A 72-year-old man with a history of Myelodysplastic syndrome and ischaemic heart disease and previous coronary stent insertion is scheduled for elective cataract surgery. His medications include aspirin 75 mg once daily and clopidogrel 75 mg once daily. His full blood count shows: Investigation Result Haemoglobin 108 g/L White cell count 4.2 × 10⁹/L Platelet count 45 × 10⁹/L His coagulation screen is normal. The ophthalmologist asks whether prophylactic platelet transfusion i

A 67-year-old man presents with a painless enlargement of the right testis. Orchidectomy confirms diffuse large B-cell lymphoma (DLBCL), with a non-germinal-centre phenotype. FISH shows no MYC, BCL2 or BCL6 rearrangements. PET-CT demonstrates disease confined to the right testis, with no nodal or other extranodal involvement. Bone marrow examination is negative. His LDH is mildly elevated, ECOG performance status is 1, and his CNS-IPI score is 2. Baseline MRI brain is normal.

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 M

A 68-year-old man is admitted with community-acquired pneumonia. His Hb is 82 g/L, WBC 14.2 × 10⁹/L and platelets 285 × 10⁹/L. Blood film shows red cell agglutination. The MCV is reported as 118 fL, but a repeat sample after warming to 37°C gives an MCV of 91 fL. DAT is: IgG: negative C3d: strongly positive An antibody screen performed at room temperature is positive with all screening cells, but testing at 37°C using the indirect antiglobulin technique is negative. The patie

A 32-year-old G2P1 RhD-negative woman with no detectable immune anti-D antibodies is scheduled for an elective Caesarean section at 38+5 weeks for placenta accreta spectrum. She has previously received routine antenatal anti-D prophylaxis. Her pre-operative antibody screen is negative and the fetus is believed to be RhD positive. Because major haemorrhage is anticipated, intraoperative cell salvage (IOCS) is established. During surgery, she loses approximately 3.5 L of blood.

A 68-year-old woman with JAK2 V617F-positive essential thrombocythaemia (ET) is reviewed after developing recurrent spontaneous epistaxis and easy bruising. Her platelet count is 1,780 × 10⁹/L. She has no previous history of bleeding. Investigations show: Hb 126 g/L WCC 11.8 × 10⁹/L Platelets 1,780 × 10⁹/L PT: normal APTT: Prolonged She is not currently taking aspirin or any anticoagulant. What is the MOST appropriate management? A. Start plateletpheresis urgently B. Start hy

A 36-year-old woman with HbSC disease is being assessed before an elective major abdominal surgery for a large intra-abdominal tumour. She has not previously required regular transfusion and has never been on a chronic transfusion programme. Her baseline haemoglobin is 102 g/L, with a reticulocyte count of 165 × 10⁹/L and bilirubin of 42 µmol/L. She has a history of two previous vaso-occlusive episodes, the most recent 18 months ago, but no previous acute chest syndrome or st

A 27-year-old woman of African ancestry is found to have a persistent neutrophil count of 0.9 × 10⁹/L during routine blood tests. She is clinically well, with no history of recurrent or unusual infections. Haemoglobin and platelet counts are normal. There is no lymphadenopathy or splenomegaly. Further investigations show: Blood film: normal neutrophil morphology CRP: normal HIV and hepatitis screen: negative ANA: negative Fya: negative Fyb: negative She is not taking any medi

A 72-year-old man with atrial fibrillation presents with sudden severe headache, vomiting and reduced consciousness. CT brain demonstrates a large intracerebral haemorrhage (ICH) with mass effect. He takes edoxaban 60 mg once daily for stroke prevention. His last dose was 4 hours ago. Blood tests show: Hb 118 g/L Platelets 214 × 10⁹/L PT 18 s APTT 38 s Renal function: normal The neurosurgical team considers the haemorrhage life-threatening and requests urgent reversal of anti

A 68-year-old man is investigated for persistent neutrophilic leukocytosis. His WCC is 42 × 10⁹/L, with predominantly mature neutrophils and minimal left shift. There is no significant dysgranulopoiesis, blasts account for <1%, and he has moderate splenomegaly. BCR::ABL1 is not detected. Which of the following mutations is most strongly associated with this condition? A. SETBP1 B. ANKRD26 C. STAT5B D. CSF3R E. LMAN1 F. NBEAL2

A 24-year-old man with HbSS is admitted with a severe vaso-occlusive episode and acute chest syndrome. His baseline haemoglobin is 82 g/L. He receives 2 units of appropriately phenotype-matched red cells, with an initial post-transfusion haemoglobin of 81 g/L. He is discharged after clinical improvement. Nine days later, he is readmitted with severe limb and back pain, fever and dark-coloured urine. His haemoglobin is now 58 g/L. Further investigations show: Hb 58 g/L Reticul

A 29-year-old woman, G2P1, is found to have a positive antibody screen at 12 weeks' gestation. She is D-negative and has no history of transfusion. Antibody identification demonstrates apparent anti-C and anti-D. The anti-C titre is relatively high. The obstetric team asks whether she should receive routine antenatal anti-D prophylaxis. The case is referred to the red cell immunohaematology reference laboratory, where further investigation demonstrates that the apparent anti-

A 61-year-old man is diagnosed with systemic primary AL amyloidosis. Investigations show: Bone marrow plasma cells: 8% Serum free light chains: markedly abnormal dFLC: 185 mg/L Serum paraprotein: 3 g/L NT-proBNP: moderately elevated Troponin-T: mildly elevated Echocardiogram: increased ventricular wall thickness with preserved ejection fraction eGFR: 68 mL/min/1.73 m² No significant peripheral neuropathy No significant gastrointestinal or respiratory involvement He is other

A 46-year-old man presents with recurrent flushing, abdominal discomfort, pruritus and episodes of unexplained hypotension. He has mild hepatosplenomegaly. FBC shows: Hb: 108 g/L WBC: 9.8 × 10⁹/L Platelets: 165 × 10⁹/L A bone marrow aspirate is haemodiluted. The trephine biopsy shows fibrosis, particularly around trabeculae. There is trabeculae thickening and distortion Immunohistochemistry demonstrates strong expression of CD117. The cells show aberrant CD25 expression. Whic

Immunohistochemistry of Common malignancies metastasizing to Bone Marrow-FRCPath Part 2 Exam❤️

An external quality assessment (EQA) sample is distributed for a laboratory test. The laboratory's result is compared with the designated target value and the performance is expressed as a Deviation Index (DI). The laboratory receives the following EQA result: Deviation Index = +2.6 Which ONE of the following is the most appropriate interpretation? A. Excellent performance; no action required B. Good performance; continue routine monitoring C. Satisfactory performance; no imm

A 29-year-old woman with known immune thrombocytopenia (ITP) is admitted at 39+1 weeks' gestation with painful uterine contractions and ruptured membranes. She is in established labour. Her pregnancy has been managed jointly by obstetric, haematology and anaesthetic teams. She has received prednisolone during pregnancy with a suboptimal response. On admission: Hb: 108 g/L WCC: 9.8 × 10⁹/L Platelet count: 20 × 10⁹/L LFT and renal function: normal No active significant bleeding