MCQ Hematology 13

A concerned 36-year old woman is referred by an oncologist for evaluation of a prolonged prothrombin time and aPTT prior to a lymph node biopsy. The patient has had mild transient lymphadenopathy, fatigue, and intermittent low-grade fevers; she denies any bleeding symptoms. Medical history reveals that she has had mild thrombocytopenia and a positive Coombs’ test in the past. She also has a history of low B12 levels for which she receives replacement therapy. Her prothrombin time is 16.2 sec (normal 12.1-14.6) and her aPTT is 48 sec (normal 24.5-34.5); the prothrombin time is 14.6 sec with a 1:1 mix with normal plasma, and the aPTT is 36.8 sec with an immediate 1:1 mixing study that increases by 1 sec after 60 minutes at 37C. Her platelet count is 105,000/l. What test(s) should be performed next?

1. von Willebrand factor activity and antigen

2. Factor V assay

3. DIC evaluation including fibrinogen and factor V

4. Platelet antibodies

5. E. Anticardiolipin antibodies and lupus anticoagulant assay

Category: Hematology MCQs