Theme: Obstetric APS Options (Each option may be used once, more than once, or not at all)   A. Aspirin alone throughout pregnancy B. Aspirin + prophylactic LMWH from positive pregnancy test C. Therapeutic-dose LMWH throughout pregnancy D. Switch from warfarin to LMWH immediately on confirmation of pregnancy E. Continue warfarin until second trimester F. Add hydroxychloroquine G. Add prednisolone or IVIG H. Refer to specialist obstetric–haematology centre I. Continue LMWH for

Theme: APS Options (Each option may be used once, more than once, or not at all)   A. Increase warfarin target INR to 3.0–4.0 B. Add low-dose aspirin while maintaining INR 2.0–3.0 C. Switch from DOAC to warfarin D. Assess time in therapeutic range (TTR) and INR reliability E. Add hydroxychloroquine F. Refer to a specialist APS centre G. Add rituximab H. Switch to long-term therapeutic LMWH I. Continue current management without change J. Intensify cardiovascular risk manageme

Theme: APS Options (Each option may be used once, more than once, or not at all) A. Test full aPL panel (LA, aCL IgG/IgM, anti-β2GPI) now B. Do not test for aPL C. Repeat aPL testing after ≥12 weeks D. Defer LA testing due to anticoagulation interference E. Defer LA testing due to recent thrombosis/acute phase F. Perform DRVVT and LA-sensitive APTT G. Perform mixing study and phospholipid neutralisation step H. Start VKA (target INR 2.0–3.0) indefinitely I. Increase VKA inten

Theme: Inherited Bone Marrow Failure Syndrome Options (Each option may be used once, more than once, or not at all)   A. FANCA B. FANCC C. DKC1 D. TERT E. RPS19 F. RPL11 G. SBDS H. ELANE I. MPL J. GATA2 K. SAMD9 L. MECOM Questions Q1 An 8-year-old boy presents with progressive pancytopenia, short stature, and radial ray abnormalities. He has café-au-lait pigmentation and renal anomalies. Bone marrow is hypocellular. Chromosomal breakage testing using diepoxybutane (DEB) is ma

Theme: Inherited bone marrow failure syndromes Pathophysiology OPTIONS (Each option may be used once, more than once, or not at all)   A. Defective DNA interstrand crosslink repair leading to chromosomal instability B. Critically short telomeres causing stem cell exhaustion C. Haploinsufficiency of ribosomal proteins leading to p53 activation D. Endoplasmic reticulum stress impairing neutrophil maturation E. Defective thrombopoietin receptor signalling impairing megakaryopoie

Theme: Inherited bone marrow failure syndromes OPTIONS (Each option may be used once, more than once, or not at all)   A. Fanconi anemia B. Dyskeratosis congenita C. Diamond–Blackfan anemia D. Shwachman–Diamond syndrome E. Severe congenital neutropenia F. Congenital amegakaryocytic thrombocytopenia G. GATA2 deficiency H. SAMD9/SAMD9 L disorder I. MECOM-associated syndrome   Questions Q1 An 8-year-old boy is referred with progressive pancytopenia. He has a history of being sma

Theme: Waldenstrom OPTIONS (Each option may be used once, more than once, or not at all) A. Immediate plasmapheresis B. Pre-emptive plasmapheresis prior to rituximab C. Observation only D. Rituximab monotherapy E. DRC (dexamethasone–rituximab–cyclophosphamide) F. Bendamustine–rituximab G. BTK inhibitor H. Bortezomib-based regimen I. Treat as high-grade lymphoma J. Intrathecal/CNS-penetrating chemotherapy     1. A 65-year-old patient with WM develops: Painful acrocyanosis Haem

Theme: Waldenstrom OPTIONS (Each option may be used once, more than once, or not at all) A. Immediate plasmapheresis B. Pre-emptive plasmapheresis prior to rituximab C. Observation only D. Rituximab monotherapy E. DRC (dexamethasone–rituximab–cyclophosphamide) F. Bendamustine–rituximab G. BTK inhibitor H. Bortezomib-based regimen I. Treat as high-grade lymphoma (e.g. R-CHOP) J. Intrathecal + CNS-penetrating chemotherapy 1. A 72-year-old man presents with blurred vision, heada

Theme: Granulocyte Transfusion Options (Each option may be used once, more than once, or not at all) A. Start granulocyte transfusion immediately B. Do not give granulocytes – infection not refractory C. Not indicated – no expectation of neutrophil recovery D. Consider granulocytes after further optimisation E. Indicated due to neutrophil functional defect F. Not indicated – infection type inappropriate G. Needs MDT discussion with Microbiology and NHSBT about Prophylactic Gr

Theme: Granulocyte Transfusion Options (Each option may be used once, more than once, or not at all) A. Start granulocyte transfusion immediately B. Do not give granulocytes – infection not refractory C. Not indicated – no expectation of neutrophil recovery D. Consider granulocytes after further optimisation E. Indicated due to neutrophil functional defect F. Not indicated – infection type inappropriate G. Needs MDT discussion with Microbiology and NHSBT about Prophylactic Gr

Theme: Inherited thrombophilia Options A. Test for inherited thrombophilia B. Do not test – results will not influence management C. Test only if results will alter pregnancy management D. Test for specific deficiency (Protein C/S or Antithrombin) E. Advise against oestrogen-containing therapy and testing F. Defer testing until off anticoagulation G. Test asymptomatic first-degree relatives selectively H. Do not test – patient already in high-risk group I. Test for antiphosph

Theme: Inherited thrombophilia Options A. Test for inherited thrombophilia B. Do not test – results will not influence management C. Test only if results will alter pregnancy management D. Test for specific deficiency (Protein C/S) E. Advise against oestrogen-containing therapy and testing F. Defer testing until off anticoagulation G. Test asymptomatic first-degree relatives selectively H. Do not test – patient already in high-risk group I. Test for antiphospholipid syndrome

Options-Theme DLBCL Treatment A. CAR T-cell therapy B. Platinum-based salvage chemotherapy (R-ICE / R-DHAP) C. High-dose therapy with autologous stem cell transplant (HDT-ASCT) D. Polatuzumab vedotin + bendamustine + rituximab (Pola-BR) E. Tafasitamab + lenalidomide F. CD3×CD20 bispecific antibody (e.g. glofitamab / epcoritamab) G. Loncastuximab tesirine H. Palliative oral chemotherapy I. Involved-site radiotherapy (ISRT) J. R-GemOx K. Allogeneic stem cell transplant L. CAR-T

Options-Theme DLBCL Treatment A. CAR T-cell therapy B. Platinum-based salvage chemotherapy (R-ICE / R-DHAP) C. High-dose therapy with autologous stem cell transplant (HDT-ASCT) D. Polatuzumab vedotin + bendamustine + rituximab (Pola-BR) E. Tafasitamab + lenalidomide F. CD3×CD20 bispecific antibody (e.g. glofitamab / epcoritamab) G. Loncastuximab tesirine H. Palliative oral chemotherapy I. Involved-site radiotherapy (ISRT) J. R-GemOx K. Allogeneic stem cell transplant L. CAR-T

A 38-year-old man, Jehovah’s Witness, is admitted after a high-speed road traffic accident. He has: Right mid-shaft femoral fracture No other injuries Observations: HR: 125 bpm BP: 90/60 mmHg RR: 24/min O2 sat: 94% Investigations: Hb: 82 g/L Platelets: 210 × 10⁹/L PT/APTT: normal Lactate: 4.2 mmol/L Blood gases: mild metabolic acidosis Patient refuses all allogeneic blood transfusions. He has a blood refusal card/advance directives for all circumstances. The orthopaedic team

A 35-year-old woman is admitted with newly diagnosed Burkitt lymphoma after presenting with: Abdominal distension , Night sweats and Early satiety . CT shows a 15 cm mesenteric mass with extensive nodal disease. Hb: 98 g/L WBC: 12 × 10⁹/L Platelets: 190 × 10⁹/L LDH: 3,200 U/L She is on IV fluids and proceeds to chemotherapy. Post chemotherapy,   she develops increasing breathlessness, reduced urine output and peripheral oedema Bloods: Potassium: 6.2 mmol/L Phosphate: 3.1 mmol

A 30-year-old woman at 8 weeks’ gestation presents with worsening abdominal pain, increasing abdominal distension, and nausea over 1 week. Examination: Mild jaundice Tender hepatomegaly Moderate ascites No splenomegaly Investigations: Hb: 122 g/L WBC: 11.0 × 10⁹/L Platelets: 1050 × 10⁹/L ALT/AST: mildly elevated Bilirubin: elevated INR: mildly prolonged Doppler ultrasound confirms hepatic vein thrombosis. Further tests: Positive for JAK2 She is commenced on therapeutic LMWH.

A 39-year-old man presents with fatigue, night sweats, and progressive dyspnoea over 3 months. He also reports pruritus and early satiety. Examination: Splenomegaly (5 cm below costal margin) No lymphadenopathy Investigations: Hb: 110 g/L WBC: 36 × 10⁹/L Eosinophils: 14 × 10⁹/L Platelets: 420 × 10⁹/L Bone marrow: Hypercellular with marked eosinophilia and granulocytic proliferation Molecular testing: Negative for FIP1L1-PDGFRA fusion Negative for BCR-ABL1 Cytogenetics reveals

A 60-year-old man with a 3-year history of Waldenström macroglobulinaemia (WM) presents with progressive unsteadiness, diplopia, and cognitive decline over 6 weeks. He is currently on second-line therapy with bendamustine-rituximab for systemic relapse. Examination reveals: Right 6th cranial nerve palsy Investigations: Hb: 102 g/L IgM: mildly elevated from baseline MRI brain and spine: diffuse leptomeningeal enhancement CSF analysis: Lymphocytosis Clonal B-cells on flow cytom

A 24-year-old woman with known sickle cell disease (HbSS genotype) is admitted with severe vaso-occlusive crisis and symptomatic anaemia (Hb 58 g/L). She receives 2 units of phenotype-matched red cells. Seven days later, she re-presents with worsening fatigue. Examination reveals scleral icterus, and oxygen saturation of 92% on air. Laboratory investigations show: Hb: 42 g/L (pre-transfusion Hb was 58 g/L) Reticulocyte count: 15 × 10⁹/L (inappropriately low) LDH: markedly ele