Which of the following is NOT indicative of accelerated red cell destruction?
decreased RBC, Hgb, Hct
increased unconjugated bilirubin, increased LDH
increase hemopexin
erythoid hyperplasia
URINE: increased urobilinogen, free hemoglobin, methemoglobin, hemosiderin
Which feature is present in BOTH intra- and extravascular hemolysis?
increased retics
spherocytes/schistocytes
increased unconjugated bilirubin
decreased poikilocytosis
A, B, and C
All of the above.
Select all that apply for INTRAVASCULAR hemolysis:
significant increase in LDH
hemoglobinemia
hemosiderinuria
IgG antibodies
decreased hemopexin
spherocytes
Select all that apply for EXTRAVASCULAR hemolysis:
presence of gall stones
splenomegaly
fragments
Normal adult hemoglobin consists of: 95% - 100% HbA 0% - 2% HbF 0% - 3.5% HbA2
Sickle Solubility screening test is a qualitative screening test that dectects the presence of sickling hemoglobins mainly HbA.
What are the components of an alkaline hemoglobin electrophoresis?
EDTA-borate buffer and cellulose acetate gel
pH 10.1
enzymatic reactions that move from cathode to anode
able to separate HbC from HbE
Alkaline electrophoresis runs SDG and CEOA2 together.
What techniques can be used to separate hemoglobin?
HbA2 ion exchange chromatography
HPLC: High Performance Liquid Chromatography
IEF: Isoelectric Focusing
Capillary Electrophoresis
Globin Chain Electrophoresis
All of the above
A positively charges cellulose attracts a negatively charged hemoglobin molecule. Which separation technique does this describe?
HPLC
Ion Exchange Chromatography
IEF
During HbA2 Column Chromatography, A2 is eluted as the 3mL glycine reagent and the absorbance of the A2 fraction and total hemoglobin are measured to determine the %HbA2.
Which hemoglobin fractions is HPLC able to detect and distinguish?
HbS
HbA2
HbF
HbA
HbC
Which hemoglobin separation technique separates fractions based on the difference in charge to size ratio through an electric field?
Isoelectric Focusing
Gas Chromatogrpahy
Gel Electrophoresis
An increase in HbA2 is associated with which condition?
IDA
Beta-Thal Major
Alpha-Thal Minor
Beta-Thal Minor
Megaloblastic Anemia
The principle behind the Kleihauer-Betke Acid Elution test is eluting HbF out of the solution, making the cells colourless, while HbA are resistant to elution and will stain pink.
Which clinical condition is screened for using the sucrose hemolysis test?
Hereditary Persistence of Fetal Hemoglobin (HPFH)
Paroxymal Nocturnal Hemoglobinuria (PNH)
Autoimmune Hemolytic Anemia (AIHA)
Filariasis
Less than 5% hemolysis indicates that RBCs of PNH are more sensitive to complement on their cell surface.
HAM test for PNH is based on:
acidified serum
neutral serum
alkaline serum
Which of the following interpretations matches G6PD deficiency screening test?
persistant fluorescence
weak or no fluorescence
NADPH not produced
NAD produced
The amount of NAD produced is proportional to the amount of PK in patient cells
What stain is required to see Heinz bodies?
Gram stain
Wright stain
Supravital stain
Eosin stain
Cells that are osmotically fragile will start to lyse at:
0.85
0.55
0.45
0.95
Which of the following is not included in the major hemostatic system?
Vascular System
Platelet Activity
Coagulation System
Fibrinolytic System
Thrombin System
Regulatory System
Which of the following is an example of an anticoagulant?
VonWillebrande's Factor
Thromboplastin
Protein S
Tissue Plasmimnogen Factor Inhibitor
What is needed for platelets to adhere to the sub-endothelium?
Thrombin
vWF
Ca2+
Phospholipid
Negatively Charged Surface
Which of the following is true about thromboxane A2?
produced by platelets
causes vasoconstriction
induces aggregation
inhibited by aspirin
all of the above are true
Which platelet membrane binding site is associated with aggregation?
GPIb/IX
GPIIb/IIIa
vWF Ag
Collagen binding site
FVIII Ag
Which of the following is not a primary hemostasis disorder?
Bernard-Soulier Syndrome
von Willebrande Disease
Gray Platelet Syndrome
Glanzmann's Thrombasthenia
Hemophilia A
Reduced aggregation with Ristocetin is associated with vWD and BSS.
Which condition is present if a patient has vWF, but lacks the receptor site on the platelet for it?
BSS
Grey Platelet Syndrome
vWD
Storage Pool Disease
What is the condition called if the platelets lack the receptor fibrinogen?
Which of the following does not contribute to clot formation?
Tissue factor
Calcium
Heparin
Which of the following does thrombin not have an effect on?
FXI activation
FVIII activation
FXIII activation
Fibrinogen --> Fibrin
FVII activation
Which of the following factors is not Vitamin K dependent?
FII
FV
FVII
FIX
FX
Select all that are TRUE:
both VIII:C and VIII:Ag are deficient in hemophilia
FVIII is released from vWF by prothrombin
FVIII is labile and degrades rapidly when unbound from vWF
FVIII is synthesized in the liver
vWF is synthesized by:
the liver
endothelial cells
plasma cells
Vitamin K
bone marrow
vWD is associated with a deficiency in:
vWF:Rco
vWF:Ag
vWF:VIII
A and B
B and C
A decreased concentration of fibrinogen leads to bleeding disorders.
A congenital deficiency in fibrinogen will result in:
Prolonged PT
Normal aPTT
Normal TT
Prolonged aPTT
Prolonged TT
Which of the Hemophilia conditions is most rare?
Hemophilia A (FVIII Deficiency)
Hemophilia B (FIX Deficiency)
Hemophilia C (FXI Deficiency)
Which of the following is not a coagulation regulator?
Protein C
TFPI
Plasmin
Which of the following regarding Protein C and Protein S is incorrect?
activated by thrombin generation by binging to thrombomodulin on endothelial cells
inactivates activated V and VIII
main regulatory system
plasminogen converted Protein C to APC
Tissue factor pathway inhibitor only affects the extrinsic pathway.
What cofactor does Antithrombin III (AT) need to effectively inhibit IXa, Xa, IIa, and XIa?
Warfarin
Why is fibrinogen important?
Prevent thrombi from getting too large
Aids in wound healing
Prevents thrombosis in undesirable places
None of the above
Which of the following are components of the fibrinolytic system?
alpha-2 antiplasmin
Plasminogen activator inhibitor-1 (PAI-1)
Tissue Plasminogen Activator
Thrombomodulin
Thrombocytopenia can be a result of:
Hypersplenism
Post-splenectomy
Acute Blood Loss
Proliferation of stem cells
Thrombosis refers to:
Formation of a blood clot following an injury to a blood vessel
Formation of a blood clot inside an intact blood vessel, obstructing the flow of blood
Formation of a blood clot that is easily solubilized
A portion of a larger clot that breaks free
Which of the following would cause a clotting disorder?
Protein C deficiency
Factor Deficiency
Hemophilia A or B
Where do the majority of pulmonary emboli originate from?
thrombi in arm
thrombi in abdomen
thrombi in deep leg
thrombi in kidney
Strokes results from the acute blockage of arterial blood flow in which artery?
Pulmonary artery
Coronary artery
Corotid artery
Hepatic artery
Which of the following will affect platelet adhesion?
Gp IIb receptor on platelet
Thromboxane A2
Fibrinogen
Gp Ib receptor on platelet
Which of the following regarding Lupus Anticoagulant is true?
causes neutralization of phospholipid reagent in vitro
miscarriages are common in SLE
LA acts as an antibody to platelet
women are more commonly affected
followup tests include DRVVT
Which of the following regarding DIC is false?
begins with excessive clotting stimulated by a substance that enters the blood
results in both excessive clotting and excessive bleeding
fibrin degradation products are generated
DIC is not a systemic problem, localized to specific area
plasminogen is consumed as it is converted into plasmin
Identify the correct lab results for DIC:
increased platelets
schistocytes
PT and aPTT prolonged
D-dimer increased
Bleeding Time prolonged
Fibrinogen increased
D-dimer has a negative predicative value for DIC because:
D-dimer measures split products formed after formation of fibrin clot, but is not specific for DIC
Usually present in chronic conditions
high levels of FDPs are specific for DIC
none of the above
Which of the following tests is normal in a patient with vWD?
Bleeding Time
aPTT
Platelet count
PT
Congenital deficiencies of which proteins will cause thrombosis?
Deficiency of Thrombin
Deficiency of factors
Deficiency of Coagulation and Fibrinolytic Regulators
Deficiency of Vitamin K
How is antithrombin deficiency acquired?
Liver disease
Nephrotic Syndrome
DIC
Prolonged heparin therapy
all of the above
Protein C and Protein S are Vitamin K independent.
If APC is added, aPTT is prolonged due to inhibition of coagulation.
Which is the most common inherited cause of thrombosis?
Protein C or Protein S deficiency
Factor V Leiden
Plasminogen deficiency
Antithrombin deficiency
Prothrombin nucleotide 20210 is:
A deletion in the gene sequence
A single adenine to guanine mutation at position 20210
A single guanine to adenine mutation at position 20210
A nonsense codon in the sequence
FXII deficiency can lead to a bleeding disorder.
An increase in plasminogen activator inhibitor 1 will result in
a bleeding disorder
an increase in fibrinolysis
a clotting tendency
decrease inhibition of tPA
In a mixing study, a prolonged aPTT is corrected with FVIII deficient plasma, but not with FIX deficient plasma. What is the deficiency due to?
FVIII
Heparin therapy
Coumadin therapy
A short-filled sodium citrate tube will have what effect on coagulation results?
Normal
Prolonged for both
Only affects PT
Only affects aPTT
Platelet poor plasma is required for which studies?
Coagulation studies
Aggregation studies
Adhesion studies
Fibrinogen studies
Which factors would be used up in a clotted specimen?
FI
FXI
FXIII
Plasma adsorbed with barium sulphate will remove which group of factors?
Fibrinogen group factors (I, V, VIII, XIII)
Vitamin K dependent factors (II, VII, IX, X)
Contact Group Factor (XII, Pre-K, HMWK)
TF complex (VII, TF)
What is needed to initiate the intrinsic pathway in vitro?
Kaolin
INR is used to monitor heparin therapy.
Select all that are true for aPTT:
monitors Coumadin therapy
screens for defects in the intrinsic and common pathways
requires a source of phospholipid
required to calculate INR
Kaolin is an example of a negatively charged surface needed to activate cascade
A mixing studies was performed on a sample and was corrected. To determine if the correction was a result of a factor deficiency or factor antibody, another mixing studies was performed and incubated. The mixing studies results were corrected. This suggests the presence of a factor antibody. Is this interpretation correct?
The euglobulin lysis time tests how long it takes for the sample to clot.
Which of the following can prolong thrombin time, which looks at how long it takes a sample to clot.
FDPs
Clot formation time is proportional to the concentration of fibrinogen in the sample plasma.
The Clauss method of fibrinogen assay involves
extended incubation time
using an undiluted plasma sample
excess thrombin
fibrinogen neutralized by protamine sulphate
5M Urea Test involves removing a clot and placing it in 5M urea and incubating it. Which of the following result interpretations are valid?
If FII levels are normal, the clot will not dissolve in 24 hours
If FXIII is deficient, the clot will not dissolves in 24 hours.
If FXIII is normal, the clot will dissolve in 24 hours.
If FXIII is deficient, the clot will dissolve in 24 hours.
Low Molecular Weight Heparin (LMWH) monitors
FVa
FVIIa
FXa
FXIa
In a plasma sample with APCr, we expect that
Protein C is able to inactive FVa and FVIIIa
AT is able to inactivate FVa and FVIIIa
Protein C is unable to inactive FVa and FVIIIa
AT is unable to inactive FVa and FVIIIa
Reptilase time
tests for FXIII deficiency
compares fibrinogen deficiency and heparin contamination
tests for factor antibody (eg. LA)
is inhibited by antithrombin
Select all that apply to the DRVVT for LA:
venom is a potent activator for FX
LA binds to phospholipid, inhibiting RVV
RVV is affected by deficiency in factors XII, XI, IX, or VIII
LA confirmed if DRVVT is corrected in excess phospholipid
PT 20s, aPTT 50s, TT 25s What is the most probably diagnosis?
FVII Deficiency
FVIII Deficiency
FX Deficiency
Hypofibrinogenemia
Which coagulation test(s) would be abnormal in a vitamin K-dependent patient?
PT only
aPTT only
Both PT and aPTT
Fibrinogen level
Thrombin time
Which of the following is an anticoagulant therapy treatment options?
Dabigatran
Anti-platelet (ASA)
How does Warfarin (Coumadin) act as a Vitamin K antagonist?
Inactivates compound
Suppresses reductase activity
Competitively binds to Vitamin K
Which factor monitored by Warfarin therapy has the shortest half-life?
II
VII
IX
X
If INR low, patient is at risk of bleeding.
Which of the following can reduce the effect of Warfarin therapy?
Drugs that interfere with Warfarin
Increased Vitamin K in diet
Taking Warfarin pill at different times every day (not at the same time each day)
Which of the following anti-clotting substances acts on factors V and VIII?
Antithrombin III
tPA
Which of the following is a cofactor?
XII
VIII
Heparin activates antithrombin to neutralize serine proteases activated by thrombin.
How is Unfractionated Heparin administered?
Subcutaneously
Intravenously
Superficially
Orally
How is a heparin overdose treated?
Dialysis
Protamine sulfate
What side affect may arise as a result of long-term Heparin use?
Dyspnea
Photophobia
Osteoporosis
Hypotension
Low Molecular Weight Heparin (LMWH) has minimal affect on FIIa activity because it is too short to properly bind IIa.
Fondaparinux is a
natural drug - pentasaccharide
inactivates thrombin by combining with antithrombin
intravenous administration
requires lab monitoring
Which of the following are requires for coagulation in aPTT?
Plasma + phospholipid + calcium
Plasma + thromboplastin + calcium
Plasma + phospholipid + thromboplastin
Plasma + thrombin + calcium
What is the most common inherited bleeding disorder?
TTP
Heparin Induced Thrombocytopenia:
IgG binds to heparin/PF4 complex
leads to coagulation of platelets
increases platelet count
associated with LMWH
Which of the following should be avoided when treating HIT?
Streptokinase
Urokinase
LMWH
Hirudin
Patients with which of the following diseases may have a normal PTT?
HIT
Which of the following does not directly inhibit FXa?
Apixaban
Riveroxaban
Edoxaban
Which direct thrombin inhibitor is not primarily used to treat HIT?
Argatroban
Bivalirudin
Lepirudin
Which of the following are advantages of using Dabigatran?
no food interactions (eg. with Vitamin K)
no need for routine monitoring
reversal of bleeding with charcoal
Which of the following is false regarding direct FXa inhibitors?
requires routine monitoring
does not need antithrombin
used for the prevention of thrombosis and venous thromboembolism
How does Aspirin inhibit platelets from aggregating?
Inhibits thrombin
Inhibits fibrinogen
Inhibits alpha granules
Inhibits Thromboxane A2
Which condition may thrombolytic therapy be used for?
venous thrombosis
myocardial infarction
can be administered to any inpatient
Which of the following is a "clot buster drug"?
Thrombin Inhibitors
Which of the following is not a thrombolytic therapy?
All of the above are used for thrombolytic therapy