The task
Assume that today's date is 5 November 2026. Ms Keevers has attended for review of her latest blood results. This is original independent practice material.
You are Ms Keevers's general practitioner. Using the information in the case notes, write a referral letter to Dr Sumathi Alagappan, Consultant Haematologist, requesting outpatient assessment of persistent thrombocytopenia of uncertain cause. Address the letter to Dr Sumathi Alagappan, Consultant Haematologist, Specialist Outpatient Clinic, 18 Station Road, Victoria 3000, Australia. In your answer: expand the relevant notes into complete sentences; do not use note form; use letter format. The body of the letter should be approximately 180–200 words.
Length: the body of the letter should be about 180–200 words. You have 45 minutes in the test: 5 minutes to read, 40 to write. Letter type: Referral letter.
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Which case notes belong in this letter?
Persistent thrombocytopenia: referral
You are Ms Keevers's general practitioner. Using the information in the case notes, write a referral letter to Dr Sumathi Alagappan, Consultant Haematologist, requesting outpatient assessment of persistent thrombocytopenia of uncertain cause. Address the letter to Dr Sumathi Alagappan, Consultant Haematologist, Specialist Outpatient Clinic, 18 Station Road, Victoria 3000, Australia. In your answer: expand the relevant notes into complete sentences; do not use note form; use letter format. The body of the letter should be approximately 180–200 words.
Mark every line: Include keeps the specific detail; Compress keeps the relevant gist in fewer words; Omit leaves it out. Then compare your choices with our reviewed analysis. Some choices are optional.
Download practice checklist (PDF)
One-page worksheet. Answers and reasons are on the linked webpage, so you can practise before checking.
Case notes
Patient details
- Name: Ms Marie-Claire Keevers
- DOB: 16/06/1977 (49 yrs)
- Review: 05/11/26 — latest FBC discussed
- Occupation: accounts administrator; working usual hours
Social background
- Lives with partner; independent in daily activities
- Alcohol: approximately 2 standard drinks/week; no previous heavy use
- Non-smoker
- Enjoys gardening and crossword puzzles
- Complained that receptionist sounded impatient during booking
- Sister privately disclosed arguments about family inheritance
Medical history
- No known liver disease, autoimmune disorder or previous bleeding disorder
- No prescribed, OTC or herbal medicines; no recent medication changes
- No recent febrile illness; no family history of abnormal bleeding
- Appendicectomy 2008 — uncomplicated
Assessment and visit notes
- Platelets (×10⁹/L): 03/09/26 86 → 01/10/26 79 → 05/11/26 77
- Previous platelets: 194 ×10⁹/L, June 2024
- Citrate sample confirms thrombocytopenia; film: no clumping or abnormal cells
- Hb and neutrophils within laboratory reference intervals throughout
- No epistaxis, gum bleeding, heavy periods, haematuria or gastrointestinal bleeding
- No excessive bruising or petechiae
- Feels well; no fever, night sweats or weight loss
- Examination: no lymphadenopathy or hepatosplenomegaly
- Alert; observations unremarkable; no active bleeding
Investigations
- LFTs, renal function, B12 and folate: unremarkable
- HIV, hepatitis B/C screening negative; consent obtained
Plan
- Cause remains uncertain; no specific diagnosis established
- Routine haematology referral: assess persistent isolated thrombocytopenia; advise further investigation/management
- No platelet-directed treatment commenced
- Advised urgent medical assessment if new bleeding develops
- Serial blood results and film report enclosed
Who is reading, and what do they need?
Dr Sumathi Alagappan is the consultant haematologist receiving this outpatient referral. Identify Ms Marie-Claire Keevers, aged 49, without allowing demographics to overshadow the request. The reader needs the platelet chronology, confirmation findings, current absence of bleeding and uncertainty about the cause. The bleeding history may be accurately summarised as 'no bleeding symptoms'. Selected supporting findings can inform assessment, while enclosed reports reduce the need to reproduce every investigation.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Persistent isolated thrombocytopenia; cause uncertain; routine haematology assessment and investigation/management advice requested. | Defines the referral purpose and preserves diagnostic uncertainty without assigning an unsupported diagnosis. |
| Platelets ×10⁹/L: 03/09/26 86; 01/10/26 79; 05/11/26 77. | Provides the dated evidence of persistence that the specialist is being asked to assess. |
| Citrate confirms thrombocytopenia; film shows no clumping or abnormal cells. | Documents confirmation of the platelet finding and the film observations relevant to further assessment. |
| No bleeding symptoms reported: no epistaxis, gum bleeding, heavy periods, haematuria or gastrointestinal bleeding. | The current absence of bleeding informs outpatient triage; 'no bleeding symptoms' conveys this without listing every category. |
| Hb/neutrophils within reference intervals throughout; no lymphadenopathy or hepatosplenomegaly. | Selected blood count or examination findings can support the description of isolated thrombocytopenia and inform assessment. |
| Unremarkable LFTs, renal function, B12/folate; HIV and hepatitis B/C screening negative. | Selected results can show investigation already undertaken; name the tests summarised without implying that every possible investigation was normal. |
| No prescribed, OTC or herbal medicines; no recent medication changes. | Selected medication details or an accurate summary can inform assessment of exposure without implying that a cause has been excluded. |
| No platelet-directed treatment commenced; serial blood results and film report enclosed. | Can clarify management to date and direct the reader to supporting evidence without duplicating reports. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Accounts administrator, working usual hours; lives with partner; independent in daily activities. | Employment and domestic arrangements do not materially advance this investigation request. |
| Non-smoker; enjoys gardening and crossword puzzles. | These lifestyle details do not help the haematologist assess the documented platelet abnormality. |
| Receptionist sounded impatient during booking. | The booking complaint has no bearing on specialist assessment or management. |
| Sister privately disclosed arguments about family inheritance. | Private family conflict supplies no documented clinical explanation and is unnecessary for this referral. |
| Uncomplicated appendicectomy in 2008. | Although surgical history may appear relevant to bleeding, this remote uncomplicated procedure adds little to the specific current assessment. |
| Existing advice about new bleeding. | May be omitted from this investigation-focused referral; detailed patient safety instructions are not requested. |
A paragraph plan for this case
Open with the assessment request, uncertain cause and dated platelet results, followed by citrate confirmation and film findings. Then clearly convey the current absence of bleeding; 'no bleeding symptoms' is an acceptable summary. Add selected supporting history, symptoms, examination findings or investigation results where useful. Optional grouped notes may be partly selected or accurately compressed without reproducing every detail or broadening their meaning. Close with the requested investigation/management advice, optionally noting treatment status and enclosed reports.
Where candidates slip on this task
- Use 5 November 2026 as the review date; distinguish the September–November results from the optional June 2024 platelet count of 194 ×10⁹/L.
- Use liver, autoimmune and bleeding history, medication exposure, recent febrile illness, family bleeding history and alcohol use only as supporting context; these notes do not establish or exclude a cause.
- Do not diagnose immune thrombocytopenia or treat the film and other unremarkable investigations as excluding alternative causes; preserve uncertainty and the routine outpatient assessment request.
No model letter is published here. Write for the named reader from the case notes in the timed editor, then get it marked.
Write it in the timed editor and get marked on the 6 criteria
More Medicine letter tasks
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Your profession's guide: OET Medicine. Layout and structure: OET letter format.
Questions about this task
Should the referral propose immune thrombocytopenia as the diagnosis?
No specific diagnosis has been established in these notes. Keep the focus on persistent isolated thrombocytopenia of uncertain cause and the request for specialist assessment. Citrate confirmation and the film findings support the referral but do not establish immune thrombocytopenia.
Must every relevant negative and investigation appear in the body?
No. Prioritise the dated platelet results, citrate and film findings, current absence of bleeding, diagnostic uncertainty and specialist request. 'No bleeding symptoms' accurately summarises the documented bleeding history without listing all five categories. Optional medication details, systemic symptoms and investigation results may be partly selected, accurately summarised or omitted according to usefulness and space. Do not broaden a summary beyond the documented facts. The enclosed reports provide supporting investigation detail.
Sources
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