COAGULATION/ HEMOSTASIS
1. An 18 year old female was scheduled to have her wisdom teethremoved. The patient has history of frequent nosebleeds, heavymenstrual periods, and easy bruising. Her labs are as follows: PT:11.8 sec, APTT: 45 sec, platelet count: 300,000, PFA : Abnormal.Based on theses results what test should be considered next andwhy?
2. A patient was admitted to the ER for a possiblestroke. The CBC and platelet were normal. Both the PT and APTT fellwithin normal limits. What laboratory testing should be consideredand why?
3. A 45 year old male with no prior history ofbleeding disorders presents with the following: abnormal PFA,prolonged APTT, normal PT, normal platelet count. What bleedingdisorder is most likely present?
4. A patient has the following coagulation results.PT = 22 sec, APTT = 65 sec, TT = 18.0 sec, Fibrinogen = 210 mg/dl,Factor V= 25%, Factor VIII = 120%, Factor IX = 22%, Factor X =18%,, platelet count 150,000. What is the probable diagnosis andwhy?
5. A 2‑year old male child was admitted to thehospital for bleeding and severe bruising. The child had the fluthree weeks previous. Lab results are: abnormal PFA, platelet countl2,000, PT and APTT normal. What is the possible diagnosis?
6. An APTT result for a 79 year old female admittedfor minor surgery was 55 seconds. The PT and TT were in the normalrange. The patient had no clinical manifestations of a bleedingproblem and no family history of bleeding problems. The APTT wascorrected with normal plasma. Which of the following which isconsistent with these lab results and Why? Lupus inhibitor, FactorXI deficiency, Factor VIII deficiency or Factor XII deficiency
7. A 54 year old male was admitted to the hospitalfor cirrhosis of the liver. There was no history of unexplainedbleeding. The lab results are PT: 24s, APTT: 58s, Plt: 20,000,fibrinogen 70 mg/dl, TT: 52s, D-Dimer >250 ug/dl, A possiblediagnosis and why? (Factor VIII deficiency, Dysfibrinogenemia,Circulating antibody or DIC)
8. A 4 year old boy has a history of bleeding.His 12 year old sister has no evidence of a bleeding disorder. Hismother’s brother died at the age of 3 from hemorrhage. Laboratoryresults: PFA Normal, APTT: 64.0, PT: 10.5, TT: 15 seconds, Mixingstudy 35 seconds. Which of the following tests should be done nextPlatelet aggregation, Circulating anticoagulant, Factor VIII,Factor XII? Why?
9. A 70 year old women is hospitalized for anelective total hip replacement. The procedure went well and she wasplaced on anticoagulant therapy while she was recovering in thehospital. After one week her WBC is 9,000/ul and her platelet countis 40,000/ul. The most likely cause of the thrombocytopenia is HIT,ITP, TTP or HUS? Why?
10. A 6 year old male had bleeding following removalof his tonsils. There is a positive family history for bleeding.Lab results are as follows: platelet count 85,000, PT: 12s, APTT:28s, PFA abnormal, platelet aggregation: abnormal with ristocetin.A possible diagnosis is Storage pool, Bernard-Soulier, Glanzmann’sthrombasthenia or Hemophilia A? Why?
