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

Systemic Mastocytosis Updates❤️

A 32-year-old woman with primary mediastinal B-cell lymphoma (PMBCL) was treated with first-line chemoimmunotherapy and achieved a complete metabolic response. She remained clinically well initially. However, 9 months after completion of first-line treatment, she develops increasing chest discomfort, cough and new left supraclavicular lymphadenopathy. PET-CT demonstrates a new intensely FDG-avid mediastinal mass with additional FDG-avid lymphadenopathy. The most metabolically

PMBCL: BSH 2026 Guidelines❤️🦋

TTP BSH 2026 Guidelines Summary

A 27-year-old woman of childbearing potential is known to be group O, RhD-negative with a negative antibody screen. She develops a major obstetric haemorrhage following emergency Caesarean section. Because of an immediate shortage of O RhD-negative red cells, she receives 6 units of O RhD-positive red cells as part of the major haemorrhage protocol. Once stabilised, the transfusion laboratory considers a red cell exchange procedure to reduce the volume of transfused RhD-posit

A 48-year-old man presents to the emergency department with sudden, painless visual loss in his left eye, which developed over the previous 12 hours. Ophthalmological examination confirms a central retinal vein occlusion (CRVO). His medical history includes: Hypertension, well controlled on amlodipine Hypercholesterolaemia BMI 31 kg/m² No diabetes No previous venous or arterial thrombosis No known thrombophilia No recent surgery, immobility, trauma or malignancy He is a non-s

A 32-year-old woman, gravida 2 para 1, at 39 weeks' gestation undergoes an emergency Caesarean section for suspected placental abruption. She is RhD-negative and has no detectable immune anti-D antibodies. Significant intraoperative haemorrhage occurs, with an estimated blood loss of 2.5 L. Intraoperative cell salvage is used, and 800 mL of salvaged red cells are reinfused. The baby is born alive and is subsequently confirmed to be RhD-positive. The obstetric team contacts th

A 52-year-old man is referred to the haematology clinic following investigation of persistently abnormal iron studies identified during a routine medical assessment. He reports increasing fatigue but has no abdominal pain, jaundice, pruritus or weight loss. He drinks approximately 8–10 units of alcohol per week. There is no history of viral hepatitis, blood transfusion or chronic liver disease. His initial investigations are: Hb: 154 g/L ALT: 48 U/L (ULN 40) ALP: 92 U/L Bilir

A 64-year-old man presents with a 3-month history of progressive fatigue, night sweats and weight loss of 9 kg. Examination reveals generalized lymphadenopathy and moderate splenomegaly. FBC: Parameter Result Hb 96 g/L WBC 58 × 10⁹/L Neutrophils 8.2 × 10⁹/L Lymphocytes 46 × 10⁹/L Platelets 112 × 10⁹/L The cells are medium-to-large, with a relatively high nuclear-to-cytoplasmic ratio. Nuclei are irregular and occasionally cleaved. The chromatin is moderately condensed but some

Business Case Structure for FRCPath Haematology Part 2 Exam with Example

A 34-year-old Afro-Caribbean woman with HbSS sickle cell disease is admitted with a 24-hour history of fever, right upper quadrant pain and vomiting. Ultrasound confirms acute calculous cholecystitis, and the hepatobiliary surgical team plans an urgent laparoscopic cholecystectomy within the next 24 hours. Her medical history includes: Previous acute chest syndrome (ACS) requiring mechanical ventilation 2 years ago Pulmonary hypertension (estimated pulmonary artery systolic p

A 46-year-old man is referred to the haematology clinic with a 4-month history of progressive fatigue, drenching night sweats, weight loss, and generalized pruritus. He has recently developed cervical and axillary lymphadenopathy. Examination demonstrates generalized lymphadenopathy, moderate hepatosplenomegaly, and a widespread erythematous rash. Full blood count reveals: Hb: 102 g/L WBC: 58.4 × 10⁹/L Eosinophils: 18.6 × 10⁹/L Platelets: 118 × 10⁹/L Peripheral blood film sho

New Bispecific Antibody For Haemophilia A-Denecimig❤️

A 76-year-old woman presents with spontaneous extensive bruising, painful swelling of the right thigh, and persistent epistaxis. She has a history of rheumatoid arthritis and hypertension but no previous bleeding disorder. Examination reveals large ecchymoses over the limbs and a tense right thigh suggestive of an intramuscular haematoma. Initial laboratory investigations show: Test Result Hb 84 g/L Platelets 295 ×10⁹/L APTT 96 seconds (reference 24–36) Mixing study Fails to

A 30-year-old woman (G3P1+1) at 28 weeks' gestation is referred to the fetal medicine unit with severe fetal anaemia secondary to anti-D alloimmunisation. The fetal middle cerebral artery peak systolic velocity (MCA-PSV) is 1.8 MoM, and fetal blood sampling confirms a fetal haemoglobin of 55 g/L. An intrauterine transfusion (IUT) is planned. The consultant transfusion laboratory scientist prepares an irradiated, CMV-negative, HbS-negative, group O RhD-negative red cell unit w