A 66-year-old male patient with amyloidosis was admitted to the hospital with severe gastrointestinal bleeding. Admission laboratory data includes: Hgb 10 g/dL Hct 0.32 Platelet count: Adequate PT 45 sec APTT 95 sec Fibrinogen 400mg/dL Thrombin Time 5 sec PT 1:1 mix 13 sec APTT 1:1 mix 30 sec (4-12 sec) Rusell’s Viper venom time 55 sec (14-20 sec) What test result indicates factor deficiency and not the presence of circulating anticoagulant?

A 66-year-old male patient with amyloidosis was admitted to the hospital with severe gastrointestinal bleeding. Admission laboratory data includes: Hgb 10 g/dL Hct 0.32 Platelet count: Adequate PT 45 sec APTT 95 sec Fibrinogen 400mg/dL Thrombin Time 5 sec PT 1:1 mix 13 sec APTT 1:1 mix 30 sec (4-12 sec) Rusell’s Viper venom time 55 sec (14-20 sec) What test result indicates factor deficiency and not the presence of circulating anticoagulant?

Cardiopulmonary Anatomy & Physiology

7th Edition

ISBN:9781337794909

Author:Des Jardins, Terry.

Publisher:Des Jardins, Terry.

Chapter15: Hemodynamic Measurements

Section: Chapter Questions

Problem 9RQ

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A 66-year-old male patient with amyloidosis was admitted to the hospital with severe gastrointestinal bleeding. Admission laboratory data includes:             Hgb     10 g/dL             Hct      0.32              Platelet count: Adequate          PT     45 sec          APTT         95 sec             Fibrinogen       400mg/dL             Thrombin Time           5 sec            PT 1:1 mix       13 sec             APTT 1:1 mix 30 sec (4-12 sec)            Rusell’s Viper venom time 55 sec (14-20 sec) What additional test should be done that would help in the diagnosis? Why both PT and APTT test are prolonged?
A 66-year-old male patient with amyloidosis was admitted to the hospital with severe gastrointestinal bleeding. Admission laboratory data includes:             Hgb      10 g/dL             Hct       0.32             Platelet count: Adequate          PT     45 sec          APTT 95 sec             Fibrinogen       400mg/dL             Thrombin Time           5 sec             PT 1:1 mix       13 sec              APTT 1:1 mix 30 sec (4-12 sec)             Rusell’s Viper venom time 55 sec (14-20 sec) Questions: Why both PT and APTT test are prolonged? What additional test should be done that would help in the diagnosis?
A 66-year-old woman was admitted to the emergency department with hemorrhage into the right arm and right breast. No previous history of bleeding or medication was indicated. Lab. Data upon admission were as follows: PT    12 sec APTT 58 sec Fibrinogen: APTT (1:1) mix    40 sec dRVVT 21 sec     N.V. <25 sec PNP (PNP vs saline): 58sec/59sec      N.V. PNP vs saline <5 sec Prolonged incubation of Patient’s plasma with Normal pooled plasma at 37 degrees Celsius for 1 hour and 2 hours was done and the result indicates prolong APTT overtime but with correction if done in more than 2 hours incubation. Question: What material is used to perform the 1:1 Ratio mixing study? What is the reason why the dRVVT is part of the lab request? What is the possible cause of the patient’s bleeding tendency? Explain your answer.
A 66-year-old woman was admitted to the emergency department with hemorrhage into the right arm and right breast. No previous history of bleeding or medication was indicated. Lab. Data upon admission were as follows: PT 12 sec APTT 58 sec Fibrinogen: APTT (1:1) mix 40 sec dRVVT 21 sec N.V. <25 sec PNP (PNP vs saline): 58sec/59sec N.V. PNP vs saline <5 sec Prolonged incubation of Patient’s plasma with Normal pooled plasma at 37 degrees Celsius for 1 hour and 2 hours was done and the result indicates prolong APTT overtime but with correction if done in more than 2 hours incubation. QUESTION What is the reason why the dRVVT is part of the lab request? What material is used to perform the 1:1 Ratio mixing study?
A 66-year-old woman was admitted to the emergency department with hemorrhage into the right arm and right breast. No previous history of bleeding or medication was indicated. Lab. Data upon admission were as follows: PT 12 sec APTT 58 sec Fibrinogen: APTT (1:1) mix 40 sec dRVVT 21 sec N.V. <25 sec PNP (PNP vs saline): 58sec/59sec N.V. PNP vs saline <5 sec Prolonged incubation of Patient’s plasma with Normal pooled plasma at 37 degrees Celsius for 1 hour and 2 hours was done and the result indicates prolong APTT overtime but with correction if done in more than 2 hours incubation. Question: What is the possible cause of the patient’s bleeding tendency? Explain your answer. Can you rule out the possibility of a clotting factor deficiency? Why? What additional test will you recommend to come-up with the final diagnosis? Why?
A 12-weeks pregnant woman complains of inability to focus, fatigue, and shortness of breath. On a physical examination, she looks pale and weak. Laboratory results are as follows: Reticulocyte count: 1%, Hematocrit: 27%; Hemoglobin: 6.5 g/dL; MCV: 105 fL, MCHC: 32%. Does this patient need a transfusion? Justify
An 80-year-old man is seen for an annual physical examination. He complains of shortness of breath on exertion and is often tired. His stool is black. Laboratory data are: Hemoglobin: 8.2 g/dL Hematocrit: 30% White cell count: 4.2 × 109/L White cell differential: Neutrophils: 60% Lymphocytes: 31% Monocytes: 7% Eosinophils: 2% Basophils: 0% Red cell count: 4.0 × 1012/L RDW: 20% Platelet count: 400 × 109/L Reticulocyte count: 1.2% Stool occult blood: Positive Critical Thinking Questions 1. What is the most probable type of anemia seen in this patient? 2. What is the cause of the anemia seen in this patient?
A 69-year-old woman presents with crushing substernal chest pain and nausea. Laboratory studies show elevated serum levels of cardiac proteins (CK-MB = 8.5 ng/mL; troponin-I = 3.2 ng/mL). A diagnosis of myocardial infarction is confirmed by ECG. Despite treatment, the patient becomes hypotensive and resuscitation attempts are unsuccessful. A cross section of the patient's right coronary artery at autopsy is shown in the image. Which of the following pathologic changes are evident in this autopsy specimen? (A) Arteritis and atherosclerosis (B) Atherosclerosis and thrombosis (C) Microaneurysm and canalization (D) Thrombosis and calcification (E) Vasodilation and arteritis
A 12-weeks pregnant woman complains of inability to focus, fatigue, and shortness of breath. On a physical examination, she looks pale and weak. Laboratory results are as follows: Reticulocyte count: 1%, Hematocrit: 27%; Hemoglobin: 6.5 g/dL; MCV: 105 fL, MCHC: 32%. If the patient's transfusion reactions history suggests anaphylactic reactions, which blood component should be given? Justify your answer.
Which ONE of the following full blood counts is most likely in a patient presenting with chronic myeloid leukaemia? Select one: A.Hb 30 g/L; WBC 60 × 109/L; platelets 500 × 109/L B.Hb 160 g/L; WBC 160 × 109/L; platelets 500 × 109/L C.Hb 90 g/L; WBC 60 × 109/L; platelets 400 × 109/L D.Hb 60 g/L; WBC 12 × 109/L; platelets 50 × 109/L
Which lab values are abnormal? Ca: 8.4 mg/dL Platelets: 123 mcL K: 3.7 mEq/L BUN: 28 mg/dL WBC: 14.8 mcL Na: 140 mEq/L
A 38-year-old white woman was treated in the emergency department for severe lacerations and abdominal injuries sustained in an automobile accident. She was admitted to the hospital for observation and further evaluation. On admission, a complete blood count (CBC), urinalysis, and radiograph series were ordered. Her CBC results were as follows: Hemoglobin 10.5 g/dL Hct 34% RBC 3.8 × 1012/L WBC 12.0 × 109 /L The RBC indices were as follows: MCV 89.6 fL MCH 27.6 pg MCHC 31 g/dL The peripheral blood smear showed essentially normal RBC morphology and platelet distribution. Forty-eight hours after admission, a stat repeat CBC was ordered. The results were as follows: Hemoglobin 8.0 g/dL Hct 26% RBC 2.9 × 1012/L WBC 15.5 × 109 /L The RBC indices were all within their normal ranges. A peripheral blood smear showed normal RBC morphology, although some polychromatophilia was noted. The distribution of platelets had increased. A follow-up platelet count was 0.60 × 1012/L. Subsequently,…