2.5 Coagulation: Hemostsis Problem Solving Questions and
Answers 2023 Verified
C. ITP
C These clinical manifestations and laboratory results are consistent with ITP. ITP is an
autoimmune thrombocytopenia. In children, acute ITP thrombocytopenia occurs
following a viral infection, as is the case in this 3-year-old patient. Clinical manifestations
are associated with petechiae, purpura, and mucous membrane bleedings such as
epistaxis and gingival bleeding. Abnormal laboratory tests include a very low platelet
count and a prolonged bleeding time. Other causes of thrombocytopenia should be
ruled out in patients with ITP.
Patient History
A 3-year-old male was admitted to a hospital with scattered petechiae and epistaxis.
The patient had normal growth and had no other medical problems except for
chickenpox 3 weeks earlier. His family history was unremarkable. Laboratory Results
Patient; Reference Range
PT: 11 sec; 10-13 sec
APTT: 32 sec; 28-37 sec
Platelet count: 18 × 103/µL; 150-450 × 103/µL
These clinical manifestations and laboratory results are consistent with which condition?
A. TTP
B. DIC
C. ITP
D. HUS
B. von Willebrand's disease
B These clinical manifestations and laboratory results are consistent with von
Willebrand's disease. Von Willebrand's disease is an inherited bleeding disorder caused
by abnormal platelet adhesion. Platelet adhesion depends on VWF and glycoprotein Ib.
In von Willebrand's disease, VWF is deficient or dysfunctional. VWF promotes
secondary hemostasis by acting as a carrier for factor VIII. Deficient or dysfunctional
VWF results in decreased factor VIII and therefore abnormal secondary hemostasis.
The clinical manifestations associated with von Willebrand's disease are easy bruising,
epistaxis, and bleeding after surgery. Abnormal laboratory test results are increased
bleeding time and abnormal platelet aggregation to ristocetin, which is corrected on
addition of normal plasma containing VWF. Activated partial thromboplastin time (APTT)
is prolonged as a result of the deficiency of factor VIII. Factor VIII activity (VIII:C), VWF
ristocetin cofactor activity (VWF:Rco), and VWF:antigenic activity (VWF:antigen) are all
abnormal. The platelet count and prothrombin time are normal in von Willebrand's
disease.
A 12-year-old white male has the following symptoms: visible bruising on arms and legs,
bruising after sports activities, and excessive postoperative hemorrhage following
, tonsillectomy 3 months ago. His family history revealed that his mother suffers from
heavy menstrual bleeding, and his maternal grandfather had recurrent nosebleeds and
bruising.
Laboratory Results
Patient; Reference Range
Platelet Count: 350 × 103/µL; 200-450 × 103/µL
PT: 11.0 sec; 10-12 sec
APTT: 70 sec; 28-37 sec
TT: 13 sec; 10-15 sec
Platelet Aggregation:
Normal aggregation with collagen, epinephrine, ADP
Abnormal aggregation with ristocetin
Confirmatory Tests:
Patient; Range Reference
VWF:Rco 25%; 45%-140%
VIII:C 20%; 50%-150%
vWF:antigen 10%; 45%-185%
These clinical manifestations and laboratory results are consistent with which
diagnosis?
A. Factor VIII deficiency
B. von Willebrand's disease
C. Glanzmann's thrombasthenia
D. Bernard-Soulier syndrome
D. Cryoprecipitate
D Cryoprecipitate contains fibrinogen, factor VIII, and VWF. Fresh frozen plasma has all
of the clotting factors; however, it is not the best choice if cryoprecipitate is available
The following results are obtained from a patient who developed severe bleeding:
Prolonged PT and APTT
Platelet count = 100 × 109 /L
Fibrinogen = 40 mg/dL
Which of the following blood products should be recommended for transfusion?
A. Factor VIII concentrate
B. Platelets
C. Fresh frozen plasma
D. Cryoprecipitate
C. Platelet counts
C The platelet count should be checked every other day in patients receiving heparin
therapy. Heparin-induced thrombocytopenia (HIT) should be suspected in patients who
are not responding to heparin therapy and/or are developing thrombocytopenia (50%
below the baseline value) and thrombotic complications while on heparin therapy.
Increase in heparin dose should be avoided in patients with the clinical symptoms of
Answers 2023 Verified
C. ITP
C These clinical manifestations and laboratory results are consistent with ITP. ITP is an
autoimmune thrombocytopenia. In children, acute ITP thrombocytopenia occurs
following a viral infection, as is the case in this 3-year-old patient. Clinical manifestations
are associated with petechiae, purpura, and mucous membrane bleedings such as
epistaxis and gingival bleeding. Abnormal laboratory tests include a very low platelet
count and a prolonged bleeding time. Other causes of thrombocytopenia should be
ruled out in patients with ITP.
Patient History
A 3-year-old male was admitted to a hospital with scattered petechiae and epistaxis.
The patient had normal growth and had no other medical problems except for
chickenpox 3 weeks earlier. His family history was unremarkable. Laboratory Results
Patient; Reference Range
PT: 11 sec; 10-13 sec
APTT: 32 sec; 28-37 sec
Platelet count: 18 × 103/µL; 150-450 × 103/µL
These clinical manifestations and laboratory results are consistent with which condition?
A. TTP
B. DIC
C. ITP
D. HUS
B. von Willebrand's disease
B These clinical manifestations and laboratory results are consistent with von
Willebrand's disease. Von Willebrand's disease is an inherited bleeding disorder caused
by abnormal platelet adhesion. Platelet adhesion depends on VWF and glycoprotein Ib.
In von Willebrand's disease, VWF is deficient or dysfunctional. VWF promotes
secondary hemostasis by acting as a carrier for factor VIII. Deficient or dysfunctional
VWF results in decreased factor VIII and therefore abnormal secondary hemostasis.
The clinical manifestations associated with von Willebrand's disease are easy bruising,
epistaxis, and bleeding after surgery. Abnormal laboratory test results are increased
bleeding time and abnormal platelet aggregation to ristocetin, which is corrected on
addition of normal plasma containing VWF. Activated partial thromboplastin time (APTT)
is prolonged as a result of the deficiency of factor VIII. Factor VIII activity (VIII:C), VWF
ristocetin cofactor activity (VWF:Rco), and VWF:antigenic activity (VWF:antigen) are all
abnormal. The platelet count and prothrombin time are normal in von Willebrand's
disease.
A 12-year-old white male has the following symptoms: visible bruising on arms and legs,
bruising after sports activities, and excessive postoperative hemorrhage following
, tonsillectomy 3 months ago. His family history revealed that his mother suffers from
heavy menstrual bleeding, and his maternal grandfather had recurrent nosebleeds and
bruising.
Laboratory Results
Patient; Reference Range
Platelet Count: 350 × 103/µL; 200-450 × 103/µL
PT: 11.0 sec; 10-12 sec
APTT: 70 sec; 28-37 sec
TT: 13 sec; 10-15 sec
Platelet Aggregation:
Normal aggregation with collagen, epinephrine, ADP
Abnormal aggregation with ristocetin
Confirmatory Tests:
Patient; Range Reference
VWF:Rco 25%; 45%-140%
VIII:C 20%; 50%-150%
vWF:antigen 10%; 45%-185%
These clinical manifestations and laboratory results are consistent with which
diagnosis?
A. Factor VIII deficiency
B. von Willebrand's disease
C. Glanzmann's thrombasthenia
D. Bernard-Soulier syndrome
D. Cryoprecipitate
D Cryoprecipitate contains fibrinogen, factor VIII, and VWF. Fresh frozen plasma has all
of the clotting factors; however, it is not the best choice if cryoprecipitate is available
The following results are obtained from a patient who developed severe bleeding:
Prolonged PT and APTT
Platelet count = 100 × 109 /L
Fibrinogen = 40 mg/dL
Which of the following blood products should be recommended for transfusion?
A. Factor VIII concentrate
B. Platelets
C. Fresh frozen plasma
D. Cryoprecipitate
C. Platelet counts
C The platelet count should be checked every other day in patients receiving heparin
therapy. Heparin-induced thrombocytopenia (HIT) should be suspected in patients who
are not responding to heparin therapy and/or are developing thrombocytopenia (50%
below the baseline value) and thrombotic complications while on heparin therapy.
Increase in heparin dose should be avoided in patients with the clinical symptoms of
