Question 1

Which of the following inherited condition is considered a low risk for a venous thromboembolic event?

Accepted Answer

A)  Homozygous factor VLeiden 
B)  Homozygous prothrombin 20210 
C)  Homozygous AT, PC, or PS deficiency 
D)  Sickle-cell anemia 
A)  Homozygous factor VLeiden 
B)  Homozygous prothrombin 20210 
C)  Homozygous AT, PC, or PS deficiency 
D)  Sickle-cell anemia D

Question 2

What are microparticles and how do they affect thrombus formation?

Accepted Answer

Microparticles are membrane-bound vesicles produced by blebbing of the cell membrane of the parental cell and are released in response to cell activation or apoptosis. They range in size from 100-1000 nM, and carry many of the antigens of the parent cell. Most of the MPs found in the circulation of healthy individuals are platelet derived. MPs were first recognized for having procoagulant potential. MPs have since been recognized as playing a role in other physiologic processes, including inflammation, angiogenesis, and immune responses.MPs have also been reported to promote anticoagulant functions and fibrinolytic responses, possibly at times counteracting their prothrombotic activity.

Question 3

Which laboratory test is considered to have a reliable negative predictive value in the diagnosis of DVT?

Accepted Answer

A)  Factor VLeiden 
B)  PT 
C)  tPA 
D)  D-dimer 
A)  Factor VLeiden 
B)  PT 
C)  tPA 
D)  D-dimer D

Question 4

Describe the recommended approach for identifying a lupus anticoagulant:

Accepted Answer

A. Screening assays
1. Prolonged APTT (p

Question 5

Why does a patient who had a thrombotic incident receive both heparin and Coumadin for 4-5 days before heparin is discontinued?

Accepted Answer

A)  Heparin is not effective as an anticoagulant without Coumadin. 
B)  Coumadin requires heparin for its full anticoagulant effect. 
C)  Coumadin and heparin have a synergistic effect 
D)  Coumadin 's full effect is not achieved for 4-5 days after initiation because of the half-life of the vitamin K coagulation factors. 
A)  Heparin is not effective as an anticoagulant without Coumadin. 
B)  Coumadin requires heparin for its full anticoagulant effect. 
C)  Coumadin and heparin have a synergistic effect 
D)  Coumadin 's full effect is not achieved for 4-5 days after initiation because of the half-life of the vitamin K coagulation factors.

Question 6

During coumadin-induced anticoagulation, which factor's activity disappears most rapidly?

Accepted Answer

A)  FIX 
B)  FVII 
C)  FVIII 
D)  FV 
A)  FIX 
B)  FVII 
C)  FVIII 
D)  FV

Question 7

It has been determined that a patient has activated protein C resistance. Name the most prevalent genetic mutation associated with this finding.

Accepted Answer

A)  Guanine to adenine substitution on nucleotide 20210 of the prothrombin gene 
B)  Lysine to glutamic acid substitution on the sixth position on the beta globin chain 
C)  Arginine to glutamine substitution at the 506 position of factor V protein 
D)  Translocation of chromosome 22 onto the long arm of chromosome 9 
A)  Guanine to adenine substitution on nucleotide 20210 of the prothrombin gene 
B)  Lysine to glutamic acid substitution on the sixth position on the beta globin chain 
C)  Arginine to glutamine substitution at the 506 position of factor V protein 
D)  Translocation of chromosome 22 onto the long arm of chromosome 9

Question 8

Which of the following best describes the most common cause of hyperhomocysteinemia?

Accepted Answer

A)  Mutations in the CBS gene or MTHFR gene 
B)  APCR 
C)  TFPI variant 
D)  Substitution in the 3' untranslated region of the prothrombin gene (nucleotide 20210) 
A)  Mutations in the CBS gene or MTHFR gene 
B)  APCR 
C)  TFPI variant 
D)  Substitution in the 3' untranslated region of the prothrombin gene (nucleotide 20210)

Question 9

Explain why many patients with an inherited thrombophilia are misdiagnosed.

Accepted Answer

Thrombophilia depends on the p

Question 10

Which of the following test results would help differentiate between type I and II protein C deficiencies?

Accepted Answer

A)  PT and APTT 
B)  Protein C antigen assay 
C)  Protein C functional activity assay 
D)  Protein S assay 
A)  PT and APTT 
B)  Protein C antigen assay 
C)  Protein C functional activity assay 
D)  Protein S assay

Question 11

A 30-year-old patient is diagnosed with a third episode of DVT. He is currently hospitalized and receiving heparin therapy. The physician orders a thrombotic risk battery of tests. What is the most appropriate action that the laboratory professional should take?

Accepted Answer

A)  Call the physician and explain that testing will not be accurate during anticoagulant therapy and during the thrombotic episode 
B)  Perform the battery of tests in the thrombosis risk profile but note that results are not reliable 
C)  Perform a PT and an APTT, and, if prolonged, refuse to do the testing 
D)  Call the physician and explain that this patient is not a candidate for thrombosis risk testing 
A)  Call the physician and explain that testing will not be accurate during anticoagulant therapy and during the thrombotic episode 
B)  Perform the battery of tests in the thrombosis risk profile but note that results are not reliable 
C)  Perform a PT and an APTT, and, if prolonged, refuse to do the testing 
D)  Call the physician and explain that this patient is not a candidate for thrombosis risk testing

Question 12

How does the INR standardize the prothrombin time?

Accepted Answer

The INR is calculated by taking the pati

Question 13

Name the genetic mutation that induces increased concentration of prothrombin in the circulation that leads to increased risk of venous thrombosis.

Accepted Answer

A)  G → A substitution on nucleotide 20210 of the prothrombin gene 
B)  Lysine to glutamic acid substitution on the sixth position on the beta globin chain 
C)  Arginine to glutamine substitution at the 506 position of prothrombin 
D)  Translocation of chromosome 22 onto the long arm of chromosome 9 
A)  G → A substitution on nucleotide 20210 of the prothrombin gene 
B)  Lysine to glutamic acid substitution on the sixth position on the beta globin chain 
C)  Arginine to glutamine substitution at the 506 position of prothrombin 
D)  Translocation of chromosome 22 onto the long arm of chromosome 9

Question 14

Which of the following alterations would most likely be associated with a hypercoagulable state?

Accepted Answer

A)  Excess plasma coagulation proteins 
B)  Decreased fibrinolytic inhibitors 
C)  Excess coagulation inhibitors 
D)  Decreased platelets 
A)  Excess plasma coagulation proteins 
B)  Decreased fibrinolytic inhibitors 
C)  Excess coagulation inhibitors 
D)  Decreased platelets

Question 15

A patient has been diagnosed with a coagulopathy and has been given Coumadin as a mode of treatment. What screening test(s) should be performed to monitor this treatment, and what effect will this therapy have on the coagulation pathway?

Accepted Answer

A)  APTT; initial decrease in the vitamin K-dependent factors of the intrinsic pathway 
B)  PT-INR; initial decrease in the vitamin K-dependent factors of the extrinsic pathway 
C)  PT-INR and APTT; initial decrease in the vitamin K-dependent factors of all pathways 
D)  PT-INR; initial decrease in all vitamin K-dependent serine proteases 
A)  APTT; initial decrease in the vitamin K-dependent factors of the intrinsic pathway 
B)  PT-INR; initial decrease in the vitamin K-dependent factors of the extrinsic pathway 
C)  PT-INR and APTT; initial decrease in the vitamin K-dependent factors of all pathways 
D)  PT-INR; initial decrease in all vitamin K-dependent serine proteases

Question 16

Heparin inhibits coagulation by:

Accepted Answer

A)  Chelating calcium release from platelet granules 
B)  Catalyzing antithrombin activity 
C)  Neutralizing labile factors V and VIII 
D)  Neutralizing the tenase complex 
A)  Chelating calcium release from platelet granules 
B)  Catalyzing antithrombin activity 
C)  Neutralizing labile factors V and VIII 
D)  Neutralizing the tenase complex

Question 17

Which of the following is thought to be a traditional risk factor associated with the formation of arterial thrombi?

Accepted Answer

A)  von Willebrand's disease 
B)  Hemophilia 
C)  Dysfibrinogenemia 
D)  Diabetes 
A)  von Willebrand's disease 
B)  Hemophilia 
C)  Dysfibrinogenemia 
D)  Diabetes

Question 18

A postoperative heart transplant patient has been given unfractionated heparin. Five days postoperative, he develops petechiae and needs multiple dressing changes over his wound site. What tests should be used to assess the patient's clinical status?

Accepted Answer

A)  Platelet count and HIT antibody assay 
B)  APTT and PT 
C)  PT and FDP 
D)  D-dimer and fibrogen 
A)  Platelet count and HIT antibody assay 
B)  APTT and PT 
C)  PT and FDP 
D)  D-dimer and fibrogen

Question 19

How does a thrombus become a thromboembolus?

Accepted Answer

A thrombus is an initial formation of a

Question 20

The reason that thrombolytic agents are not recommended for prolonged anticoagulation therapy is that they:

Accepted Answer

A)  Are weak anticoagulants that often cause repeat thrombotic episodes 
B)  Are powerful agents that increase the risk of hemorrhage 
C)  Often need another agent for full anticoagulant effect 
D)  Are used for prolonged anticoagulation therapy 
A)  Are weak anticoagulants that often cause repeat thrombotic episodes 
B)  Are powerful agents that increase the risk of hemorrhage 
C)  Often need another agent for full anticoagulant effect 
D)  Are used for prolonged anticoagulation therapy

Exam 35: Thrombophilia

Which of the following inherited condition is considered a low risk for a venous thromboembolic event?

What are microparticles and how do they affect thrombus formation?

Which laboratory test is considered to have a reliable negative predictive value in the diagnosis of DVT?

Describe the recommended approach for identifying a lupus anticoagulant:

Why does a patient who had a thrombotic incident receive both heparin and Coumadin for 4-5 days before heparin is discontinued?

During coumadin-induced anticoagulation, which factor's activity disappears most rapidly?

It has been determined that a patient has activated protein C resistance. Name the most prevalent genetic mutation associated with this finding.

Which of the following best describes the most common cause of hyperhomocysteinemia?

Explain why many patients with an inherited thrombophilia are misdiagnosed.

Which of the following test results would help differentiate between type I and II protein C deficiencies?

A 30-year-old patient is diagnosed with a third episode of DVT. He is currently hospitalized and receiving heparin therapy. The physician orders a thrombotic risk battery of tests. What is the most appropriate action that the laboratory professional should take?

How does the INR standardize the prothrombin time?

Name the genetic mutation that induces increased concentration of prothrombin in the circulation that leads to increased risk of venous thrombosis.

Which of the following alterations would most likely be associated with a hypercoagulable state?

A patient has been diagnosed with a coagulopathy and has been given Coumadin as a mode of treatment. What screening test(s) should be performed to monitor this treatment, and what effect will this therapy have on the coagulation pathway?

Heparin inhibits coagulation by:

Which of the following is thought to be a traditional risk factor associated with the formation of arterial thrombi?

A postoperative heart transplant patient has been given unfractionated heparin. Five days postoperative, he develops petechiae and needs multiple dressing changes over his wound site. What tests should be used to assess the patient's clinical status?

How does a thrombus become a thromboembolus?

The reason that thrombolytic agents are not recommended for prolonged anticoagulation therapy is that they:

Introduction

Cellular Homeostasis

Structure and Function of Hematopoietic Organs

Hematopoiesis

The Erythrocyte

Hemoglobin

Granulocytes and Monocytes

Lymphocytes

The Platelet

The Complete Blood Count and Peripheral Blood Smear Evaluation

Introduction to Anemia

Anemias of Disordered Iron Metabolism and Heme Synthesis

Hemoglobinopathies: Qualitative Defects

Thalassemia

Megaloblastic and Nonmegaloblastic Macrocytic Anemias

Hypoproliferative Anemias

Hemolytic Anemia: Membrane Defects

Hemolytic Anemia: Enzyme Deficiencies

Hemolytic Anemia: Immune Anemias

Hemolytic Anemia: Nonimmune Defects

Nonmalignant Disorders of Leukocytes: Granulocytes and Monocytes

Nonmalignant Lymphocyte Disorders

Introduction to Hematopoietic Neoplasms

Myeloproliferative Neoplasms

Myelodysplastic Syndromes

Acute Myeloid Leukemias

Precursor Lymphoid Neoplasms

Mature Lymphoid Neoplasms

Hematopoietic Stem Cell Transplantation

Morphologic Analysis of Body Fluids in the Hematology

Primary Hemostasis

Secondary Hemostasis and Fibrinolysis

Disorders of Primary Hemostasis

Disorders of Secondary Hemostasis

Hemostasis: Laboratory Testing and Instrumentation

Hematology Procedures

Bone Marrow Examination

Automation in Hematology

Flow Cytometry

Chromosome Analysis of Hematopoietic and Lymphoid Disorders

Molecular Analysis of Hematologic Diseases

Quality Assessment in the Hematology Laboratory

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