Haematology

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    Emergency treatment required - needs discussion with on call specialist and/or emergency department

    NB: Cancer in a child or young person is uncommon but must be addressed as a matter of urgency. Advice should be sought from an on-call specialist and/or emergency department when a diagnosis of cancer is strongly suspected.

    Biopsy proven new diagnosis of lymphoma

    • Highly aggressive lymphoma
      • Burkitt’s lymphoma
      • lymphoblastic lymphoma
    • Symptomatic hypercalcaemia
    • Biochemical changes suggestive of tumour lysis syndrome
    • Severe or life-threatening symptoms (spinal cord, SVC compression, ureteric compression, airway compromise etc)

    Bleeding disorders

    • Consider urgent referral for pregnant patients

    Chronic anaemia

    • Haemolytic anaemia
    • Any evidence of pancytopenia (Hb <100g/L, Neutrophils <1.0, PLT <50)
    • Abnormal blood film (circulating blasts, leucoerythroblastic or dysplastic changes)
    • New unexplained back pain along with features of myeloma
    • Hypercalcaemia

    Haemoglobinopathies

    • Acute presentation of severe pain, acute chest syndrome, stroke, or priapism

    Lymphadenopathy for investigation

    • Symptomatic hypercalcaemia
    • Biochemical changes suggestive of tumour lysis syndrome
    • Elevated LDH >1000
    • Severe or life-threatening symptoms (spinal cord, SVC compression, ureteric compression, airway compromise etc)
    • Other organ dysfunction

    Lymphocytosis

    • Lymphocytosis with associated haemolytic anaemia
    • Associated tumour lysis syndrome

    Multiple myeloma

    • Symptomatic hypercalcaemia
    • Severe or life-threatening symptoms (spinal cord, SVC compression, ureteric compression, airway compromise etc.)
    • New severe renal impairment

    Neutropenia (isolated)

    • Any patient with a neutropenia <1.0 X 109/l and signs of sepsis should be urgently referred to Emergency
    • Circulating blasts on blood film
    • Abnormal lymphoid cells
    • Low fibrinogen
    • Pancytopenia

    Neutrophilia

    • Splenomegaly
    • Basophilia
    • Leucoerythroblastic film

    Pancytopenia

    • Pancytopenia and
      • Febrile/unwell
    • Severe pancytopenia (any 2 or more of):
      • Hb <80gm/L
      • Neutrophils <0.5X109/L
      • Plts <30X109/L
    • Presence of features on blood film of:
      • Disseminated intravascular coagulation
      • Circulating Blasts on blood film
      • Leucoerythroblastic
      • Raised LDH

    Paraproteinaemias (monoclonal only)

    • Haemolytic anaemia
    • Any evidence of pancytopenia (Hb <100g/L, Neutrophils <1.0, PLT <50)
    • Abnormal blood film (circulating blasts, leucoerythroblastic or dysplastic changes)
    • New unexplained back pain
    • Symptomatic Hypercalcaemia
    • Weight loss
    • Splenomegaly
    • Lymphadenopathy
    • Fevers/night sweats
    • Presence of a paraprotein or abnormal serum free light chain ratio

    Polycythaemia

    • History of amaurosis fugax or TIA
    • Symptoms of hyper viscosity

    Raised ESR

    • Haemolytic anaemia
    • Any evidence of pancytopenia (Hb <100g/L, Neutrophils <1.0, PLT <50)
    • Abnormal blood film (circulating blasts, leucoerythroblastic or dysplastic changes)
    • Symptomatic Hypercalcaemia
    • Splenomegaly
    • Lymphadenopathy
    • Fevers/night sweats
    • Presence of a paraprotein or abnormal serum free light chain ratio

    Thrombocytopenia

    • All patients with low platelets and active bleeding should be referred to Emergency.
    • All patients with a platelet level of < 10 X 109/l should be urgently referred to Emergency
    • Any evidence of pancytopenia (Hb <100g/L, Neutrophils <1.0 and thrombocytopenia)
    • Raised LDH (seen in TTP)
    • Associated new renal impairment

    Thrombocytosis

    • Platelet count of above 1000
    • TIA’s or Amaurosis fugax
    • Aquagenic prurtits

    Thrombophilia

    • Occurrence of acute thrombotic event

  • Please note this is not an exhaustive list of all conditions for outpatient services and does not exclude consideration for referral unless specifically stipulated in the CPC out of scope section.

  • The following are not routinely provided in a public Haematology service.

    • Elevated ferritin with normal/low transferrin saturation unless specific concerns
    • Simple folate, B12 deficiency
    • Isolated lymphopenia without evidence of lymphoproliferative disorder
    • Mild stable isolated cytopenia (Neutrophils >1.5, platelets >100, Hb>100) with unremarkable blood film
    • Isolated raised ESR, CRP or microglobulin without evidence of lymphoproliferative disorder or myeloma
    • Isolated red cell macrocytosis without cytopenia’s and otherwise unremarkable blood film
    • Iron deficiency with Hb >100

Last updated: 3 June 2025

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