G6PD deficiency, all of the following is true, EXCEPT:


A- The gene is carried on the X chromosome.
B- Is the commonest RBC enzyme deficiency.
C- Retics contain normal amounts of G6PD in G6PD deficient patients.
D- Should be diagnosed during acute hemolysis phase.
E- Bitten RBCs may be seen in blood films.

Kleihauer-Betke test detects:


A- Red cells containing HbF.
B- Red cells containing HbA.
C- Red cells containing HbA2.
D- Red cells containing HbH.
E- Red cells containing Hb constant spring

In Hereditary Spherocytosis all of the following are FALSE statements, EXCEPT:


A- The genetic defect can be seen by a G banded karyotype.
B- Spherocytes are larger than normal RBCs.
C- Decreased osmotic fragility
D- Has a X-linked mode of inheritance.
E- Spherocytes are red cells with absent central pallor.

Hemoglobin can be increased erroneously when there is:


A] Leukopenia.
B] Increased plasma hemoglobin
C] Paraproteinemias
D] Low triglycerides levels.
ُE] High RDW
10- When precursor cells are present in a blood film, they tend to accumulate in
the:
A] Tail.
B] Edges.
C] Multilayer zone.
D] Monolayer zone.
E] Thick area\

A patient with a platelet count of 43x109/L, you noted the presence of platelet
aggregates in his blood film, the most probable cause of his thrombocytopenia is:
A- Idiopathic thrombocytopenia purpura (ITP).
B- This is most probably a manual count but in automated count PLT will be normal.
C- Disseminated intravascular coagulation (DIC).
D- EDTA induced platelet aggregation.
E- Thrombotic thrombocytopenic purpura (TTP).

12- Left shift in a blood film means:


A- Presence of all blood cell types.
B- Presence of immature granulocytes.
C- Presence of NRBCs.
D- Presence of immature platelet forms.
E- None of the above.

58-year-old female has a decreased serum iron and TIBC in association with an
increased serum ferritin. These findings are most indicative of:
A- Anemia of chronic disease.
B- Iron deficiency anemia.
C- Sickle cell anemia.
D- Sideroblastic anemia, Hereditary type.
E- Low hepcidin levels.

15- Select the Hb that is the major hemoglobin found in infants with hydrops fetalis:
A- Hb A
B- Hb Lepore
C- Hb H
D- Hb Bart's
E- Hb F

16- NRBC in the peripheral blood could normally be seen in:


A- Newborns.
B- Infants.
C- Children.
D- Female adults.
E- Male adults

A patient with anemia has an RDW-CV% of 14.0 and an MCV of 120 fL. However,
examination of the blood smear reveals significant anisocytosis. How do you
explain these results?
A- The instrument needs calibration.
B- MCV looks like to be falsely elevated.
C- The RDW is only elevated if there is anisocytosis and a normal MCV.
D- High MCV may causes a falsely normal RDW-CV%.
E- High MCV will not affect RDW-SD.

18- Regarding to sideroblastic anemia, which is a false statement among the


following:
A- Ringed sideroblasts are found in the BM.
B- May end as acute leukemia
C- Dimorphic blood film picture is characteristic within the inherited types..
D- Mode of inheritance within the inherited types is X-linked and autosomal
recessive
E- Serum iron will be low.

The direct precursor of the pronormoblast is:


A- CFU-E
B- BFU-E
C- CFU-GEMM
D- Pluripotential Stem Cell
E- CFU-EK
20-
What is the RPI given the following: Hct 16%, retic count 12%?
A- 4.27
B- 1.7
C- 2.9
D- 12.0
E- Non of the above

Another :

‫ بسؤالين‬MCQ ‫واتمنى من الجميع المشاركة‬:-


1- The globin structure of the major hemoglobin
found in human adults is:
A- α2 β2
B- α2 γ2
C- α2 δ2
D- α2 ε2
E- ζ2 ε2

2- Tear drop cells are found at increasing number in


all of the following cases, EXCEPT:
A- Thalassemias.
B- Myelofibrosis.
C- BM tumors.
D- Extramedullary hemopoiesis.
E- None of the above

‫السؤالين الجديدين لليوم‬:


3- Spherocytes can be seen in cases with:
A- Thalassemias
B- Sickle cell anemia
C- Severe burns.
D- Abetalipoproteinemia.
E- PNH

4- In Hb electrophoresis at alkaline pH, all of the


following statements are true, EXCEPT:
A- HbA is faster than HbF and HbA2.
B- HbC have the same mobility as HbA2.
C- HbH is a fast moving Hb, while Hb Bart's is a slow moving Hb.
D- Hb S and Hb D, and Hb G have the same
electrophoretic mobility.
E- Hb Lepore is slower than HbA

Because :
1- S and G and D all have the same electrophoretic
mobility at alkalaine electrophoresis. (:‫احفظها كالتالي‬
‫ سجد )س لـ‬S ) (‫ ج لـ‬G ) ‫ و )د لـ‬D ).
2- Hb-H and Hb Bart's both are very fast moving.
Hb-H is composed of 4 beta globin chains, while Hb
Bart's is composed of 4 gamma globin chains, usually
we see both of them in alpha thalassemia (Hb-Barts is
incompatible with life).

5--The hematologic disease which is expected to be highly seen


in spring season is:
A- Glucose 6 phosphate dehydrogenase deficiency.
B- Hereditary pyropoikilocytosis.
C- Hereditary stomatocytosis.
D- Spur cell anemia.
E- All of the above diseases can be seen in spring at
the same rate.

6- In G6PD deficiency, all of the following is true,


EXCEPT:
A- The gene is carried on the X chromosome.
B- Is the commonest RBC enzyme deficiency.
C- Retics contain normal amounts of G6PD in G6PD
deficient patients.
D- Should be diagnosed during acute hemolysis phase.
E- Bitten RBCs may be seen in blood films

G6PD enzyme is carried on the X chromosome, this is


why is seen in males more more tham females. In
acute hemolysis there will be reticulocytosis, and
reticulocytes are characterized by increasing amounts
of G6PD enzyme, so G6PD enzyme in deficient
patients will be normal during hemolytic episodes

‫السؤالين الجديدين‬:
7- Kleihauer-Betke test detects:
A- Red cells containing HbF.
B- Red cells containing HbA.
C- Red cells containing HbA2.
D- Red cells containing HbH.
E- Red cells containing Hb constant spring

8- In Hereditary Spherocytosis all of the following are


FALSE statements, EXCEPT:
A- The genetic defect can be seen by a G banded
karyotype.
B- Spherocytes are larger than normal RBCs.
C- Decreased osmotic fragility
D- Has a X-linked mode of inheritance.
E- Spherocytes are red cells with absent central pallor

9] Hemoglobin can be increased erroneously when there is:


A] Leukopenia.
B] Increased plasma hemoglobin
C] Paraproteinemias
D] Low triglycerides levels.
ُE] High RDW

Hemoglobin is increased errornously when there is


leukocytosis (high WBC count), Lipidemia (high
lipids), and high protein. With paraproteinemia there
is high protein!!!!

10- When precursor cells are present in a blood film, they tend
to accumulate in the:
A] Tail.
B] Edges.
C] Multilayer zone.
D] Monolayer zone.
E] Thick area

Immature precursor cells tend to accumulate at the edges of the


blood film because of there big size. This is why in blood film
preparation it is recommended that the film should
not touch the edges of the slide.!!!

11- A patient with a platelet count of 43x109/L, you noted the


presence of platelet aggregates in his blood film, the most
probable cause of his thrombocytopenia is:
A- Idiopathic thrombocytopenia purpura (ITP).
B- This is most probably a manual count but in
automated count PLT will be normal.
C- Disseminated intravascular coagulation (DIC).
D- EDTA induced platelet aggregation.
E- Thrombotic thrombocytopenic purpura (TTP).

12- Left shift in a blood film means:


A- Presence of all blood cell types.
B- Presence of immature granulocytes.
C- Presence of NRBCs.
D- Presence of immature platelet forms.
E- None of the above.

Another :
What is the most important side effect of heparin?
Heparin can cause thrombocytopenia that in some unlucky patients is associated with
arterial thrombosis.

Measure complete blood counts to monitor for this side effect, which usually occurs on day
3-7 of heparin administration. Discontinue heparin immediately if platelet counts begin to
fall.
How is the effect of heparin monitored?
Heparin is monitored with PTT (partial thromboplastin time), a measure of the internal
coagulation pathway
How is the effect of warfarin monitored?
Warfarin is monitored with the PT (prothrombin time), a measure of the external coagulation
pathway
How do you keep PTT and PT straight?
PTT has a "T" inside, intrinsic, internal coagulation pathway.

PT is the other
Memorize:
Measure heparin with ______
Measure warfarin with ______
Measure heparin with PTT
(Hep to the PTT!)

Measure warfarin with PT


(War with the PT)
How is the effect of aspirin monitored?
Aspirin prolongs bleeding time, a measure of platelet function. Clinically, the effect of aspirin
is not monitored with lab testing, but be aware that it prolongs bleeding time test.
How are the effects of low-molecular-weight heparin monitored?
LMW Heparin does not affect any of the coagulation parameters (PT or PTT or bleeding
time), and its effect is not clinically monitored. Rarely, a special type of factor X assay (anti-
Xa) is used to measure the effect.
In an emergency, how can you reverse the effects of heparin?
Heparin and LMW heparin can be reversed with protamine.
In an emergency, how can you reverse the effects of warfarin?
Warfarin with fresh frozen plasma (contains clotting factors; immediate effect) and or vitamin
K (takes a few days to work).
In an emergency, how can you reverse the effects of aspirin?
Platelet transfusions
Condition: Hemophilia A

PT
PTT
Bleeding time
Inheritance
Condition: Hemophilia A

PT: normal
PTT: prolonged (low levels of factor 8)
Bleeding time: normal
Inheritance: X-linked
Condition: Hemophilia B

PT
PTT
Bleeding time
Inheritance
Condition: Hemophilia B

PT: normal
PTT: prolonged (low levels of factor 9)
Bleeding time: normal
Inheritance: X-linked
How do you keep Hemophilia A and B straight?
Hemophilia A is 8A (eight = ate = A) missing factor 8), the more common form.

Hemophilia B is 9B
Condition: vWF deficiency

PT
PTT
Bleeding time
Inheritance
Condition: vWF deficiency

PT: normal
PTT: prolonged
Bleeding time: prolonged
Inheritance: autosomal dominant

***Normal levels of factor 8 and factor 9


Condition: Disseminated intravascular coagulation

PT
PTT
Bleeding time
Inheritance
What else is elevated in terms of labs?
When do you encounter DIC?
What do you see on the blood smear?
Condition: DIC

PT: prolonged
PTT: prolonged
Bleeding time: prolonged
Inheritance: N/A

Positive D-dimer or FDPs (fibrin degradation products); postpartum, infection, malignancy;


schistocytes and fragmented cells on peripheral smear.
Condition: Liver Disease

PT
PTT
Bleeding time
Inheritance
Condition: Liver Disease

PT: Prolonged
PTT: normal or prolonged
Bleeding time: normal
Inheritance: N/A

All factors but 8 are low, you see stigmata of liver disease; no correction with vitamin K
Condition: vitamin K deficiency

PT
PTT
Bleeding time
Inheritance
Condition: vitamin K deficiency

PT: prolonged
PTT: slightly prolonged
Bleeding time: normal
Inheritance: N/A
** low levels of factors 2,7,9,10, proteins C and S; look for neonate who did not receive
prophylactic vitamin K; malabsorption, alcoholism, or prolonged antibiotic use (which kills
vitamin K-producing bowel flora)
MEMORIZE:

PT (extrinsic): 2,5,7,10: increased with warfarin use, vit K deficiency, liver disease

PTT (intrinsic): 8,9,11,12: increased with heparin use, hemophilia A, B, vWF deficiency
PT (extrinsic): 2,5,7,10: increased with warfarin use, vit K deficiency, liver disease

PTT (intrinsic): 8,9,11,12: increased with heparin use, hemophilia A, B, vWF deficiency
Remember that uremia causes a qualitative platelet defect and that vitamin C deficiency and chronic
steroid therapy can cause bleeding tendency with normal coagulation tests.
Remember that uremia causes a qualitative platelet defect and that vitamin C deficiency
and chronic steroid therapy can cause bleeding tendency with normal coagulation tests.

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