1High-yield associations
| Finding or trigger | Classic association | The exam point |
|---|---|---|
| Platelets halve 5 to 10 days into heparin | Heparin-induced thrombocytopenia | 4Ts score first; stop all heparin; therapeutic non-heparin anticoagulant (THANZ, MJA 2019). |
| Schistocytes, confusion, normal clotting times | TTP (ADAMTS13 activity under 10%) | Urgent plasma exchange; no platelets unless bleeding is life-threatening (Lifeblood 2026). |
| Haemolysis, cytopenias, hepatic vein thrombosis | Paroxysmal nocturnal haemoglobinuria | Flow cytometry for GPI-anchored proteins. PBS lists eculizumab and ravulizumab for PNH. |
| Itch after a hot shower, high haematocrit | Polycythaemia vera (JAK2 V617F) | Venesection to haematocrit under 0.45 plus aspirin. PBS lists ruxolitinib for PV. |
| Teardrop cells, leucoerythroblastic film, dry tap | Primary myelofibrosis | PBS lists ruxolitinib for intermediate-1, intermediate-2 and high-risk myelofibrosis. |
| Anaemia, hypercalcaemia, renal impairment | Multiple myeloma | Dipstick misses light chains: serum free light chains, electrophoresis, immunofixation. |
| Lymphocytosis with smudge cells | Chronic lymphocytic leukaemia | Test TP53 and del(17p) first; if present, a BTK inhibitor or venetoclax, not chemoimmunotherapy. |
| New bruising in an older adult, long APTT | Acquired haemophilia A (factor VIII inhibitor) | Incubated mixing study fails to correct; bypassing agent, then immunosuppression. |
| Bite cells after primaquine or dapsone | G6PD deficiency | The level can read normal during haemolysis (young cells); repeat once recovered. |
| Low MCV, normal ferritin, high red cell count | Beta thalassaemia trait | Raised HbA2 confirms; normal HbA2 does not exclude alpha trait. Test the partner. |
| Triple-positive antiphospholipid antibodies | High-risk antiphospholipid syndrome | Warfarin, not a DOAC: rivaroxaban had more thrombotic events in TRAPS (2018). |
2Australia-only high-yield (won't be in UK or US banks)
Transfusion (NBA PBM guidelines; Lifeblood 2026). Stable: red cells under 70 g/L (80 in ACS), one unit then reassess. Prophylactic platelets under 10 x 109/L in marrow failure. No FFP for abnormal tests alone. Consent is documented. Victoria reports serious incidents to STIR (Blood Matters, 2025).
Critical bleeding (NBA guideline, MJA 2024). At least 4 FFP and 1 adult platelet unit per 8 red cells; tranexamic acid within 3 hours in trauma and obstetric haemorrhage; no rFVIIa. Warfarin (THANZ, MJA 2025): four-factor PCC plus vitamin K, no FFP.
Irradiated components (Lifeblood 2026, from ANZSBT). Hodgkin lymphoma (indefinitely), purine analogues or bendamustine, allogeneic HSCT (12 months or more), CAR-T (6 months).
Immunoglobulin (NBA Criteria, version 3.5, 2025). With CLL, myeloma, lymphoma or after HSCT, Ig is funded at IgG under 4 g/L (excluding paraprotein), or low IgG with one life-threatening or two serious infections. Review by 6 months, then yearly.
VTE (THANZ, MJA 2019). Proximal DVT or PE after surgery: 3 months; unprovoked or other transient trigger: 3 to 6 months; active cancer: LMWH at least 6 months. No routine thrombophilia testing; APS testing if unprovoked. PBS lists apixaban and rivaroxaban for DVT and PE, dabigatran only for stroke and VTE prevention.
PBS (October 2026). Eltrombopag, romiplostim and avatrombopag: severe thrombocytopenia. Luspatercept and caplacizumab: not found in the PBS medicine index in October 2026. Emicizumab, also not found, is NBA-funded for eligible patients via haemophilia centres (BVTH 2024).
Haemochromatosis (IMJ 2026; Lifeblood 2026). About 1 in 7 carry one HFE mutation. Venesect to ferritin 50 to 100 µg/L; assess fibrosis above 1,000. Lifeblood venesects HFE haemochromatosis, PV and PCT only.
3Sample questions (Physify format)
1. A 68 year old man with chronic lymphocytic leukaemia under observation has a serum IgG of 3.6 g/L on two occasions, with no paraprotein. In the past year he had one chest infection, treated with oral antibiotics at home. Under the National Blood Authority immunoglobulin Criteria, which statement is correct?
- A. Not eligible until two serious infections occur within 6 months
- B. Eligible now, with a review within 6 months
- C. Eligible only after prophylactic antibiotics have failed
- D. Not eligible, as CLL is not a qualifying condition
- E. Eligible only if his pneumococcal vaccine response is poor
Answer: B
B. Correct. An IgG under 4 g/L, excluding paraprotein, qualifies whatever the infection history; review within 6 months, then at least yearly (NBA Criteria 2025).
A. The infection rules apply only when IgG is above 4 g/L but below the reference range.
C. The Criteria do not require a failed antibiotic trial; antibiotics may be added to Ig.
D. CLL is a named condition under secondary hypogammaglobulinaemia with haematological malignancy.
E. Vaccine response is not a qualifying criterion for this condition.
2. A 45 year old man with Hodgkin lymphoma, in complete remission for 3 years after chemotherapy, needs red cells for an upper gastrointestinal bleed. He is CMV seropositive. Which red cell modification does Lifeblood guidance recommend?
- A. Irradiated red cells
- B. CMV seronegative red cells
- C. Washed red cells
- D. None, as he is in remission
- E. Irradiated only within 2 years of chemotherapy
Answer: A
A. Correct. In Hodgkin lymphoma, irradiated cellular components are recommended during treatment and indefinitely after remission, to prevent TA-GVHD (Lifeblood 2026, from ANZSBT).
B. He is already CMV seropositive, and all Australian cellular components are leucodepleted.
C. Washing is for recurrent severe allergic reactions, not TA-GVHD prevention.
D. Remission does not remove the recommendation in Hodgkin lymphoma.
E. There is no time limit in Hodgkin lymphoma; the recommendation is indefinite.
3. A 79 year old woman taking warfarin for atrial fibrillation presents with an intracerebral haemorrhage. Her INR is 4.2. Following the 2025 Australian and New Zealand recommendations, which reversal is most appropriate?
- A. Four-factor PCC and vitamin K
- B. Four-factor PCC, vitamin K and fresh frozen plasma
- C. Fresh frozen plasma and vitamin K
- D. Vitamin K alone, then repeat the INR
- E. Withhold warfarin and give tranexamic acid
Answer: A
A. Correct. THANZ (MJA 2025): four-factor PCC replaces three-factor PCC for urgent reversal, with vitamin K for sustained effect.
B. FFP was added to three-factor PCC for factor VII; four-factor PCC makes it unnecessary.
C. FFP is slower and needs a large volume; Lifeblood advises against it when four-factor PCC is given.
D. Vitamin K takes hours to work; critical bleeding needs immediate factor replacement.
E. Tranexamic acid does not replace the missing vitamin K dependent factors.