A 30-year-old woman is brought to casualty with fever and confusion. Hb 7.2 g/dL, platelets 18,000/µL, many schistocytes on the smear, LDH 1,450 U/L, creatinine 1.4 mg/dL, PT 13 s (control 12 s), aPTT 31 s (control 30 s) and fibrinogen 310 mg/dL. What is the next best step in management?

Urgent therapeutic plasma exchange

Transfusion of random donor platelets

A 4-day-old exclusively breastfed baby, delivered at home by a traditional birth attendant in rural Madhya Pradesh, is brought with oozing from the umbilical stump and blood in the stools. Platelets are 2,40,000/µL; PT and aPTT are both prolonged, and fibrinogen is normal. Which step at birth would most likely have prevented this?

Early initiation of breastfeeding

A 14-year-old boy with severe haemophilia A has received factor VIII concentrate on demand for years. He now has a knee bleed that does not settle despite usual doses. aPTT is 74 s (control 30 s); a 1:1 mix with normal plasma corrects it to 33 s at once, but after incubation at 37 °C for 2 hours the mix prolongs again to 62 s. Which test should be done next?

Bethesda assay for factor VIII inhibitor

Lupus anticoagulant by dilute Russell viper venom time

A 32-year-old woman who had two pregnancies and a transfusion after her second delivery receives two crossmatch-compatible red cell units for menorrhagia. Eight days later she returns with fatigue and yellow eyes. Hb has fallen from 10.2 to 7.9 g/dL, indirect bilirubin is 3.1 mg/dL, urine is clear and the direct antiglobulin test is now positive with IgG. The pre-transfusion antibody screen was negative. What is the most likely explanation?

Anamnestic alloantibody such as anti-Jka

New warm autoimmune haemolytic anaemia

ABO-incompatible unit given in error

Bacterial contamination of a red cell unit

Bleeding and coagulation disorders, transfusion

26 NEET-PG practice questions on Bleeding and coagulation disorders, transfusion, part of Pathology. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Hard
A 30-year-old woman is brought to casualty with fever and confusion. Hb 7.2 g/dL, platelets 18,000/µL, many schistocytes on the smear, LDH 1,450 U/L, creatinine 1.4 mg/dL, PT 13 s (control 12 s), aPTT 31 s (control 30 s) and fibrinogen 310 mg/dL. What is the next best step in management?
1. ALow-molecular-weight heparin
2. BUrgent therapeutic plasma exchange
3. CTransfusion of random donor platelets
4. DInfusion of cryoprecipitate
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Answer: B · Urgent therapeutic plasma exchange
Microangiopathic haemolysis with severe thrombocytopenia and normal PT, aPTT and fibrinogen points to thrombotic thrombocytopenic purpura rather than DIC, in which clotting factors and fibrinogen are consumed. TTP is caused by severe ADAMTS13 deficiency, usually from an autoantibody, so ultra-large von Willebrand factor multimers build platelet microthrombi. Plasma exchange removes the antibody and replaces the enzyme; it should start urgently, after drawing a sample for ADAMTS13 but without waiting for the result. Steroids, and caplacizumab where available, are added.
- A: Heparin has no role; the thrombi are platelet-rich and the patient is profoundly thrombocytopenic.
- C: Platelet transfusion is avoided in TTP unless bleeding is life-threatening, as it can feed microthrombi.
- D: Cryoprecipitate replaces fibrinogen, which is normal here.
Question 2 · Easy
A 4-day-old exclusively breastfed baby, delivered at home by a traditional birth attendant in rural Madhya Pradesh, is brought with oozing from the umbilical stump and blood in the stools. Platelets are 2,40,000/µL; PT and aPTT are both prolonged, and fibrinogen is normal. Which step at birth would most likely have prevented this?
1. ADelayed cord clamping
2. BEarly initiation of breastfeeding
3. CHepatitis B vaccine birth dose
4. DIntramuscular vitamin K
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Answer: D · Intramuscular vitamin K
Bleeding in a well baby in the first week with normal platelets and prolonged PT and aPTT is vitamin K deficiency bleeding of the newborn. Newborns have low vitamin K stores, little placental transfer, a sterile gut and breast milk poor in vitamin K, so factors II, VII, IX and X are low. A single intramuscular dose of vitamin K at birth prevents it, and home deliveries often miss it. Treatment is parenteral vitamin K, with fresh frozen plasma if bleeding is serious.
- A: Delayed cord clamping improves iron stores but does not supply vitamin K.
- B: Breastfeeding is beneficial but breast milk is low in vitamin K, a cause of this disorder.
- C: Hepatitis B vaccine prevents perinatal hepatitis B and has no effect on clotting factors.
Question 3 · Medium
During an induction programme at a district blood centre, the medical officer reviews storage of components. Consider four statements: 1. Red cells in CPDA-1 are stored at 2-6 °C and expire after 35 days. 2. Platelet concentrates are stored at 20-24 °C with continuous gentle agitation. 3. Cryoprecipitate is rich in fibrinogen, factor VIII, von Willebrand factor and factor XIII. 4. Platelet concentrates have a shelf life of 5 days. Which statements are correct?
1. A2 and 3 only
2. B1, 2 and 4 only
3. C1 and 4 only
4. D1, 2, 3 and 4
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Answer: D · 1, 2, 3 and 4
All four statements are correct. Red cells are kept at 2-6 °C to slow metabolism; CPDA-1 gives 35 days, and additive solutions such as SAGM extend this to 42 days. Platelets are kept at room temperature (20-24 °C) with agitation because cold makes them clump and be cleared quickly; the warm storage allows bacterial growth, which limits shelf life to 5 days and makes bacterial contamination the main infectious risk of platelets. Cryoprecipitate carries fibrinogen, factor VIII, vWF, factor XIII and fibronectin.
- A: Omits the CPDA-1 rule and the platelet shelf life, both correct.
- B: Omits the composition of cryoprecipitate, which is correct.
- C: Omits platelet storage temperature and cryoprecipitate content, both correct.
Question 4 · Hard
A 14-year-old boy with severe haemophilia A has received factor VIII concentrate on demand for years. He now has a knee bleed that does not settle despite usual doses. aPTT is 74 s (control 30 s); a 1:1 mix with normal plasma corrects it to 33 s at once, but after incubation at 37 °C for 2 hours the mix prolongs again to 62 s. Which test should be done next?
1. APlatelet aggregation studies
2. BFactor IX activity assay
3. CLupus anticoagulant by dilute Russell viper venom time
4. DBethesda assay for factor VIII inhibitor
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Answer: D · Bethesda assay for factor VIII inhibitor
Failure of factor VIII to control bleeding in a treated haemophiliac suggests an alloantibody (inhibitor) against factor VIII. These antibodies are time- and temperature-dependent, so the mix corrects at first but prolongs again after incubation at 37 °C, which is the clue here. The Bethesda assay measures the inhibitor titre in Bethesda units and guides treatment: high-titre inhibitors need bypassing agents such as recombinant factor VIIa or activated prothrombin complex concentrate, emicizumab prophylaxis and, later, immune tolerance induction. Inhibitors develop in a substantial minority of severe haemophilia A patients.
- A: Platelet function is not the issue in a factor VIII-deficient patient with an inhibitor pattern.
- B: Factor IX deficiency is haemophilia B; the patient's diagnosis is already known.
- C: Lupus anticoagulant usually fails to correct even on the immediate mix and does not cause bleeding.
Question 5 · Hard
A 32-year-old woman who had two pregnancies and a transfusion after her second delivery receives two crossmatch-compatible red cell units for menorrhagia. Eight days later she returns with fatigue and yellow eyes. Hb has fallen from 10.2 to 7.9 g/dL, indirect bilirubin is 3.1 mg/dL, urine is clear and the direct antiglobulin test is now positive with IgG. The pre-transfusion antibody screen was negative. What is the most likely explanation?
1. ANew warm autoimmune haemolytic anaemia
2. BABO-incompatible unit given in error
3. CBacterial contamination of a red cell unit
4. DAnamnestic alloantibody such as anti-Jka
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Answer: D · Anamnestic alloantibody such as anti-Jka
Falling haemoglobin, jaundice and a newly positive IgG DAT 3-14 days after transfusion is a delayed haemolytic transfusion reaction. She had been sensitised earlier by pregnancy and transfusion, but the antibody fell below detectable levels, so the screen was negative; re-exposure caused a rapid secondary (anamnestic) IgG response. Kidd antibodies such as anti-Jka are typical because they fade quickly. The new antibody is identified by elution and panel testing, recorded, and antigen-negative blood is given in future.
- A: The timing after transfusion and her sensitisation history point to an alloantibody, not autoimmunity.
- B: ABO incompatibility causes immediate intravascular haemolysis within minutes, not after a week.
- C: Bacterial contamination causes fever and shock during or soon after the transfusion.
Question 6 · Easy
An 8-year-old boy with beta-thalassaemia major receives his monthly red cell transfusion at a day-care centre in Kolkata. Forty minutes into the unit, his temperature rises from 37.0 to 38.4 °C with chills, but BP is normal, urine is clear and a post-transfusion DAT is negative. He has had similar episodes before. Which product should he receive in future to prevent this?
1. AGamma-irradiated red cells
2. BWashed red cells
3. CLeucoreduced red cells
4. DCMV-seronegative red cells
Answer and explanation in LearnFree account
Question 7 · Medium
A 55-year-old man with a lymphoma is receiving chemotherapy with fludarabine at a cancer centre in Thiruvananthapuram. Twelve days after a red cell transfusion, he develops fever, an erythematous rash, diarrhoea, raised liver enzymes and falling blood counts. How could this complication have been prevented?
1. AGamma irradiation of the units
2. BWashing the red cells before issue
3. CGiving antipyretic premedication
4. DChoosing CMV-seronegative donor units
Answer and explanation in LearnFree account
Question 8 · Medium
A 6-year-old girl has had gum bleeding and prolonged bleeding after minor cuts since infancy. Her parents are first cousins. Platelets are 2,80,000/µL with normal size on the smear; PT and aPTT are normal. Platelets fail to aggregate with ADP, collagen and adrenaline, but agglutinate normally with ristocetin. Which molecule is most likely deficient?
1. AGlycoprotein IIb/IIIa
2. BPlatelet dense granule contents
3. Cvon Willebrand factor
4. DGlycoprotein Ib-IX-V complex
Answer and explanation in LearnFree account
Question 9 · Easy
A 30-year-old woman has massive postpartum haemorrhage after a placental abruption in a district hospital. Her fibrinogen is 90 mg/dL and she continues to ooze from venepuncture sites. Which blood component gives the most fibrinogen per unit volume?
1. ACryoprecipitate
2. BRandom donor platelet concentrate
3. CFresh frozen plasma
4. DPacked red blood cells
Answer and explanation in LearnFree account
Question 10 · Medium
In a busy surgical ward in Lucknow, a 50-year-old man with blood group O RhD positive is accidentally transfused a unit meant for another patient. Ten minutes later he has fever, chills, pain in the loins, a burning feeling along the vein and BP 84/50 mmHg. What should the resident do first?
1. ASlow the rate and give IV paracetamol
2. BGive IV antihistamine and continue the unit
3. CStop the unit and run normal saline
4. DSend the bag for culture and continue slowly
Answer and explanation in LearnFree account
Question 11 · Hard
A 38-year-old woman with three previous pregnancies is receiving induction chemotherapy for AML. She is afebrile, with no splenomegaly, bleeding or DIC. Her count is 8,000/µL before and 11,000/µL one hour after a platelet dose of 3.4 x 10^11; body surface area is 1.7 m². The corrected count increment (CCI) = increment (per µL) x BSA (m²) / platelets given (x 10^11); a 1-hour CCI below 7,500 indicates a poor response. The same happened after the previous dose. What should she receive next?
1. AGamma-irradiated platelets
2. BPlatelets given over 4 hours
3. CHLA-matched platelets
4. DA doubled dose of pooled platelets
Answer and explanation in LearnFree account
Question 12 · Medium
A 28-year-old woman from Pune has had easy bruising and heavy periods for eight months. Platelets are 22,000/µL with large platelets on the smear; Hb and WBC are normal and she takes no drugs. A pathology resident lists four statements about her likely disease: 1. Her bone marrow will show normal or increased megakaryocytes. 2. Her autoantibodies are most often directed against platelet GpIIb/IIIa. 3. Her spleen is likely to be markedly enlarged. 4. Splenectomy helps because the spleen both destroys platelets and makes the antibody. Which statements are correct?
1. A1 and 4 only
2. B1, 2 and 4 only
3. C2, 3 and 4 only
4. D1 and 2 only
Answer and explanation in LearnFree account
Question 13 · Medium
A 60-year-old man with painless progressive jaundice, pale stools and itching has a mass in the head of the pancreas on CT. Before ERCP, his PT is 24 s (control 13 s) with a normal platelet count. After 10 mg of parenteral vitamin K, the PT is 14 s the next day. Why was his PT prolonged?
1. ALoss of hepatocyte synthetic capacity
2. BAn acquired inhibitor against factor VII
3. CPoor absorption of fat-soluble vitamin K
4. DConsumption of clotting factors in DIC
Answer and explanation in LearnFree account
Question 14 · Medium
A 34-year-old man with a crushed pelvis after a highway accident receives 12 units of red cells and 8 units of FFP over 2 hours in a trauma centre. He then develops tingling around the lips, muscle twitching and hypotension that does not respond to fluids, and the ECG shows a prolonged QT interval. Which derangement is most likely?
1. ALow ionised calcium from citrate
2. BMetabolic alkalosis from bicarbonate
3. CHigh potassium from stored red cells
4. DLow magnesium from dilution
Answer and explanation in LearnFree account
Question 15 · Medium
A 52-year-old woman with rheumatic heart disease and atrial fibrillation is started on warfarin in the cardiology OPD. Her INR rises within 2 days of starting the drug, well before its full antithrombotic effect is reached. Which vitamin K-dependent factor explains this early rise?
1. AFactor II
2. BFactor X
3. CFactor VII
4. DFactor IX
Answer and explanation in LearnFree account
Question 16 · Medium
A 22-year-old man bled for two days after a molar extraction at a dental college in Mysuru; his father has similar problems. Platelets are 2,60,000/µL, PT is normal, aPTT is 42 s (control 30 s), and vWF antigen and ristocetin cofactor activity are both reduced to a similar degree, with a normal multimer pattern. Before his next extraction, desmopressin is planned. How does desmopressin help him?
1. AIt increases hepatic synthesis of fibrinogen
2. BIt enhances platelet thromboxane A2 production
3. CIt releases stored vWF from endothelium
4. DIt inhibits plasmin-mediated breakdown of fibrin
Answer and explanation in LearnFree account
Question 17 · Easy
A 58-year-old man on daily low-dose aspirin after a coronary stent is scheduled for an elective hernia repair. His platelet count, PT and aPTT are normal. How does aspirin increase his bleeding risk?
1. AReduced hepatic synthesis of factors II, VII, IX, X
2. BReversible blockade of the platelet P2Y12 receptor
3. CIrreversible inhibition of platelet cyclooxygenase-1
4. DAntibody-mediated destruction of circulating platelets
Answer and explanation in LearnFree account
Question 18 · Medium
A 5-year-old boy is brought to the paediatric OPD in Jaipur with a petechial rash and bruises on his legs for two days, three weeks after a viral fever. He is active, with no mucosal bleeding, lymphadenopathy or hepatosplenomegaly. Hb 11.8 g/dL, WBC 8,400/µL with a normal differential, platelets 18,000/µL; the smear shows a few large platelets and no abnormal cells. What is the most appropriate management?
1. ABone marrow aspiration first
2. BObservation with advice to avoid injury
3. CIntravenous immunoglobulin infusion
4. DRandom donor platelet transfusion
Answer and explanation in LearnFree account
Question 19 · Hard
A 28-year-old woman is admitted from the haematology OPD in Delhi with gum bleeding and bruises. Hb 7.8 g/dL, WBC 3,200/µL, platelets 22,000/µL; the smear shows abnormal promyelocytes with heavy granules and bundles of Auer rods. PT 21 s (control 13 s), fibrinogen 70 mg/dL, D-dimer raised. The plan proposed: 1. Start all-trans retinoic acid at once, before genetic confirmation. 2. Give cryoprecipitate and platelets to correct the coagulopathy. 3. Give routine therapeutic heparin to halt the DIC. 4. Send PML::RARA testing to confirm the diagnosis. Which parts of the plan are correct?
1. A2 and 4 only
2. B1, 2 and 4 only
3. C1 and 4 only
4. D1, 3 and 4 only
Answer and explanation in LearnFree account
Question 20 · Medium
A 40-year-old man receiving a red cell unit for a bleeding duodenal ulcer develops wheeze, stridor, generalised urticaria and a BP of 70/40 mmHg within a few minutes of starting the unit, with no fever. After resuscitation, his serum IgA is found to be undetectable and anti-IgA antibodies are present. What product should he receive for future transfusions?
1. AFresh whole blood
2. BIrradiated red cells
3. CWashed red cells
4. DLeucoreduced red cells
Answer and explanation in LearnFree account
Question 21 · Medium
A 35-year-old man is admitted with fluctuating confusion and fever. Hb 8.1 g/dL, platelets 16,000/µL, many schistocytes, LDH 1,900 U/L, indirect bilirubin raised, creatinine 1.5 mg/dL; PT, aPTT and fibrinogen are normal. ADAMTS13 activity is below 10%. Accumulation of which protein causes the microthrombi in his disorder?
1. AThrombin-antithrombin complexes
2. BCross-linked fibrin polymers
3. CUltra-large vWF multimers
4. DComplement membrane attack complexes
Answer and explanation in LearnFree account
Question 22 · Hard
A 45-year-old man is in the ICU with Klebsiella sepsis and shock. He is oozing from line sites. Platelets 38,000/µL, PT 26 s (control 13 s), aPTT 58 s (control 30 s), fibrinogen 80 mg/dL, D-dimer markedly raised, and the smear shows a few schistocytes. Bilirubin is 2.4 mg/dL and ALT 140 U/L, raising the question of liver failure. Which result best supports DIC rather than liver disease as the main cause of his coagulopathy?
1. ALow factor VIII activity
2. BProlonged prothrombin time
3. CLow serum albumin level
4. DLow factor VII activity
Answer and explanation in LearnFree account
Question 23 · Easy
A 12-year-old boy from Bareilly, born of a consanguineous marriage, has had nosebleeds and gum bleeding since early childhood. Platelets are 70,000/µL and the smear shows many giant platelets. Aggregation is normal with ADP, collagen and adrenaline, but absent with ristocetin, and adding normal plasma does not correct it. Which platelet defect is most likely?
1. ADefect of the P2Y12 ADP receptor
2. BDeficiency of plasma von Willebrand factor
3. CDeficiency of glycoprotein Ib-IX-V
4. DDeficiency of glycoprotein IIb/IIIa
Answer and explanation in LearnFree account
Question 24 · Medium
A 70-year-old man on an IV unfractionated heparin infusion for acute limb ischaemia in a Kolkata vascular unit has a platelet count that falls from 2,10,000/µL on admission to 80,000/µL on day 6. A painful black patch of skin necrosis appears at a heparin injection site and the other leg turns cold. What is the mechanism of his thrombocytopenia?
1. AConsumption of antithrombin by the heparin infusion
2. BDirect non-immune clumping of platelets by heparin
3. CHeparin-induced suppression of marrow megakaryocytes
4. DIgG against PF4-heparin complexes activating platelets
Answer and explanation in LearnFree account
Question 25 · Medium
A 76-year-old woman with known heart failure is given two units of packed red cells over three hours for Hb 6.8 g/dL. Near the end of the second unit she becomes breathless with BP 176/96 mmHg, raised JVP, basal crepitations and bilateral infiltrates on chest X-ray. NT-proBNP is markedly raised and she improves after IV furosemide. What is the most likely diagnosis?
1. AAnaphylactic transfusion reaction
2. BTransfusion-associated circulatory overload
3. CSeptic reaction from bacterial contamination
4. DTransfusion-related acute lung injury
Answer and explanation in LearnFree account

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Bleeding and coagulation disorders, transfusion

A 30-year-old woman is brought to casualty with fever and confusion. Hb 7.2 g/dL, platelets 18,000/µL, many schistocytes on the smear, LDH 1,450 U/L, creatinine 1.4 mg/dL, PT 13 s (control 12 s), aPTT 31 s (control 30 s) and fibrinogen 310 mg/dL. What is the next best step in management?

A 30-year-old woman has massive postpartum haemorrhage after a placental abruption in a district hospital. Her fibrinogen is 90 mg/dL and she continues to ooze from venepuncture sites. Which blood component gives the most fibrinogen per unit volume?

In a busy surgical ward in Lucknow, a 50-year-old man with blood group O RhD positive is accidentally transfused a unit meant for another patient. Ten minutes later he has fever, chills, pain in the loins, a burning feeling along the vein and BP 84/50 mmHg. What should the resident do first?

A 60-year-old man with painless progressive jaundice, pale stools and itching has a mass in the head of the pancreas on CT. Before ERCP, his PT is 24 s (control 13 s) with a normal platelet count. After 10 mg of parenteral vitamin K, the PT is 14 s the next day. Why was his PT prolonged?

A 52-year-old woman with rheumatic heart disease and atrial fibrillation is started on warfarin in the cardiology OPD. Her INR rises within 2 days of starting the drug, well before its full antithrombotic effect is reached. Which vitamin K-dependent factor explains this early rise?

A 58-year-old man on daily low-dose aspirin after a coronary stent is scheduled for an elective hernia repair. His platelet count, PT and aPTT are normal. How does aspirin increase his bleeding risk?