NOTRE DAME UNIVERISTY

DEPARTMENT OF MEDICAL LABORATORY TECHNOLOGY

MLT 318: HEMATOLOGY & HEMOSTASIS

Final Exam
Fall Term 2014-2015

Date:
Time:
Students Name: _____________________________________________
(First)
(Father)
(Family)
ID #: _____________________
Section: A
Instructors Name: Dr. Nadim Azar

Kindly make sure that you read and understand the following points:

Anyone caught cheating or aiding another in cheating will have his/her exam confiscated
immediately and will be given an F in the course.
Calculators are not allowed.
Access to books, notes, mobile phones, pagers or other aids is strictly prohibited whilst sitting an
examination.
Illegible answers will not receive credit. Write clearly to get credits.
You are not allowed to remove examination paper, booklets, completed scripts or other materials
from the examination room.
Your answers to all the questions should be written only on the exam sheets.
Time duration is 120 minutes.
Total number of exam sheets including this cover is 9.

Good Work!

I- MULTIPLE CHOICE QUESTIONS (total 20 points, 1 point each).

CLS 340
HEMATOLOGY & HEMOSTASIS

Final Exam
Fall Term 2014-2015

a.
b.
c.
d.

Circle in each of the following the answer(s). One or Two answer(s) per question is (are)
correct.
Which condition causes a prolonged thrombin time test result?
Prothrombin deficiency
Heparin
hypofibrinogenemia
oral anticoagulants

a.
b.
c.
d.

A person taking Aspirin presents:

Prolonged PT and PTT
Prolonged coagulation tests
Deficiency in vit K dependent factors
None of the above
The protein C system
a. inactivates factors Va and VIIIa
b. inactivates factor Va and Xa
c. activates factor V
d. Inactivates factors VIIIa and Xa
Proteins C and proteins S are
a. Produced by the endothelial cells
b. Produced by the liver and are Vit K dependent
c. Produced by the liver and are vit K independent
d. Are strong anticoagulants

a.
b.
c.
d.

A person taking oral anticoagulants has:

Low level of platelets
PT and APTT prolonged ( PT more prolonged than APTT)
PT and APTT prolonged (APTT more prolonged than PT)
INR level must be < 1.0

a.
b.
c.
d.

What test is best usually used to screen for LA (Lupus anticoagulant) in the absence of LA
integrated kit
DRVVT (Dilute Russells Viper Venom Test)
PT
APTT
TT

a.
b.
c.
d.

A person with bleeding disorder and normal PT, PTT, TT and platelet count and functions may
present :
Deficiency in F IIa
Deficiency in FXIII
Deficiency in protein C system
Deficiency in F XII

a.
b.
c.
d.

A person with type IIa Von Willebrand disease has:

APTT prolonged
APTT normal
Platelet count low
Bleeding time normal
A person with type I Von Willebrand disease has
Page 2 of 10

CLS 340
HEMATOLOGY & HEMOSTASIS

a.
b.
c.
d.

Final Exam
Fall Term 2014-2015

Bleeding time normal

Platelet count low
APTT normal or slightly prolonged
Factor VIII level < 10%

a.
b.
c.
d.

Deficiency in factor V
PT prolonged
APTT prolonged
TT prolonged
Protein C decreased

a.
b.
c.
d.

In severe liver disease, all propositions are true except :

Fibrinogen less than 200 mg/dL
TT prolonged
APTT mildly prolonged
Reptilase time prolonged

a.
b.
c.
d.

To what factor deficiency is the PT most sensitive

II
VII
VIII
X

a.
b.
c.
d.

Protein S system
Is a cofactor that binds and stabilizes APC
Only free protein S can participate in the APC anticoagulant pathway
More the C4bp is elevated , more APC-protein S system is active
All the above

a.
b.
c.
d.

Thrombosis risk testing

The thrombin mutation G20210 is associated with increased risk
The prothrombin mutation G20120 is associated with increased risk
The prothrombin mutation G20210 is associated with increased risk
None of the above is true
Protein C assays
a. In chromogenic assays, both qualitative and quantitative deficiencies are evaluated
b. Clotting tests can evaluate the protein C activity
c. In clotting tests, prolongation is proportional to plasma protein C activity
b. All the above

a.
b.
c.
d.

In LA Lupus anticoagulant syndrome:

The APTT is always prolonged
The PT is always prolonged
APTT may be normal
Platelet rich plasma is used

Page 3 of 10

CLS 340
HEMATOLOGY & HEMOSTASIS

a.
b.
c.
d.
a.
b.
c.
d.

Final Exam
Fall Term 2014-2015

In LA, all the propositions are true except:

We perform a mixing study if the APTT is abnormal
We perform a mixing study if the DRVVT is abnormal
We stop the evaluation of LA if both APTT and DRVVT are normal
We confirm the presence of LA if the phospholipids dependence test is negative
In a mixing study, in order to increase the sensitivity of the test to detect LA
We use 3 parts of patient plasma + 1 part normal plasma
We use 3 parts of normal plasma + 1 part patient plasma
We use 2 parts of normal plasma + 2 part patient plasma
We use only patient plasma without any normal plasma
In DIC

a.

Platelet count < 200.000/ul, PT prolonged, APTT prolonged, D-dimers increased and TT
prolonged
b.
Platelet count < 200.000/ul, PT prolonged, APTT prolonged, D-dimers increased and
fibrinogen decreased
c.
Coagulation factors and platelets are consumed
d.
All the above
a.
b.
c.
d.

What is the most important application of the quantitative D-Dimers test?

Diagnose primary fibrinolysis
Diagnose liver and renal disease
Rule out DVT (deep venous thrombosis)
Diagnose acute myocardial infarction

II- MATCH THE FOLLOWING (total 8 points: 1 point each)

1. prolonged PT, Normal FV

___

a. vW disease

2. Prolonged TT normal reptilase

_
___

b. LA

_
___

c. Liver disease

4. Mildly prolonged aPTT and PT

_
___

d. Heparin

5. Low platelets and high FDP

_
___

e. DIC

6. prolonged PT, low levels FV

_
___

f. Vit K deficiency

7. prolonged reptilase time

_
___

g. afibrinogenemia

3. Prolonged bleeding time, prolonged

aPTT

_
Page 4 of 10

CLS 340
HEMATOLOGY & HEMOSTASIS

Final Exam
Fall Term 2014-2015

8. normal PT, PTT and TT

___
_

Page 5 of 10

h. Deficiency F XIII

CLS 340
HEMATOLOGY & HEMOSTASIS

Final Exam
Fall Term 2014-2015

III- ESSAY QUESTIONS

ANSWER THE FOLLOWING QUESTIONS (total 47 points).
Discuss the function of heparin in relation to blood coagulation. What coagulation factors does
heparin affect (4 points)?
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Name three assays used to evaluate thrombosis risk (3 points).
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
_______________________________________________________________________________
How and why do we perform a mixing study (3 point)?
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Describe the principles in APC resistance assay (3 points).
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Name three generalized bleeding signs (3 points).
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Name the Vit K Dependent factors and explain the mechanism of action of VitK (2 points).
________________________________________________________________________________
________________________________________________________________________________

Page 6 of 10

CLS 340
HEMATOLOGY & HEMOSTASIS

Final Exam
Fall Term 2014-2015

DIC: Pathophysiology & symptoms and laboratory diagnosis (6 points).

________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Heparin induced thrombocytopenia: cause, clinical significance and laboratory diagnosis (6 points).
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
How should we report the PT result in case of a patient under AVK? Why (6 points)?
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

Page 7 of 10

CLS 340
HEMATOLOGY & HEMOSTASIS

Final Exam
Fall Term 2014-2015

What is the interest of measuring factor V in case of prolonged PT (6 points)?

________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
For what reason the citrated tube should be well filled? Explain (5 points).
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

IV- TRUE OR FALSE QUESTIONS

Indicate whether each of the following questions is "true" by circling the letter "T or false by
circling the letter "F (total 25 points: 0.5 points each).
F

Factors V and XI are cofactors

F A bleeding time is prolonged when a person is on Anti Vit K drugs

F

F A+B are products of cleavage of fibrinogen by thrombin

F Factor VIII activates factor VII in presence of TF

F D-dimers is a product of degradation of the activated thrombin
F The TFPI inactivates factor VIIa in presence of factor Xa
F TF activates factor VII and the complex VIIa-TF activates factor X
Page 8 of 10

CLS 340
HEMATOLOGY & HEMOSTASIS

Final Exam
Fall Term 2014-2015

F The protein C is synthesized in the endothelial cells

F The endothelial cells secrete secrete vWF that is necessary for platelets to adhere to exposed
subendothelial collagen.
F Factor vW is essential in stabilizing factor VIII
F Factor vW stabilizes the thrombin
F The thrombin-thrombomodulin complex activates the protein C to APC
F Liver normally secrete toxins that may cause DIC
F When the plasma C4bp level rises, such in inflammation conditions, free protein S level
decreases
F AT III (antithrombin III) neutralizes thrombin and factors Xa, XIa and XIIa.
F Reptilase time is not affected by heparin
F Mixing study is not used in the detection of LA (Lupus anticoagulant)
F In liver disease TT, PT and reptilase time are prolonged
F In case of multi-factor deficiency, a mixture plasma (normal+patient) will correct the
coagulation time
F In VW disease, the platelet count shows thrombopenia
F Antithrombin ability to neutralize thrombin increases greatly in presence of heparin
F In DIC, coagulation factors, platelets and fibrinogen are consumed
F Hemophilia inheritance is sex linked so it can be transmitted by unprotected sexual
relations
F Factor V leiden is a mutation of factor V that renders it more active
hemophilia A is a autosomal recessive disease
F In hemophilia A, the classification depends on the remaining level of F VIII and F
IX
F VW factor is essential in stabilizing factor VIII
F We may have a VWF Ag normal and still have a VW disease
F Protein C and S evaluation are a major part in the thrombosis risk evaluation tests
F APC resistance concerns a mutation in the protein C
F The presence of LA can be detected by using a PTT reagent rich with phospholipids
Page 9 of 10

CLS 340
HEMATOLOGY & HEMOSTASIS

Final Exam
Fall Term 2014-2015

F Very severe plasma depletion in calcium will cause a prolonged PT and PTT
F Confirmation tests for the presence of Lupus anticoagulant consist of neutralizing the effect
of the LA by adding excess of phospholipids
F Mixing study is not used in the process of detecting an anti VIII
F If an Anti VIII is present, the mixture (patient- normal) presents the same coagulation time
APTT than the normal APTT
F In order to get a test more sensitive to the presence of LA, phospholipids must be
diluted.
F In the LA integrated kits the two DRVVT reagents included in the kit differ by their
phospholipids concentration
F In the LA integrated kits, the DRVVT results from reagent 1 and two must be as close as
possible (difference less than 8 secondes) to confirm the presence of LA
F In severe liver disease, it is preferable to report PT in seconds or percentage not in
INR
F In hemophilia the bleeding time is prolonged
F Lupus anticoagulant is a major cause of bleeding in females
F Lupus anticoagulant (LA) shortens the coagulation times
F In hemophilia A, the classification depends on the remaining level of F VIII
F Hemophilia inheritance is sex linked
F In case of Vit K deficiency or anti vit K drugs, the thrombin time is prolonged
F In liver disease, the PT and TT are prolonged; reptilase time normal
F Lupus anticoagulant screening is a part of the thrombosis risk evaluation
F

In VW disease, we have normal bleeding time and prolonged APTT

In hemophilia the level of factor VIII and factor VW is decreased

F LA (Lupus anticoagulant) detection tests are more sensitive when the level of phospholipids
used are decrease
F Antithrombin III is only active on thrombin

Page 10 of 10