PANGMALAKASANG REVIEW NI SIR JED

HEMATOLOGY II
PREPARED BY: Louisse Nicole Manliclic, RMT
100. Which of the following is not included in primary
hemostasis?
A. Vasoconstriction
B. Platelet aggregation
C. Platelet adhesion
D. Coagulation system

**Rationale - Rodak’s

104. Anticoagulant property of blood vessel that activates

fibrinolysis

A. Prostacyclin
B. Nitric oxide
C. Tissue Plasminogen Activator (TPA)
D. Tissue Factor Pathway Inhibitor (TFPI)
101. Secondary hemostasis includes
A. Vasoconstriction **Ratione - Rodak’s
B. Platelet aggregation Tissue Plasminogen Activator (TPA) - It converts plasminogen
C. Platelet adhesion to plasmin that will degrade the fibrin products.
D. Coagulation system Prostacyclin, Nitric oxide, and TFPI = anticoagulant properties
Prostacyclin = inhibits platelet activation
102. Which of the following is the inner layer of the blood Nitric oxide = vasodilation
vessel? TFPI = controls the activation of extrinsic pathway
A. Vascular intima
B. Vascular intermedia 105. The recommended type of micrsocopy for the
C. Vascular adventitia performance of manual platelet count is
D. Subendothelium lining
A. Dark-field
**Rationale - Rodak’s B. Light
 Vascular intima - inner layer C. Phase contrast
 Vascular intermedia - middle layer D. Electron
 Vascular adventitia - outer layer
**Rationale - Ciulla
According to Brecher and Conkrite, phase contrast
microscope is the reference method for manual platelet
count. Light microscope may be used. However, visialization
of platelets may be difficult.

106. Largest cell in the bone marrow that contains multiple

chromosome copies
A. Megakaryoblast
103. When the blood vessel was damaged, which of the B. Promegakaryocte
following procoagulant properties of endothelium induces C. Megakaryocyte
vasocontriction? D. Platelets

A. Smooth muscle cells of arteries and arterioles **Rationale - Rodak’s and Turgeon
B. Subendothelial collagen Megakaryoblast → Promegakaryocyte → Megakaryocyte →
C. Fibroblasts Platelets
D. Elastic fibers Endomitosis! :)

**Rationale - Rodak’s 107. Which megakaryocyte progenitor undergoes normal

mitosis?

I. BFU-Meg
II. CFU-Meg

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 PANGMALAKASANG REVIEW NI SIR JED
HEMATOLOGY II
PREPARED BY: Louisse Nicole Manliclic, RMT
III. LD-CFU-Meg A. 500 - 1000
B. 1000 - 1500
A. I and II C. 2000 - 4000
B. II and III D. 6000 - 8000
C. I and III
D. All of the above **Rationale - Rodak’s
1 Megakaryocyte = 2000 - 4000 platelets
**Rationale - Rodak’s
BFU-Meg and CFU-Meg = diploid and undergoes normal 111. What is the reference range of platelet count?
mitosis in order to maintain viable population of platelets
LD-CFU-Meg = start of endomitosis or mitosis without cell A. 50 - 100 × 109/L
division B. 20 - 200 × 109/L
These progenitors cannot be morphologically differentiated C. 100 - 150 × 109/L
in a wright stained smear and resembles lymphocytes D. 150 - 450 × 109/L

108. Platelet shedding is also known as **Rationale - Rodak’s

A. Thrombopoiesis
B. Thrombocytopoiesis
C. Thrombasthenia
D. Megkaryocytopoeisis

**Rationale - Rodak’s
Thrombocytopoeisis - It is also known as platelet shedding

109. Demarcation system is present in which of the following

precursors?

I. MK-I
II. MK-II 112. Platelet turn over
III. MK-III A. 2 - 3 days
B. 4 - 5 days
A. I and II C. 6 - 7 days
B. I and III D. 7 - 8 days
C. II and III
D. AOTA **Rationale - Rodak’s
Turn-over = life span
**Rationale - Rodak’s RBC = 120 days
WBC = varies per cell
Platelets = 7 - 8 days

113. Alpha granules are found on the platelet in:

A. Sol gel zone
B. Organelle zone
C. Peripheral zone
D. Platelet membrane

**Rationale - Brown
Organelle zone Mitochondria
Alpha granules
Dense granules
Lysosome
Sol gel zone Microfilament
Microtubules
Peripheral zone Glycocalyx
What is Demarcation System? Plasma membrane

110. How many platelets can be shed from a single

megakaryocyte?

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 PANGMALAKASANG REVIEW NI SIR JED
HEMATOLOGY II
PREPARED BY: Louisse Nicole Manliclic, RMT
B. Platelets
1. Glycocalyx C. Both
2. Plasma membrane D. Neither
3. Microfilaments
4. Microtubules
5. Alpha granules
6. Dense granules
**Rationale - Rodak’s
7. Lysosomal granules
8. Mitochondria
9. Dense tubular system
10. Surface connecting
system

114. Alpha granules consist of the following except:

A. vWF
B. Plasminogen
C. Protein C inhibitor Weibel-Palade Bodies = an organelle located in the
D. ADP endothelial cells that serve as storage granule for vWF
vWF is not produced by the liver
**Rationale - Rodak’s
117. A patient came forth in the laboratory complaining of
bruising with no known physical cause and moderate
bleeding. CBC shows large platelets (20μm in diameter) with
coarse granulation and vacoules. Bleeding time is prolonged,
however, clot retraction is normal. Platelet aggregation
shows normal with ADP, epinephrine, and collagen but
abnormal in ristocetin. This is diagnostic of what condition?

A. Glanzmann’s thrombasthenia
B. vonWillebrand disease
C. Bernard Soulier Syndrome
D. Platelet secretion defect

**Rationale - Brown
Platelet Adhesion Disorders
 Von Willebrand Disorder = absence of VWF
 Bernard Soulier Syndrome = absence of GP IB/IX/V

Platelet Aggregation Disorder

 Glanzmann’s Thrombasthenia = absence of GP IIb-IIIa
Dense Granules - Ca, Mg, Serotonin, ATP, ADP complex
Lysosomes  Abnormal aggregation with ADP, collagen, and
epinephrine; Normal aggregation in ristocetin
115. Upon activation, the platelet change shape into
A. Biconcave
B. Cylindrical
C. Round with pseudopods
D. Biconvex

**Rationale - Rodak’s
118. Storage pool disorder characterized with absence alpha-
granules leading to moderate thrombocytopenia, large
platelets, lifelong bleeding tendencies, and fibrosis of the
marrow

A. Hermansky-Pudlak Syndrome
B. Gray platetelet syndrome
C. Chediak-Higashi Syndrome
116. Von Willebrand Factor is stored in D. Wiskott-Aldrich Syndrome
A. Weibel-Palade Bodies

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 PANGMALAKASANG REVIEW NI SIR JED
HEMATOLOGY II
PREPARED BY: Louisse Nicole Manliclic, RMT
**Rationale - Rodak’s and Ciulla B. II, III, and IV
C. I, III, and IV
D. AOTA

Hermansky-Pudlak
Syndrome
Chediak-Higashi Syndrome
Wiskott-Aldrich Syndrome
Gray Platelet Syndrome
Storage pool disorder = ADP deficiency
**Rationale - Brown
Bleeding Time = prolonged
 Platelet Function Disorder
 vWF disease
 Low Platelet Count (30,000 - 50,000/μL)
Tyrosinase positive  Drug Therapy (aspirin, anti-inflammatory, some
occultaneous albinism antibiotics) - most common cause of prolonged bleeding
 Swiss cheese platelet time
Partial occultaneous albinism  SEVERE coagulation factor deficiency
Small platelets,
thrombocytopenia, 122. A 2-year-old male patient was subjected into the
decreased amount of alpha laboratory with abrupt onset of bruising, petechiae, and
and dense granules occasional epistaxis 2 weeks after he has been vaccinated
Large platelet appearing gray with MMR. CBC parameters are normal and as well as
in Wright stain physical examination (except the bleeding). This is suggestive
of

119. Aspirin blocks the synthesis of A. Drug induced thrombocytopenia

A. Collagen B. Acute ITP
B. ADP C. Purpura fulminans
C. Thromboxane A2 D. TTP
D. Ionized Calcium
**Rationale - Rodak’s
**Rationale - Rodak’s Drug Induced  Drug dependent
Aspirin blocks the synthesis of thromboxane A2 by Thrombocytopenia antibodies
irreversibly blocking cyclooxygenase  Drug induced
autoantibodies
120. Vascular disorder characterized by a generalized  Immune complex
vasculitis involving the small vessels of the skin, GI tract, induced
kidneys, joints, and rarely the lungs and CNS. thrombocytopenia
A. Senile Purpura Pupura fulminans Clinical manifestation of
B. Henoch-Schonlein Purpura acute sepsis from bacterial
C. Ehlers-Danlos Syndrome infection
D. Scurvy  N. meningitidis
 S. pneumoniae
**Rationale - Turgeon  S. aureus and H.
Senile Purpura Thinning of the skin among influenze (rare)
elderly people -Large and irregular areas of
Ehlers-Danlos Syndrome Abnormality in collagen blue-black cutaneous
synthesis (Type III) which is bleeding that progresses to
abundant in arterial wall and necrosis
intestines Thrombotic Disorder that is characterized
-Hyperelastic skin and joints Thrombocytopenic Purpura with dysfunctional ADAMTS-
Scurvy Vitamin C deficiency will 13
result to weakened collagen --explain--
strands Laboratory Findings
 Microangipathic
121. Bleeding Test is prolonged in the following situations Hemolytic Anemia
I. Mild coagulation factor deficiency  Thrombocytopenia
II. vWF Disease  Neurologic
III. Low Platelet Count abnormalities
IV. Vascular Disorder  Fever and renal
dysfunction
A. I, II, and III
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 PANGMALAKASANG REVIEW NI SIR JED
HEMATOLOGY II
PREPARED BY: Louisse Nicole Manliclic, RMT
123. Hallmark signs of Hemolytic Uremic Syndrome
A. No history of bleeding
I. Renal dysfunction B. Common factor deficiency
II. Mild thrombocytopenia C. Decreased risk of forming blood clots
III. Mild anemia D. Frequent nosebleeds

A. I and II **Rationale - Turgeon

B. II and III Factor XII/Hageman Factor = It is suspected when APTT and
C. I and III PT is prolonged without history of bleeding
D. AOTA
128. What are the possible findings in Hemophilia A, B, and C?
**Rationale - Rodak’s
In order to be differentiated with TTP, HUS has the following I. Fibrinogen - Increased
hallmarks II. APTT - Decreased
 Renal Dysfunction III. Platelet aggregation - Normal
 Mild thrombocytopenia IV. Bleeding Time - Normal
 Mild anemia
 Occurrence in children A. I and II
B. II and III
124. Coagulation Factor I is also known as C. III and IV
D. AOTA
A. Fibrinogen
B. Prothrombin **Rationale - Turgeon
C. Hageman Factor
D. Fibrin Stabilizing Factor

**Rationale - Rodak’s

Factor I Fibrinogen
Factor II Prothrombin
Factor XII Hageman Factor
Factor XIII Fibrin Stabilizing Factor

125. Which of the following belongs to the prothrombin

group
129. The expected screening test results for a patient with a
fibrin stabilizing factor deficiency are
A. Factor XI
B. Factor V
A. Normal PT and APTT
C. Factor IX
B. Prolonged PT and APTT
D. Factor I
C. Prolonged APTT
D. Prolonged PT
**Rationale - Ciulla
Contact Group Fibrinogen Group Prothrombin
**Rationale - Turgeon and Ciulla
Group
Prekallikrein, Factors I, V, VIII, Factors II, VII, IX, X
HMWK, Factor IX XIII
and XII
5M Urea Test
126. Owren’s disease is deficient of what coagulation factor?  Soluble clot = deficient
A. Factor II  Insoluble clot = sufficient
B. Factor IV
C. Factor V 130. MIXING STUDIES
D. Factor X PT = N
APTT = Abnormal
**Rationale - Turgeon
Owren’s disease/Parahaemophilia = Factor V Deficiency Fresh Plasma = corrected
Aged Plasma = corrected
127. Unique characteristic of Factor XII deficiency Adsorbed Plasma = not corrected
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 PANGMALAKASANG REVIEW NI SIR JED
HEMATOLOGY II
PREPARED BY: Louisse Nicole Manliclic, RMT
Aged Serum = corrected APTT = Abnormal
The missing coagulation factor is
A. Factor X Problem = COMMON PATHWAY (X,V, II, I)
B. Factor IX
C. Factor VIII Fresh Plasma = Corrected
D. Factor XII Adsorbed Plasma = Corrected
Aged Plasma = Not Corrected (does NOT contain Factor V
**Rationale and VIII)
Technique in Substitution Studies Aged Serum = Not corrected (Factors I, II, V, VIII, XIII)

Fresh plasma = all coagulation factors is present 132. What is the coagulation factor deficient in the
Aged plasma = does NOT contain Factors V and VIII following results:
Aged Serum = does NOT contain Factors I, V, VIII, PT = Normal
XIII, and II APTT = Abnormal
Adsorbed Plasma = does NOT contain Factors II, VII,
IX, X Fresh Plasma = corrected
Aged Plasma = not corrected
PT = Normal Aged Serum = not corrected
APTT = Increased (intrinsic pathway = XII, XI, IX, VIII) Adsorbed Plasma = corrected

Fresh Plasma = corrected A. Factor VIII

Aged Plasma = corrected B. Factor IX
Adsorbed Plasma = not corrected (no Factor II, VII, IX, and X) C. Factor XI
Aged Serum = corrected D. Factor XII

1. Consider first which of the following tests is **Rationale

abnormal PT = Normal
(PT only = Extrinsic; APTT = Intrinsic; APTT and PT = APTT = Increased (intrinsic pathway = XII, XI, IX, VIII)
Common)
2. Check which of the following fresh plasma, aged Fresh Plasma = corrected
plasma, aged serum, and adsorbed plasma is not Aged Plasma = not corrected (no V and VIII)
corrected. It means that, the factor missing is also not Aged Serum = not corrected (no I, V, VIII, XIII, and II)
in the said correcting factors. Adsorbed Plasma = corrected
3. Cross out all the following factors that are not
involved on the pathway that is abnormally increased 133. Which of the following results maybe suggestive of
Check which of the following coagulation factor is Factor II deficiency
consistently not corrected
I. Normal APTT; Abnormal PT
131. MIXING STUDIES II. Aged Plasma: corrected
III. Abnormal PT and APTT
PT = Abnormal IV. Adsorbed Plasma: not corrected
APTT = Abnormal
A. I, II, and III
Fresh Plasma = Corrected B. II, III, and IV
Adsorbed Plasma = Corrected C. I, III, and IV
Aged Plasma = Not Corrected D. Results are not suggestive of Factor II deficiency
Aged Serum = Not corrected
**Rationale
The coagulation factor deficient is Factor II Deficiency
A. Factor II  Common Pathway = Abnormal APTT and PT
B. Factor V  Mixing substitutes
C. Factor X  Fresh plasma (corrected) = all coagulation
D. Factor VIII factors is present
 Aged plasma (corrected) = does NOT contain
**Rationale Factors V and VIII
PT = Abnormal
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 PANGMALAKASANG REVIEW NI SIR JED
HEMATOLOGY II
PREPARED BY: Louisse Nicole Manliclic, RMT
 Aged Serum (not corrected) = does NOT  Vascular constrictive response to injury
contain Factors I, V, VIII, XIII, and II  Stabilization of fibrin clot network
 Adsorbed Plasma (not corrected) = does NOT  Ability to debulk the clot
contain Factors II, VII, IX, X Methodology and Expected Result (Brown)
 Whole blood incubated at 37 deg C and observed in 1, 2,
4, and 24 hours
134. Factor X Deficiency results are of the following except
 Normal = 2-4 hrs
 Poor = 4-24 hrs
I. Prolonged PT; Normal APTT
Conditions Associated/Assessed (Brown)
II. Prolonged APTT; Normal PT
 Glanzmann Thrombasthenia
III. Prolonged APTT and PT
 Dysfibrinogenemia
IV. Adsorbed Plasma: not corrected
 Paraproteinemias
 DIC
A. I and II
B. II and III
137. What is the specimen required for Prothrombin Time?
C. III and IV
A. Citrated Platelet Rich Plasma
D. NOTA
B. Citrated Platelet Poor Plasma
C. Citrated Fresh Plasma
**Rationale
D. Citrated Adsrobed Plasma
Factor II Deficiency
 Common Pathway = Abnormal APTT and PT (I, II, V, and
**Rationale - Steininger
X)
 Mixing substitutes Prothrombin Time = used for screening coagulation factor
deficiencies
 Fresh plasma (corrected) = all coagulation
factors is present Specimen Requirements = citrated poor plasma
 Aged plasma (corrected) = does NOT contain Reagents
Factors V and VIII  Thromboplastin/CaCl2
 Aged Serum (corrected) = does NOT contain  Controls
Factors I, V, VIII, XIII, and II Temperature = 37 degC
 Adsorbed Plasma (not corrected) = does NOT Reference Range
contain Factors II, VII, IX, X  Photo-optical method = 10 - 12 seconds
 Manual method = 12 - 14 seconds
135. The platelet defect associated with increased
paraprotein is: 138. Which test result would be normal in a patient with
A. Hypercoagulability, owing to antibody binding and dysfibrinogenemia?
membrane activation A. Thrombin time
B. Hypercoagulability. because the increased proteins bring B. APTT
platelets closer together, which leads to inappropriate C. PT
aggregation D. Fibrinogen level
C. Impaired membrane activation, owing to protein coating
D. Impaired aggregation, because of the hyperviscous plasma **Rationale -
Dysfibrinogenemia - fibrinogen is malfunctional and there’s
**Rationale - Rodak’s no effect in fibrinogen level
Myeloma proteins inhibits platelet function (aggregation,
secretion, and procoagulant activity) due to paraproteins 139. Reversal of heparin overdose can be achieved through
coating the platelet membrane. administration of
-Paraproteins also inhibit assembly of clotting factors on the A. Protamine Sulfate
platelet surface B. Antithrombin
C. Warfarin
136. Clot retraction defect is most likely due to D. Vitamin K
A. Insufficient ADP in dense bodies
B. Absence of von Willebrand factor **Rationale - Rodak’s
C. Lack of platelet receptor glycoprotein Ib Protamine sulfate (Protamine chloride in Europe)
D. Lack of platelet receptor glycoprotein IIb/IIIa  Salmon sperm
 Neutralizes 100 units of unfractionated heparin therapy
**Rationale - Brown, Steininger, and Ciulla per mg
Clot Retraction
Purpose (Steininger) 140. Lumiaggregation measures
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 PANGMALAKASANG REVIEW NI SIR JED
HEMATOLOGY II
PREPARED BY: Louisse Nicole Manliclic, RMT
I. Platelet aggregation ADAMTS-13
II. ATP release
III. Platelet adhesion
IV. Platelet glycoprotein Ib

A. I and II
B. II and III
C. III and IV
D. I, II, and IV
**Rationale - Rodak’s and Harr
Platelet lumiaggregometry
 Simultaneous measurement of platelet aggregation and
ATP release
 Measurement
 Platelet aggregation = impedance 144. What is the PT/INR therapeutic range for coumadin
 ATP release = luciferin-luciferase oxidation (level of therapy when a patient has a mechanical heart valve?
chemiluminiscence = ATP concentration)
A. 1 to 2
141. Which of the following is associated with multiple factor B. 2 to 3
deficiencies? C. 2.5 - 3.5
A. Dysfibrinogenemia D. Coumadin is not indicated in patient with mechanical
B. Inherited disorder of coagulation heart valve
C. Lupus anticoagulant
D. Severe liver disease **Rationale - Rodak’s and Ciulla

**Rationale - Rodak’s
Liver primarily makes up the coagulation factors (except
vWF). Thus, when the liver is damaged, its synthesis of
International Normalized Ratio (INR) = it is a means of
coagulation factors is heavily affected
standardizing the reporting of prothrombin times worldwide
142. Heparin works as an inhibitor to clotting by
A. Antagonizing vitamin K’s role in factor synthesis Patient PT (in seconds) ISI
INR = [ ]
B. Enhancing inhibitory effects of antithrombin Control PT (in seconds)
C. Chelation of calcium ions International Sensitivity Index (ISI) = It is a value determined
D. Prevents activation of prothrombin by the manufacturer of the thromboplastin reagent.

**Rationale - Ciulla and Rodak’s 145. Which of the following enzymatically degrades the
Heparin induces conformational change in antithrombin stabilized fibrin clot
leading to its enhancement to bind with activated coagulated A. Prothrombin
factors. B. Thrombin
C. Plasminogen
143. A 30 year old female is admitted to the hospital with D. Plasmin
neurologic symptoms. The following results are obtained
**Rationale - Ciulla and Steininger
Hemoglobin = 60 g/L
Hematocrit = 0.19 L/L
Platelet Count = 25 × 109/L
RBC morphology = schistocytes
ADAMTS-13 = markedly decreased

The most likely diagnosis is:

A. HUS
B. TTP
C. ITP
D. Von Willebrand disease

**Rationale - Rodak’s 146. It is the final stage of hemostatic activation in which

Thrombotic Thrombocytopenic Purpura = deficiency of there is an accelerating hydrolysis of fibrin to plasmin

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 PANGMALAKASANG REVIEW NI SIR JED
HEMATOLOGY II
PREPARED BY: Louisse Nicole Manliclic, RMT
A. Platelet aggregation
B. Platelet secretion Platelet count = markedly decreased
C. Platelet adhesion PT = prolonged
D. Fibrin hydrolysis APTT = prolonged
TT = Prolonged
**Rationale - Rodak’s Fibrinogen = decreased
Fibrinolysis - final stage of hemostatic activation in which it D-dimer = positive
degrades the clot to restore the normal blood flow. FDP = positive
Antithrombin = decreased
147. Which plasminogen activator is secreted by kidney cells? RBC morphology = schistocytes
A. Anti-plasmin
B. Streptokinase These laboratory results are consistent with
C. Urokinase A. Factor II deficiency
D. Anti-thrombin B. Heparin therapy
C. Primary fibrinogenolysis
D. DIC with secondary fibrinolysis

**Rationale - Turgeon and Ciulla

Disseminated Intravascular Coagulopathy (Laboratory
Results)
APTT, PT, and TT Prolonged
Fibrinogen May vary, but commonly
decreased
D-dimer Increased
148. Which is true about primary fibrinolysis?
Platelet count May vary but
thrombocytopenia is common
I. Platelet count: Normal
II. Protamine sulfatase test: Negative
III. FSP: Decreased
IV. Fibrinogen: Increased

A. I and II
B. II and III
C. II and IV Key feature = evaluation of circulating fibrin split products
D. III and IV
150. Magiging RMT ka ba?
**Rationale - Turgeon A. Yes
B. No
C. Maybe
D. YES NA YES

**Rationale - Louisse Nicole Manliclic, RMT

Magpahinga ka if gusto mo maging RMT. Natural lang ‘yon na
wala kang maalala, parang walang sense na yung binabasa
mo, napapagod at nasusuka ka na. Ibig sabihin non, kailangan
mo na magpahinga. Magiging okay din ang lahat at
mapapasayo lahat nang pinapalanganin mo sa takdang oras
Primary Fibrinolysis = It is associated with conditions
at panahon. :)
associated with gross activation of fibrinolytic mechanism
with subsequent fibrinogen and coagulation factor
Feel your rhythm and look forward to begin again if you feel
consumption
like you’re in the end. The truth is, no one can stop you from
 Trauma
doing better each and every day and your best is not the
 Surgery
same each day. All you have to do is to give yourself a break.
 Malignancy

149. A 25 year old obstetrical patient at 35 weeks gestation is

admitted through the emergency room. She has bleeding in
the genitourinary tract, and there are visible petechiae and
ecchymoses. The following laboratory results are obtained:
9