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

A 32-year-old woman is referred to the haematology clinic for advice regarding contraception. She is otherwise well, BMI 27 kg/m², non-smoker, with no personal history of thrombosis. She is planning to start the combined oral contraceptive pill (COCP) for menstrual regulation. Her family history is notable for the following: Her mother developed a proximal deep vein thrombosis at age 48 following a long-haul flight. No thrombophilia testing was performed. Her maternal aunt ha

A 70-year-old man was diagnosed 3 years ago with systemic AL amyloidosis presenting with nephrotic-range proteinuria and early cardiac involvement (NT-proBNP elevated, echocardiography showing concentric left ventricular thickening with preserved ejection fraction). At diagnosis: · Serum free light chain assay: markedly elevated lambda chains · Bone marrow: 15% clonal plasma cells · Congo red staining of renal biopsy confirmed amyloid · Mass

A 66-year-old man is diagnosed with systemic progressive dyspnea and proteinuria 3+. Congo red stain positive. Bone marrow shows 12% clonal plasma cells. NT-proBNP is elevated, but he remains ambulatory with preserved performance status. What is the most appropriate first-line treatment? A. Cyclophosphamide, thalidomide, dexamethasone (CTD) B. Bortezomib, cyclophosphamide, dexamethasone (VCD) C. Daratumumab + VCD (Dara-VCD) D. Lenalidomide + dexamethasone E. High-dose mel

A 69-year-old man with known cold agglutinin-mediated haemolysis presents with Hb 62 g/L and symptomatic anaemia. He has: DAT: C3d only Anti-I antibody, titre 1:2048 Thermal amplitude: 32°C Crossmatch incompatible at room temperature but compatible at 37°C using prewarmed technique Which single parameter is most useful in distinguishing clinically significant cold haemolysis (CHAD) from incidental cold agglutinins? A. DAT result B. Antibody specificity C. Thermal amplitude

A 72-year-old man presents with fatigue, dyspnoea and Hb 78 g/L. Laboratory findings: DAT: IgG weak positive, C3d strong positive Antibody screen: 37°C: weak pan-reactive IgG 30°C: stronger reactivity 4°C: strong agglutination Cold agglutinin titre: 1:32 Eluate: nonspecific IgG Thermal amplitude: up to 30°C What is the most likely diagnosis? A. Warm AIHA B. Cold agglutinin disease C. Mixed AIHA D. Paroxysmal cold haemoglobinuria E. CHAD