Kassala University

Faculty of Medicine & Health Sciences

Medical Laboratory Sciences Program
Hematology and Immunohematology Final Exam FourthYear Semester Seven
Date 27 /3/2018 Time 2 Hours
Name: Index No:

Section A
Interpret the data for the following patients by identifying the platelet disorder
(1) Khadiga was 54-years old, suffering from carcinoma of lung ecchymoses and post surgical
oozing from operative site.
WBC: 11 x109 HB : 89g/L Platelets count :35 x109
PT (s): 18.5 APTT(s): 63 Thrombin Time(s): 30
Fibrinogen :105mg/dl D.Dimer < 1.0 ug/ml Bleeding Time:13.0min
Miscellaneous test: No specific finding.
Interpretation:-
(2) Khalid was 7-years old, suffering from bleeding following removal tonsils, family has
history of bleeding disorder.
WBC: 14.3x109 Hb : 105g/L Platelets count :165 x109
PT (s): 12.1 APTT(s): 41 Thrombin Time(s): 18
Fibrinogen :257mg/dl Bleeding Time:15.5min Factor VIIIassay: 45% Platelets
aggregation studies: Abnormal with ristocetin Miscellaneous test: No specific finding
Interpretation:-
(3) Fatima was 5-years old, suffering from multiple petechiae and purpura. She had the
measles
two weeks ago
WBC: 8.8x109 HB : 125g/L Platelets count :24x109
PT (s): 11.7 APTT(s): 28 Thrombin Time(s): 15
Fibrinogen :315mg/dl D.Dimer > 0.5 Bleeding Time:18.0min
Miscellaneous test: Increased megakaryocytes in bone marrow
Interpretation:-
Section B
(1) Identify the most probable factor deficiency on the following laboratory result
Key
N: normal AB: abnormal C: corrected
NC: not corrected n/a :not applicable
Laboratory Test Patient Patient Patient Patient Patient Patient
A B C D E F
PT N N AB AB AB AB
APTT AB AB N AB AB AB
Adsorbed plasma PT n\a n\a NC NC C NC
Aged Serum PT n\a n\a C NC NC C
Adsorbed plasma APTT C NC n/a NC C NC
Aged Serum PTT NC C n/a NC NC C
Interpretation

1
 (2) Case problem
Laboratory Test patient
Mohammed was 9- month –old , was seen in
PT 11.2
emergency department with ecchymoses following
APTT 90
fall from chair .his maternal grandfather has
Bleeding Time 5.0
bleeding episode .no other history of bleeding was
Platelet count 263
noted .the initial work up revealed the following
result:-

a) Identify the coagulation factors that may be deficient?

b) Based on the clinical history which deficiencies identified in part A are un likely??
c) Based on the following mixed study , identify the most factor deficiency?
Laboratory Test Patient+ aged serum Patient + adsorped plasma
APTT 35 87

d) Dose the history support the mode of inheritance of this deficiency ??

Section C
Write short noteon the following:
1. Laboratory test that are used to evaluate qualitative platelet disorder
2. Interaction of coagulation and fibrinolytic system
3. Laboratory diagnosis of lupus anticoagulant
4. Causes of primarily acquired disorders
5. Cause of thrombosis
6. Principle of coagulation automation
7. How to investigate patient with Thrombotic Tendency
8. Variations in vWF Activity in Health and Disease
9-Different between DIC and primary fibernolysis
10-How to investigate patient with bleeding disorder
Section D
(1) Fill the gap with suitable letter coagulation problem with the coagulation test.each
answer may be used only once
A- Factor 1 deficiency B- Factor XIII C- Von Willebrand disease
D- Hemophilia A E. Prekarllrein deficiency F- Factor inhibitors

1- abnormal urea solubility test

2- correction of prolonged APTT when the Incubation time is increased or kaolin
is added
3- prolonged thrombin time
2
4- inadequate correction of prolonged PT or PTT when patient plasma is mixed
with normal plasma
5- normal platelet aggregation with all Reagent except ristocetin
Section E

(2) Define the following

1. Ecchymosis.
2. Zymogens
3. Ehlers-Danlos syndrome:
4. Organelle zone
5. Thrombophilia.
6. RIPC
7. Hyperhomocysteinemia
8. Owren disease,
9. PF3
10. Dysfibernogemia