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Questions and Answers for BIOL135 - Diagnosis in Biomedical Science
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Questions and Answers for BIOL135 - Diagnosis in Biomedical Science
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BIOL 135 Diagnosis in Biomedical Science Short answer questions1
, Case A
Background
Mr Oh, a 57 year old man, has presented to his GP with a complaint of ease of bruising.
He reports that he feels otherwise fine but for the last year or so he’s begun to notice that
he bruises even following a quite modest bump. He wouldn’t have bothered coming to
the GP but he and his wife returned from a short skiing trip over Easter during which he
became heavily bruised. He comments that he’d not skied for 10 years and is a bit fatter
now, so he fell a few times, but he became covered in bruises, many of which are still
visible. He’s a regular at his local pub and one of the bar‐staff, who is studying Diagnosis in
Biomedical Science, recommended that he go along to his GP.
The GP refers him to a haematologist who orders some analyses with the following
results;
His PT is 19 seconds (reference = 12 ‐ 20)
His aPTT is 52 seconds (reference = 21 ‐ 34)
His CBC reveals a normal platelet count but some oval RBCs are present.
Questions
1. What can you conclude from these analyses? Maximum 100 words (12 marks)
His PT is within the reference range, not prolonged. This tells us that there’s not a
problem in the extrinsic pathways or the final part of the final common pathway in the
coagulation cascade. Eliminates a problem with tissue factors, factors VII, II
(prothrombin), V, X and fibrinogen. His aPTT is above the reference range, prolonged.
Indicated a problem in the intrinsic pathway and common pathway. The problem could be
found with Factors VII, IX, XI, XII, V and X. Also, with the factors prekallinkrein, kininogen
and fibrinogen.
2. List three possible reasons for his ease of bruising. Answer using bullet points. (3
marks)
Haemophilia A
Von Willebrand disease
Vitamin K deficiencies
3. Describe what tests you would undertake to decide what the actual reason is for his
ease of bruising? Maximum 150 words (15 marks)
Mixing studies are used to determine where the problem is in the coagulation cascade.
The aPTT shows that there’s a possible problem in the intrinsic pathway or common
pathway. The mixing study involves taking a sample of test plasma and combining with
serum, barium sulphate absorbed plasma or normal blood. After these have been mixed
perform another aPTT and see if it normalises or stays prolonged. The normal plasma
contributes a significant concentration of clotting factors to correct for a factor
deficiency. If aPTT is still prolonged after mixing with normal blood the sample could
contain an inhibitor. If mixing with barium sulphate absorbed plasma gives a prolonged
2
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