Exam 34: Disorders of Secondary Hemostasis

A 34-year-old woman has just given birth to a healthy baby boy.After the delivery of the baby,the physician proceeds to deliver the placenta.After it has been extracted from the mother's uterus,the resident examines it and notes that it appears incomplete.They try to deliver the remainder but are unsuccessful.A few moments later,the mother loses consciousness,and is bleeding profusely from her uterus.Blood is collected,and the results follow. PT: 17 sec (RR: 11.3-12.8 sec) INR: 3.02 APTT: 67 sec (RR: 23-32 sec) D-dimer: 540 ng/mL (RR: <400 ng/mL) Fibrinogen: 82 mg/dL (RR: 200-400 mg/dL) Factor V assay: 12% Based on this information,from what is the patient most likely suffering?

How does von Willebrand's disease (VWD)differ from Bernard-Soulier syndrome? Correlate the pathophysiology of both disorders in your response.Name at least two laboratory tests that differentiate each.

What laboratory tests typically are utilized to detect lupus anticoagulants?

What is the inheritance pattern of hemophilia A?

Explain how liver disease can be differentiated from DIC through laboratory test analysis.

Screening tests for the evaluation of VWD include the platelet count,APTT,PT,bleeding time,and/or PFA-100.Which of the following results would be evident in most cases of VWD?

Explain the inheritance pattern of the following disorder and how it contributes to the clinical manifestations of each of the following disorders:a.Hemophilia A

A preterm infant (29 weeks old)has a platelet count of 85 × 10⁹/L.Is this a normal or abnormal finding?

A patient might be suffering from a coagulopathy.Which of the following physical manifestations would suggest a primary hemostatic pathway problem?

Which of the following laboratory assays would be useful in identifying the presence of primary fibrinolysis?

Which congenital deficiency(ies)is(are)suspected with a normal platelet count,an abnormal PT and APTT,and normal PFA-100 and thrombin time?

A physician has confirmed von Willebrand's disease in a patient.Further testing is needed to determine which subtype the patient has.Multimer analysis is performed and comes back normal.What is the most probable explanation for this?

A patient with a protein C deficiency is at risk for developing which of the following?

What type of VWD is the only type to have a decreased platelet count?