Referral

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Haematology

Scope

This guidance covers the referral of a patient who presents with symptoms suggesting haematological cancer to a team specialising in the management of haematological cancer, depending on local arrangements.

GPs can refer a patient they suspect of having cancer to be seen within 14 days by a specialist. GPs must send the referral within 24 hours of the decision to refer.

Please use the referral forms listed on this page to ensure appropriateness. They have been agreed by the Peninsula Cancer Network.

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Be aware that haematological cancers can present with a variety of symptoms that may have a number of different clinical explanations.

Combinations of the following symptoms and signs warrant full examination, further investigation (including a blood count and film) and possible referral:

  • fatigue
  • drenching night sweats
  • fever
  • weight loss
  • generalised itching
  • breathlessness
  • bruising
  • bleeding
  • recurrent infections
  • bone pain
  • alcohol-induced pain
  • abdominal pain
  • lymphadenopathy
  • splenomegaly

The urgency of referral depends on the symptom severity and findings of investigations.

Refer patients immediately with:

  • a blood count/film reported as acute leukaemia.
  • spinal cord compression or renal failure suspected of being caused by myeloma

Refer patients urgently with:

  • persistent unexplained splenomegaly

In patients with:

  • persistent unexplained fatigue carry out a full blood count, blood film and erythrocyte sedimentation rate, plasma viscosity or C-reactive protein (according to local policy). Repeat at least once if the patient's condition remains unexplained and does not improve
  • unexplained lymphadenopathy carry out a full blood count, blood film and erythrocyte sedimentation rate, plasma viscosity or C-reactive protein (according to local policy)
  • any of the following additional features of lymphadenopathy:
    • persistence for 6 weeks or more
    • lymph nodes increasing in size
    • lymph nodes greater than 2cm in size
    • widespread nature
  • associated splenomegaly, night sweats or weight loss investigate further and/or refer
  • unexplained bruising, bleeding and purpura or symptoms suggesting anaemia, carry out a full blood count, blood film, clotting screen and erythrocyte sedimentation rate, plasma viscosity or C-reactive protein (according to local policy)
  • persistent and unexplained bone pain, carry out a full blood count and x-ray, urea and electrolytes, liver and bone profile, PSA test (in males) and erythrocyte sedimentation rate, plasma viscosity or C-reactive protein (according to local policy)

Referral Criteria

Acute Leukaemia

  • If a blood film suggests an acute leukaemia please arrange an immediate admission with a haematologist.

Myeloma

  • Results of protein electrophoresis or a Bence-Jones protein urine test suggest myeloma.
  • Radiology reported as suggestive of myeloma and myeloma screen confirms myeloma

When considering referral take into account other features including: hypercalcaemia, abnormal full blood count, acute kidney injury.

  • A myeloma screen includes: full blood count, renal function, calcium, protein electrophoresis, urinary Bence Jones Protein
  • Myeloma is unlikely with a IgG below 15g/l or IgA below10g/l in the absence of other symptoms (e.g. renal failure, hypercalcaemia, back pain, bone marrow failure), in which case consider a routine referral
  • Spinal cord compression or acute kidney injury suspected of being caused by myeloma should be discussed more urgently with on call haematologist
  • A polyclonal (diffuse) increase in gammaglobulin is not associated with haematological malignancy.

Hodgkin's & Non-Hodgkin's lymphoma

  • Unexplained lymphadenopathy
    • Unexplained lymphadenopathy is defined as >1cm and persisting for six weeks
  • Unexplained palpable splenomegaly
  • Unexplained radiological splenomegaly plus symptoms or signs

When considering referral take into account any associated symptoms, particularly unexplained high fever, drenching night sweats (with or without weight loss), shortness of breath, pruritus or alcohol-induced lymph node pain

Please attach the following recent pathology results if available (less than 8 weeks old)

Myeloma

  • FBC, renal function, calcium, serum protein electrophoresis, urinary Bence Jones Protein

Lymphoma

  • FBC U+Es, LFTs, LDH

Chronic Lymphoid Leukaemia (CLL) is not an indication for a 2 week wait referral

Referral Instructions

The GP should use e-Referral Service to book an appointment or send the referral.

Please ensure you include:

  • The patient's NHS number
  • Tell the patient that this is an urgent referral and they will be seen within 14 days

e-Referrals selection:

  • Specialty: 2WW
  • Clinic type: 2WW Clinical Haematology
  • Service: Telephone Assessment Service-Derriford-RK9

Referral Forms

Suspected Haematological cancer referral form adults - No merge fields

Suspected Haematological cancer referral form - EMIS

Suspected Haematological cancer referral form adults - Systmone


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