MBBS OSCE · Haematology
OSCE — Haemolytic Anaemia
Eight-minute OSCE station on Haemolytic Anaemia: focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Haemolytic Anaemia.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.[1]
Clinical context
Haemolytic anaemia is anaemia caused by premature destruction of red blood cells (lifespan shortened from the normal 120 days) at a rate that exceeds marrow compensation. Classify by site (intravascular vs extravascular) and by origin (inherited vs acquired). Biochemical signature: raised reticulocytes, raised LDH, raised unconjugated bilirubin, low/absent haptoglobin, with haemoglobinaemia/haemoglobinuria in intravascular forms. The direct antiglobulin (DAT/Coombs) test is the single most important discriminator: positive = immune (warm IgG AIHA, cold IgM agglutinin, paroxysmal cold haemoglobinuria), negative = non-immune (hereditary spherocytosis, G6PD deficiency, PNH, microangiopathic, sickle cell, thalassaemia).[1]
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).[1]
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Sudden fall in haemoglobin with reticulocytopenia in a chronic haemolytic patient — parvovirus B19 aplastic crisis; transfuse |
| Safety | Cola-coloured urine + schistocytes + thrombocytopenia + neurology/renal — TTP/HUS; emergency plasma exchange |
| Safety | AIHA with Hb under 70 g/L or haemodynamic compromise — urgent transfusion of least-incompatible blood |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.[2][3][1]
References3ShowHide
- [1]Phillips J, Henderson AC. Hemolytic Anemia: Evaluation and Differential Diagnosis Am Fam Physician, 2018.PMID 30215915
- [2]Jäger U, Barcellini W, Broome CM, et al. Diagnosis and treatment of autoimmune hemolytic anemia in adults: Recommendations from the First International Consensus Meeting Blood Rev, 2020.PMID 31839434
- [3]Di Sabatino A, Carsetti R, Corazza GR. Post-splenectomy and hyposplenic states Lancet, 2011.PMID 21474172