RCPA Haematology Fellowship Exam 2026 Study Guide: what you actually need to know.

This guide is for haematology trainees sitting the RCPA Haematology Fellowship Exam in the next 12 months. It covers all 5 components: the Part I Written Paper, Digital Slides Morphology, Dry Practical, and Part I Oral, plus the Part II Oral (lab standards, research, and leadership), with a realistic study timeline and the failure modes that catch competent candidates. PRIMEX started in 2025 when an anaesthetic trainee at a regional NSW hospital built study tools for the ANZCA Primary. It now covers 21 Australasian specialty exams because trainees from each specialty asked for it, including haematology trainees who needed a tool that could grade SAQ-style answers and run viva-style cases.

What is in this guide

• The format of every component, paper by paper, with the time allocations to verify against the college site for the 2026 sitting
• The 216 learning objectives across 133 topic areas mapped to the 15 RCPA Haematology Trainee Handbook curriculum domains, with the high-yield areas pulled out
• Three realistic study timelines (4 month, 6 month, 9 month) with weekly hours, when to start past papers, and when to begin viva practice
• The single most common failure mode, in plain language
• An FAQ that does not pretend the exam is easier than it is

The PRIMEX RCPA Haematology curriculum is maintained against the college's published syllabus, with topic mapping reviewed for accuracy. Where this guide cites format details, time allocations, or scoring rules, the standing instruction is the same: check the college site for the sitting you are entering. The college can change the structure between cycles and this guide is not a substitute for the official information pack.

Exam structure: every component, in order

The RCPA Haematology Fellowship Exam is not one paper. It is a sequence of components, and the candidates who treat it as a single exam tend to under-prepare for the practical and oral pieces. Here is what you are actually sitting.

Part I Written Paper

• 3 hr 15 min, online. MCQ and SAQ covering basic haematology sciences and laboratory methods
• The exact MCQ count and option format are not publicly specified by RCPA; do not rely on figures from other college exams
• SAQ mark schemes expect numerical thresholds: ADAMTS13 below 10 percent for TTP, blast count at or above 20 percent for AML by WHO 2022 (with genetic exceptions qualifying at any blast count)
• Day-of logistics: check the college site for venue list and any computer-based testing arrangements for your sitting

Part I Digital Slides Morphology

• 3 hr 15 min, online or at a local centre. Blood films and bone marrow aspirate/trephine cases presented as digital images, with structured SAQs per case
• You are tested on cell lineage, maturation, and the abnormalities that change a diagnosis: blasts versus reactive monocytes, toxic granulation, Doehle bodies, rouleaux, spherocytes, schistocytes, target cells, and parasites
• The cognitive process is identical to bench work: systematic film walk, differential, confirmatory investigations
• This is a separate component from the Written Paper and is assessed independently. Under-preparing it relative to the Written Paper is a common error

Part I Dry Practical

• 3 hr 15 min, online. Pre-prepared laboratory data interpretation without wet bench work
• Coagulation panels (mixing studies for lupus anticoagulant versus factor deficiency), FBCs, protein electrophoresis, chromogenic factor assays, von Willebrand disease multimer analysis, flow cytometry numbers, transfusion serology, and cytogenetics
• The data is the question. If you treat the laboratory results as backdrop instead of the substrate of the answer, you will lose marks

Part I Oral

• All-day, station-based. Each station runs 10-20 min. All candidates receive the same structured questions
• Clinical vignettes paired with laboratory data: CBC, blood film description, coagulation, flow cytometry, cytogenetics, molecular results
• Probes mechanism, not just diagnosis. Examiners ask why del(17p) predicts chemoimmunotherapy failure, why TRALI causes non-cardiogenic pulmonary oedema, why APL is a same-day emergency
• Recurring scenarios: a 55-year-old with fatigue and circulating blasts; post-cardiac surgery thrombocytopaenia on day 5 of unfractionated heparin; a young woman with menorrhagia and a prolonged APTT; rouleaux with elevated total protein and back pain; thrombocytopaenia at 32 weeks of pregnancy; post-allograft fever and diarrhoea on day 45

Part II Oral

• 3 stations of 20-30 min each. Focused on haematology lab standards, research standards, and lab innovation and leadership
• This is a consultant and leadership scope examination. The scenarios are not clinical vignettes; they are quality systems, research appraisal, and organisational leadership questions
• Candidates who prepare only Part I clinical content and then sit Part II without targeted preparation consistently find these stations harder than expected
• The 93 cross-cutting LOs in the RCPA Haematology curriculum (laboratory management, research, professional qualities) map directly to Part II content. Do not skim them

Pass mark: the college does not publish a standardised pass mark for this exam in the form of a fixed cut score across all components. The RCPA does not publish aggregate pass-rate statistics; it releases individual candidate results only. Any combined per-sitting pass figure circulating in trainee summaries is unverifiable, so rely on your own result and the published curriculum.

What the college actually tests

The RCPA Haematology curriculum on PRIMEX maps 216 LOs across 133 topic areas, organised into the 15 curriculum domains of the RCPA Haematology Trainee Handbook (January 2025). The 15 domains are foundation knowledge and laboratory practice, techniques and equipment, clinical procedures, morphology, immunophenotyping and flow cytometry, genomic studies (cytogenomics and molecular), erythrocyte / haemolysis / haemoglobin studies, coagulation studies, blood transfusion studies, paediatric haematology, obstetric haematology, other studies (paraproteins, cryoglobulins, stem cells), laboratory management quality and safety, research scholarship and education, and professional qualities and communication.

Of those 216 LOs, 123 map directly to per-topic study panels and 93 are cross-cutting LOs that sit in the curriculum tab (laboratory management, research, professional qualities). Both groups are testable. The cross-cutting domain in particular is where candidates lose easy marks: questions on quality systems, adverse event reporting, root cause analysis, and consent for testing get treated as filler when they are not.

The high-yield topic areas

1. Acute myeloid leukaemia and APL. AML classification under WHO 2022, the genetic abnormalities that define AML at any blast count (NPM1, biallelic CEBPA, t(8;21), inv(16), t(15;17)), and the FLT3 / NPM1 status that drives risk stratification. Acute promyelocytic leukaemia is the recurring emergency case. The film shows hypergranular blasts, the coagulation panel shows DIC, and the answer the examiners want is same-day all-trans retinoic acid before the cytogenetics confirm it.
2. Coagulation panels and the bleeding patient. Mixing studies, factor assays, von Willebrand workup with VWF:RCo, VWF:Ag, and FVIII activity, and the type 1 / 2A / 2B / 2M / 2N classification. Heparin-induced thrombocytopaenia with the 4T score, PF4 / heparin IgG ELISA, the serotonin release assay as the confirmatory test, and the alternative anticoagulant (argatroban, danaparoid, fondaparinux) when 4T is high. Thrombotic thrombocytopaenic purpura with ADAMTS13 less than 10 percent and plasma exchange.
3. Lymphoid malignancy and CLL. Chronic lymphocytic leukaemia FISH panel, the impact of del(17p) and TP53 mutation on treatment selection, ZAP-70 status, and the move from chemoimmunotherapy to ibrutinib or venetoclax in poor-risk disease. Diffuse large B-cell lymphoma with the GCB versus ABC distinction and the IPI score. Follicular lymphoma grades, BCL2-IGH rearrangement, and the FLIPI score. Hodgkin lymphoma and the Reed-Sternberg cell.
4. Plasma cell disorders. Multiple myeloma with the IMWG 2014 diagnostic criteria, ISS and R-ISS staging, and the role of free light chain assays. Light chain myeloma. Waldenstrom macroglobulinaemia with MYD88 L265P. Amyloidosis at the interface with renal and cardiac biopsy.
5. Transfusion medicine. Compatibility testing, the indirect antiglobulin test, the difference between TRALI and TACO (timing, BNP, response to diuretics), massive transfusion protocol triggers, platelet refractoriness with HLA alloimmunisation, and the obstetric haematology adjuncts: anti-D prophylaxis dosing and antenatal screening.
6. Bone marrow pathology and HSCT. Bone marrow biopsy interpretation, cellularity, and dysplasia. Haematopoietic stem cell transplantation with allograft versus autograft, HLA matching, and graft-versus-host disease. Acute GvHD with Glucksberg grading. Chronic GvHD with NIH scoring. Ruxolitinib for steroid-refractory disease.
7. Laboratory practice and quality. Sample cycle, LIMS, critical results reporting, and test appropriateness. The professional qualities domain that includes consent, communication, and ethics. This is where the 93 cross-cutting LOs live and where candidates underprepare.

The pitfalls that fail competent candidates

The pattern PRIMEX sees most often, watching how trainees use the platform in the months before a sitting, is not a knowledge gap. It is a process gap. The candidates who fail are usually the ones who know the textbook and cannot put the parts together under examination conditions.

• Treating the laboratory data as backdrop. In the Dry Practical and the Part I Oral, the CBC, blood film description, and coagulation panel are the question. Candidates who summarise the lab and then pivot to a generic differential lose the marks that depend on noticing the specific finding (a single blast on the differential, an MCV of 110, a fibrinogen of 0.8 with prolonged PT and APTT)
• Using FAB criteria when the WHO criteria are different. WHO 2022 sets AML at 20 percent blasts, with the genetic-defining abnormalities qualifying at any blast count. Candidates who quote 30 percent are quoting FAB and lose the answer
• Missing the AML-defining genetic abnormalities. NPM1, biallelic CEBPA, t(8;21), inv(16), t(15;17): if any of these are present, the diagnosis is AML even at 8 percent blasts. RCPA examiner reports flag this as a recurring miss
• Confusing WHO 2016 and WHO 2022. The CMML-1 blast threshold moved from less than 10 percent to less than 5 percent. Candidates citing the older threshold lose the mark
• Not knowing ADAMTS13 below 10 percent for TTP. The threshold and its sensitivity / specificity (96 percent and 95 percent) are quoted in examiner reports and asked in the viva
• Vague management. "Steroids" is not management. Methylprednisolone 1 to 2 mg per kg per day with a written taper is. Examiners want the dose, the duration, and the monitoring
• Underpreparing for the cross-cutting domains. The laboratory management, research, and professional qualities domains hold 93 cross-cutting LOs. The candidates who skim them lose easy marks
• Doing past papers without timed conditions. An SAQ practised at home with a coffee break is not a calibrated rehearsal. The exam is paced, and pace decides the borderline cases

A realistic study timeline

Three timelines below, by run-up duration. Hours per week assume you are still working clinically at variable load. If you are on protected study leave the hours can compress; if you are running a busy lab on top of trainee duties they cannot. Be honest about which one you are on.

9-month run-up (12 to 15 hours per week)

• Months 1 to 3. Foundation knowledge and laboratory practice, techniques and equipment, morphology, and immunophenotyping. Do not start with malignant haematology. Build the bench-side reasoning first. Open the curriculum tab and tick LOs as you cover them; the volume is what trips people up, not the content of any single LO
• Months 4 to 5. Clinical procedures, erythrocyte / haemolysis / haemoglobin studies, and coagulation. Start mixing in cases that integrate CBC, film, and coagulation. This is the substrate for the Dry Practical and Part I Oral
• Month 6. Genomic studies (cytogenomics and molecular), other studies (paraproteins, cryoglobulins, stem cells), and the malignant haematology load. WHO 2022 AML, CLL FISH and TP53, myeloma IMWG 2014, lymphoma GCB / ABC and IPI
• Month 7. Transfusion, paediatric, and obstetric haematology. Cross-cutting domains (laboratory management, research, professional qualities). Start past papers under timed conditions
• Month 8. Daily SAQ practice with a marker (peer or AI). Daily morphology cases. Begin viva-style cases two or three times a week with a colleague or with PRIMEX's viva simulator
• Month 9. Tapered, broad revision. Stop introducing new content in the last two weeks. Do timed past papers and timed viva-style cases. Sleep

6-month run-up (18 to 22 hours per week)

• Month 1. Foundation knowledge and laboratory practice, techniques, morphology, immunophenotyping. Push hard. Do not get stuck on any single LO; you are mapping the volume
• Month 2. Erythrocyte and coagulation domains. Begin integrating CBC and coag panel cases by the end of the month
• Month 3. Malignant haematology in full (AML, ALL, CML, CLL, lymphomas, myeloma, MDS, MPNs). Start past Part I MCQs
• Month 4. Genomics, transfusion, HSCT, paediatric and obstetric haematology, cross-cutting domains. Start Dry Practical data-interpretation drills and Part II Oral preparation (lab standards, research appraisal)
• Month 5. Daily SAQ practice. Daily morphology. Viva practice three times a week. First full mock under timed conditions
• Month 6. Tapered revision, second full mock, viva drills, light final week

4-month run-up (25 to 30 hours per week, sustainable for a short block only)

• Month 1. Foundation, morphology, immunophenotyping, erythrocyte, coagulation. This is heavy. If you can take protected leave, take it
• Month 2. Malignant haematology and genomics. By end of the month you should be mixing in Part II scenarios
• Month 3. Transfusion, HSCT, paediatric, obstetric, cross-cutting. Daily SAQs with marking. Viva practice three times a week
• Month 4. Two full mocks under timed conditions. Daily morphology. Viva drills. Final week light, sleep prioritised

Across all three timelines: start past papers when the underlying domain is mapped, not before. Doing past papers cold is morale damage with no learning. Finish past papers with at least two weeks of margin so the patterns settle.

The single biggest mistake people make

The pattern that breaks competent candidates in this exam is leaving timed practice until the last six weeks. It is not a knowledge mistake. It is a calibration mistake. You can know WHO 2022 cold and still fail an SAQ block if you have never written eight answers in a row at exam pace, in your own handwriting, with no pause to look something up. The bottleneck the exam tests is your ability to retrieve and structure under time. That bottleneck only widens with rehearsal.

You do this and you will see it: you study domain by domain for four months, you tell yourself you will do papers in the final stretch, and the first timed SAQ block reveals that you can recall facts but cannot land a structured answer in the time the marker expects. The fix is not more reading. The fix is to start timed conditions early, ideally from week eight onwards, even if you only have one domain mapped. Time pressure is a separate skill. Train it separately, train it long, and stop pretending it will assemble itself in the last fortnight.

How PRIMEX helps

• AI SAQ grader at examiner standard. Every SAQ you write gets marked against the kind of mark scheme RCPA examiners use, with specific feedback on numerical thresholds (ADAMTS13 less than 10 percent, AML 20 percent blast threshold, ISTH DIC score). Available inside the RCPA Haematology section.
• Curriculum tracker for all 216 LOs. The 15 curriculum domains, 133 topic areas, and 216 LOs are mapped in the curriculum tab with checkbox progress and per-domain progress bars, so you can see where the volume is and where you are behind.
• Ask PRIMEX. Ask any haematology question and get an answer grounded in the curriculum, with the exam-relevant numerical thresholds called out. Try it on the PRIMEX homepage.
• Viva simulator with four station types. Morphology, coagulation, malignancy, and transfusion / consultative stations. Each generates a case with CBC, blood film description, and coagulation data, and probes systematic interpretation, differential, confirmatory investigations, and management with specific drug names and doses.

Worked topic deep-dives

Three high-yield topics drawn straight from the PRIMEX RCPA Haematology study notes. Each one is a teaser; the full note carries the complete laboratory and clinical detail.

Acute haemolytic transfusion reaction

Transfusion reactions span mild urticaria to life-threatening anaphylaxis, acute haemolysis and TRALI. Recognition, systematic investigation and timely management are core haematology fellow competencies.

• Classify reactions temporally as acute (within 24 hours) or delayed, and by mechanism as immunological or non-immunological.
• For a suspected severe reaction, stop the transfusion and disconnect the pack and giving set immediately, keeping both for investigation.
• Maintain access with saline, resuscitate as needed, and collect samples including direct antiglobulin test, LDH, plasma and urine haemoglobin, and repeat compatibility testing.
• Report serious reactions to the transfusion team and the national haemovigilance scheme (the ANHVS in Australia and New Zealand).

How it is examined: the exam tests the structured first response and the haemovigilance reporting obligation. Common pitfall: discarding the blood pack and giving set, which are needed for the reaction workup.

Read the full note →

The direct antiglobulin test

The direct antiglobulin test (Coombs test) detects immunoglobulin or complement bound to red cells in vivo, using antihuman globulin reagents to bridge antibody-coated cells into visible agglutination. It is one of the most powerful assays in transfusion medicine.

• Distinguish it from the indirect antiglobulin test: the direct test interrogates the patient's own circulating red cells, while the indirect test detects free serum antibody in vitro.
• The indirect test is used for antibody screening and identification, crossmatching and antigen phenotyping.
• Polyspecific reagents contain anti-IgG and anti-complement and are the first-line screening reagent.

How it is examined: the exam tests the direct-versus-indirect distinction and the reagent choice. Common pitfall: confusing the direct and indirect antiglobulin tests and their respective indications.

Read the full note →

G6PD deficiency

Glucose-6-phosphate dehydrogenase deficiency is the most prevalent human enzyme defect, with a distribution that mirrors historical malaria endemicity, consistent with a heterozygote survival advantage against falciparum malaria.

• It is X-linked recessive, so males are predominantly affected, while heterozygous females show variable expression through X-inactivation.
• G6PD generates NADPH via the pentose phosphate pathway, the sole source of NADPH in the mature red cell, protecting against oxidative stress.
• Other clinically important red cell enzymopathies include pyruvate kinase deficiency, the most common glycolytic enzymopathy.

How it is examined: the exam tests the inheritance, the biochemistry and the laboratory diagnosis including timing relative to a haemolytic episode. Common pitfall: testing enzyme activity during acute haemolysis, when young red cells can give a falsely normal result.

Read the full note →

FAQ

Related study guides

• RCPA Anatomical Pathology 2026 Study Guide
• RACP BPT 2026 Study Guide