Exam 31: Disorders of Secondary Hemostasis

Deficiencies of the fibrin-forming proteins often have a delayed bleeding symptom that is due to which of the following?

Use this case to answer the following questions: A 5-year-old boy visits his primary care physician after an accident on his bike.It was his first accident, and he fell on his knees.His mother noticed severe swelling in his knees and elbows, but thought that it was from the accident.She placed an ice pack on the affected areas and put him to rest.After a few days, the swelling had not improved, so she made an appointment to see his pediatrician.The physician asks him a few questions about the accident and then proceeds to perform a physical examination.The physician notes small hematomas on his elbows and knees and also on his upper torso.He draws blood, and the results are shown below. PT: 12.2 sec (RR: 11.3-12.8 sec) INR: 1.12 APTT: 72 sec (RR: 23-32 sec) Platelet aggregation studies: normal aggregation with all agonists The physician admits him to the area hospital. -What disorder is the patient most likely suffering from?

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

What is the inheritance pattern of hemophilia A?

George Jones is admitted to the hospital with abdominal pain.Upon physical examination, the attending physician notices a yellow ring around George's green eyes.George has a significant swelling in his abdomen, and has been suffering from swollen joints for the last month.The physician runs a battery of labs.The results are below: TEST George Jones Reference Range PT 16.8 11-13 INR 3.85 NA APTT 71 23-32 BT 5 2-6 Fibrinogen 275/ 200-400/ Factor X 22\% >50\% activity Factor II 21\% >50\% activity Factor VII 23\% >50\% activity Factor V 28\% >50\% activity Factor XII 95\% >50\% activity Factor XI 99\% >50\% activity Factor IX 30\% >50\% activity RIPA 95\% >50\% activity AST Elevated Normal ALT Elevated Nomal GGT Elevated Normal TBL Elevated Normal DBI Elevated Nomal Based on this information, from what is George most likely suffering?

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

Which assay would assess for the presence of a circulating nonspecific inhibitor?

What plasma factor levels can be expected in a female carrier of F-VIII or F-IX deficiency?

What tests typically are utilized in the detection of lupus anticoagulants in the laboratory?

Use this case to answer the following questions: A 5-year-old boy visits his primary care physician after an accident on his bike.It was his first accident, and he fell on his knees.His mother noticed severe swelling in his knees and elbows, but thought that it was from the accident.She placed an ice pack on the affected areas and put him to rest.After a few days, the swelling had not improved, so she made an appointment to see his pediatrician.The physician asks him a few questions about the accident and then proceeds to perform a physical examination.The physician notes small hematomas on his elbows and knees and also on his upper torso.He draws blood, and the results are shown below. PT: 12.2 sec (RR: 11.3-12.8 sec) INR: 1.12 APTT: 72 sec (RR: 23-32 sec) Platelet aggregation studies: normal aggregation with all agonists The physician admits him to the area hospital. -Predict results that will confirm the patient's diagnosis.

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 are shown below. 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?

Interpret the following results: PT: 11.8 sec (RR: 11.2-13.8 sec) INR: 1.07 APTT: 57 sec (RR: 23-32 sec) BT: 12 min Ristocetin aggregation: decreased aggregation Based on this information, from what is the patient most likely suffering?

A physician has confirmed von Willebrand's disease in his 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?

Which of the following is used in the identification of a secondary hemostatic pathway anomaly?

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

Explain how disseminated intravascular coagulation is not a primary disease state.Correlate etiology, pathophysiology, and laboratory analysis in your response.

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

A patient has a prolonged PT.What can you infer from this result?

Hemophilia A is caused by a deficiency in which of the following proteins?

An advantage of prenatal diagnosis by genotypic analysis for hemophilia over phenotypic analysis is: