FRCPath Haem Part 1 MCQs-Haemostasis 491

A 27-year-old woman with a history of menorrhagia and prolonged bleeding after dental extraction is referred to a haemophilia centre at 35 weeks of pregnancy. Her parents are first cousins. She has never had a thrombotic event and is not taking anticoagulants.

Investigation	Result
Hb	105 g/L
Platelets	248 × 10⁹/L
PT	18.2 s (prolonged)
APTT	68 s (prolonged)
Fibrinogen	4.1 g/L
Factor V activity	8 IU/dL
Factor VIII activity	34 IU/dL
VWF antigen	118 IU/dL
VWF activity	105 IU/dL

Mixing studies correct both the PT and APTT.

At 38 weeks, she presents in spontaneous labour. The obstetric team anticipates a possible emergency caesarean section. She has no active bleeding, and her factor VIII activity has risen to 62 IU/dL, while factor V remains at 8 IU/dL.

Which of the following is the single most appropriate management strategy?

Choose ONE best answer.

A. Administer desmopressin alone, as the pregnancy-associated rise in factor VIII should correct the combined deficiency.

B. Administer solvent/detergent-treated fresh frozen plasma (SD-FFP) at approximately 15–20 mL/kg

C. Administer recombinant factor VIII alone, targeting factor VIII above 100 IU/dL, because factor V deficiency does not independently increase surgical bleeding risk.

D. Administer recombinant activated factor VII (rFVIIa) alone as mandatory first-line treatment

E. Proceed without factor replacement because a factor V level above 5 IU/dL and a normal platelet count exclude clinically significant bleeding risk.