Emerging therapies & exam strategy
What's changing in each specialty: the trials, agents and guideline shifts most likely to matter for the FRACP Divisional Written Exam.
Polycythemia Vera
Management of polycythemia vera (PV) rests on phlebotomy and low-dose aspirin, with cytoreduction (traditionally hydroxyurea) for higher-risk patients — but the options for disease control have…
Myelodysplastic Syndromes
Myelodysplastic syndrome (MDS) management is stratified by risk, and progress has been uneven — real gains in lower-risk anemia, but a series of disappointments in higher-risk disease.
Complement-Mediated Thrombotic Microangiopathies
The microangiopathic haemolytic anaemias (MAHAs) share a common picture of mechanical red-cell fragmentation, thrombocytopenia, and small-vessel thrombosis, but their treatment depends entirely on…
Transplant-Associated Thrombotic Microangiopathy
Transplant-associated thrombotic microangiopathy (TA-TMA) is a severe, often fatal complication of haematopoietic stem-cell transplantation, driven by endothelial injury and inappropriate complement…
Disseminated Intravascular Coagulation
Disseminated intravascular coagulation (DIC) remains fundamentally a disorder to treat by treating its cause — sepsis, malignancy, obstetric catastrophe, or trauma — with anticoagulant and supportive…
Heparin-Induced Thrombocytopenia
Heparin-induced thrombocytopenia (HIT) is an immune reaction to heparin — driven by antibodies against platelet factor 4/heparin complexes — that paradoxically causes thrombocytopenia together with a…
Haemolysis and Paroxysmal Nocturnal Haemoglobinuria
Complement-driven haemolytic disorders have seen an explosion of targeted therapies, transforming paroxysmal nocturnal haemoglobinuria (PNH) in particular from a disease controlled by intravenous…
Aplastic Anaemia
The key advance in severe aplastic anaemia has been the addition of eltrombopag, an oral thrombopoietin-receptor agonist, to standard immunosuppressive therapy (horse antithymocyte globulin plus…
Vitamin B12 Deficiency
Management of vitamin B12 deficiency is being refined toward simpler, individualized repletion. Parenteral hydroxocobalamin or cyanocobalamin (intramuscular or subcutaneous, with loading doses…
Microcytic Anaemia
For iron deficiency anaemia, tolerability has improved with newer oral iron formulations (ferric maltol, sucrosomial iron, ferric citrate), and the recognition that alternate-day dosing enhances…
Normocytic Anaemia
Normocytic anaemia is dominated by the anaemias of chronic kidney disease and inflammation, where the notable pharmacologic development is the hypoxia-inducible factor prolyl-hydroxylase inhibitors…
Macrocytic Anaemia
Macrocytic anaemia spans nutritional (megaloblastic) and marrow (myeloid neoplasm) causes, and modern therapy tracks that division. For anaemia associated with myeloid neoplasms — myelodysplastic…
Lymphoma
Diffuse large B-cell lymphoma (DLBCL) exemplifies how lymphoma therapy has advanced on three fronts: better frontline chemoimmunotherapy, off-the-shelf bispecific antibodies, and CAR T-cell therapy…
Leukaemia
Leukaemia therapy has become increasingly targeted and molecularly defined, with new drug classes reaching approval across the myeloid and lymphoid leukaemias.
Venous Thromboembolism
The mainstay of venous thromboembolism (VTE) treatment is now the direct oral anticoagulants (DOACs), and the frontier is a new class designed to prevent clotting with even less bleeding.
Tumour Lysis Syndrome
Tumour lysis syndrome (TLS) is an oncologic emergency caused by rapid release of intracellular contents when large numbers of malignant cells die, producing hyperuricemia, hyperkalemia,…
Hereditary Thrombophilia
Management of hereditary thrombophilia has become more restrained and evidence-based. The 2023 American Society of Hematology guidelines recommend against routine long-term prophylactic…
Haemoglobinopathies: Gene Therapy for Sickle Cell Disease and Thalassemia
Gene therapy for the haemoglobinopathies has crossed a historic threshold — moving from clinical trials to approved, potentially curative treatments, including the first CRISPR-based medicine ever…
Graft-Versus-Host Disease
Both the prevention and the treatment of graft-versus-host disease (GVHD) have advanced meaningfully, giving transplant physicians better tools at each stage.
Sideroblastic Anaemia and Lower-Risk MDS with Ring Sideroblasts
For the anemia of lower-risk myelodysplastic syndromes (MDS) with ring sideroblasts — the disorder underlying most acquired sideroblastic anemia — two agents have reshaped care beyond…
Multiple Myeloma
Multiple myeloma therapy has been reshaped by anti-CD38 antibodies, BCMA-directed cell therapy, and bispecific antibodies, extending both the depth and duration of response across the disease course.
Myelofibrosis and Myeloproliferative Neoplasms
For myelofibrosis, JAK inhibitors remain the therapeutic backbone, and the field now has four approved agents, each suited to a different clinical problem. Ruxolitinib and fedratinib reduce spleen…
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