Anaemias, Haemoglobinopathies, and Bone Marrow Failure — WACS Viva & Clinical Scenarios (Haematology and Medical Oncology)

Exam-style anaemias, haemoglobinopathies, and bone marrow failure viva scenarios with examiner probes and model answers for Internal Medicine candidates.

Scenarios covered

• SCENARIO 1: A 28-year-old female presents to the emergency medical unit with a 5-day history of high-grade fever, extensive spontaneous ecchymoses, epistaxis, and oromucosal bleeding. Complete blood count shows haemoglobin 6.8 g/dL, white cell count 2.4 x 10⁹/L, and platelet count 14 x 10⁹/L. Peripheral blood smear reveals prominent hypergranular promyelocytes with numerous Auer rods arranged in bundles (faggot cells). Coagulation studies demonstrate prolonged prothrombin time, international normalised ratio 2.1, activated partial thromboplastin time 48 seconds, plasma fibrinogen 0.8 g/L (reference 2.0 to
• SCENARIO 2: A 54-year-old male is referred following a routine medical examination. He is asymptomatic apart from mild pruritus after warm baths and a feeling of left upper quadrant fullness. Physical examination reveals a plethoric facies and splenomegaly palpable 5 cm below the left costal margin. Full blood count shows haemoglobin 19.8 g/dL, haematocrit 0.62, white cell count 13.5 x 10⁹/L, and platelet count 520 x 10⁹/L. Detail the systematic diagnostic algorithm to differentiate primary polycythaemia vera from secondary erythrocytosis, the molecular markers required, the formal diagnostic criteria, an
• SCENARIO 3: A 68-year-old male presents with persistent painless cervical and bilateral axillary lymphadenopathy. Full blood count reveals an isolated absolute lymphocytosis of 38 x 10⁹/L with normal red cell parameters and platelet count. Peripheral blood film demonstrates mature-appearing, small, monomorphic lymphocytes with clumped chromatin and numerous smudge (Gumprecht) cells. Describe the diagnostic flow cytometry immunophenotypic panel required to establish the diagnosis, the staging systems (Rai and Binet), the molecular/genetic prognostic markers to evaluate, and the evidence-based indications f
• SCENARIO 4: A 22-year-old male presents with rapidly enlarging bilateral cervical lymphadenopathy, fever, night sweats, and an 8 kg weight loss over 4 weeks. Excisional lymph node biopsy confirms high-grade B-cell Non-Hodgkin Lymphoma with a starry-sky histological appearance and flow cytometry showing CD19, CD20, and CD10 positivity. Cytogenetics confirm the t(8;14)(q24;q32) translocation resulting in c-MYC overexpression. Outline the staging evaluation, International Prognostic Index scoring, prevention and emergency management of acute tumour lysis syndrome, and definitive multi-agent chemo-immunothera
• SCENARIO 5: A 62-year-old woman presents with persistent lower thoracic and lumbar back pain, progressive fatigue, and polydipsia. Laboratory investigations reveal haemoglobin 8.2 g/dL, serum corrected calcium 3.1 mmol/L, serum creatinine 210 µmol/L, and an elevated total protein with a reversed albumin-to-globulin ratio. Discuss the structured diagnostic approach using the SLIM-CRAB criteria, serum and urine protein electrophoresis, free light chain quantification, Revised International Staging System (R-ISS) stratification, and the initial systemic induction regimen.