A 27-year-old woman with Sickle Cell Disease (HbSS) is referred to the transfusion laboratory at 18 weeks' gestation. She has received multiple previous red cell transfusions. Her blood group investigations show: Group O RhD positive Antibody screen: Strong Anti-U Phenotype: S−, s−, U− Partner: U-positive Maternal Anti-U titre: 1:64 The fetus is confirmed to be U-positive. The mother is clinically well and does not require transfusion. Which one of the following is the mo

A 26-year-old woman is referred to the haematology clinic because of lifelong intermittent jaundice and increasing fatigue. She reports no history of blood transfusions. Her father underwent splenectomy in his twenties for a chronic haemolytic disorder. Examination reveals mild scleral icterus and a spleen palpable 3 cm below the costal margin. Investigations show: Hb: 109 g/L MCV: 91 fL MCHC: 372 g/L LDH: Mildly elevated Haptoglobin: Undetectable DAT: Negative Blood film dem

A 42-year-old patient returns to the UK after six months working in rural Uganda. Five days after returning, he develops intermittent fever, rigors, headache and malaise. Initial laboratory investigations demonstrate: Hb 118 g/L WBC 6.4 × 10⁹/L Platelets 42 × 10⁹/L CRP 176 mg/L Following the departmental standard operating procedure, four thick and four thin blood films are prepared. Thick films stained with Giemsa are independently examined by two experienced biomedical scie

A 33-year-old G2P1 woman with a 5-year history of chronic immune thrombocytopenia (ITP) is referred to the combined obstetric-haematology clinic at 35+4 weeks' gestation. Her previous pregnancy was complicated by neonatal thrombocytopenia (platelet count 18 ×10⁹/L) requiring neonatal intravenous immunoglobulin (IVIg). During the current pregnancy, her platelet counts have been: 12 weeks 94 32 weeks 59 35+4 weeks 46 She reports mild bruising but no mucosal bleeding. She strong

A 29-year-old woman with transfusion-dependent β-thalassaemia major attends her annual comprehensive iron overload review. She has received approximately 180 units of packed red blood cells since childhood and is currently receiving deferasirox 21 mg/kg/day, with excellent reported adherence. Examination reveals: Mild bronze skin pigmentation Liver palpable 3 cm below the costal margin Test Result Hb 95 g/L Ferritin 2,650 µg/L (stable for 18 months) Transferrin saturation 91%

A 36-year-old woman is referred to the haematology clinic with progressive fatigue, exertional dyspnoea, restless legs, and poor concentration. She has a 10-year history of rheumatoid arthritis treated with methotrexate and adalimumab. She reports menorrhagia for the past 2 years. There is no history of gastrointestinal symptoms. Examination reveals pallor but no hepatosplenomegaly or lymphadenopathy. Investigations: Test Result Hb 92 g/L MCV 84 fL WBC 7.1 ×10⁹/L Platelets 48

A 68-year-old man is reviewed in a haematology clinic. Ten years previously he underwent splenectomy for splenic involvement by a low-grade B-cell lymphoma. He completed post-splenectomy vaccinations at the time of surgery and has remained clinically well. His current medications include phenoxymethylpenicillin 250 mg twice daily. He is planning a 3-month trip to sub-Saharan Africa. Blood film examination demonstrates Howell-Jolly bodies, target cells and occasional Pappenhei

A 48-year-old man is admitted with a 4-week history of fever, drenching night sweats, weight loss and progressive confusion. He has received three courses of broad-spectrum antibiotics without clinical improvement. Examination reveals: Temperature 39.5°C Splenomegaly (5 cm below costal margin) Test Result Hb 78 g/L WBC 1.8 × 10⁹/L Neutrophils 0.7 × 10⁹/L Platelets 42 × 10⁹/L Ferritin 21,500 µg/L Triglycerides 5.8 mmol/L Fibrinogen 0.9 g/L AST 245 U/L ESR 7 mm/hr EBV PCR Posit

A 28-year-old woman of Thai ancestry is referred to a specialist haemoglobinopathy clinic at 12 weeks' gestation. She is asymptomatic and has never required transfusion. Her booking bloods show: Hb 118 g/L MCV 67 fL MCH 21 pg HPLC demonstrates: HbA 97.4% HbA₂ 2.1% HbF 0.5% Capillary electrophoresis is unremarkable. Because of her ethnic background, α-globin genotyping is performed and identifies --/αα. Her partner is subsequently tested: Hb 133 g/L MCV 70 fL MCH 23 pg HbA₂ 2.