Neutrophilia
ADULT
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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.
- Splenomegaly
- Basophilia
- Leucoerythroblastic film
- 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.
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- Refer to local HealthPathways or local guidelines
- Patients with high neutrophilia and with high fever/sweats are likely to have an infective cause and urgent referral to Emergency should be considered.
- Most cases of neutrophilia are reactive and not associated with haematological malignancy. Co-existing persistent, non-reactive monocytosis (monocytes >1.0 x109/L) may be seen in chronic myelomonocytic leukaemia (CMML). Additionally potential red flags include associated polycythaemia, thrombocytosis, basophilia or leucoerythroblastic blood film which should raise a clinical suspicion of a potential myeloproliferative neoplasm.
- Isolated mild neutrophilia (Neut 8-15 x 109/L) may commonly be seen in chronic smokers, patients receiving corticosteroids and during pregnancy and if non-progressive and not associated with splenomegaly, or clonality (BCR ABL and JAK2 negative) then may be safely followed up in primary care 3-6 monthly.
- JAK2 V617F and BCR-ABL testing should be considered as part of a diagnostic work-up under specialist oversight. Please note that these tests may incur costs if not requested in alignment with Medicare criteria.
| Category 1 (appointment within 30 calendar days) |
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| Category 2 (appointment within 90 calendar days) |
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| Category 3 (appointment within 365 calendar days) |
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Please insert the below information and minimum referral criteria into referral
1. Reason for request Indicate on the referral
- To establish a diagnosis
- For treatment or intervention
- For advice and management
- For specialist to take over management
- Reassurance for GP/second opinion
- For a specified test/investigation the GP can't order, or the patient can't afford or access
- Reassurance for the patient/family
- For other reason (e.g. rapidly accelerating disease progression)
- Clinical judgement indicates a referral for specialist review is necessary
2. Essential referral information Referral will be returned without this
- Serial FBC
- ESR, CRP
- E/LFT
3. Additional referral information Useful for processing the referral
- BCR-ABL & JAK2 V617F testing*
- Smoking history including cannabis use
*JAK2 V617F and BCR-ABL testing should be considered as part of a diagnostic work-up under specialist oversight. Please note that these tests may incur costs if not requested in alignment with Medicare criteria.
4. Request
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Patient's Demographic Details
- Full name (including aliases)
- Date of birth
- Residential and postal address
- Telephone contact number/s – home, mobile and alternative
- Medicare number (where eligible)
- Name of the parent or caregiver (if appropriate)
- Preferred language and interpreter requirements
- Identifies as Aboriginal and/or Torres Strait Islander
Referring Practitioner Details
- Full name
- Full address
- Contact details – telephone, fax, email
- Provider number
- Date of referral
- Signature
Relevant clinical information about the condition
- Presenting symptoms (evolution and duration)
- Physical findings
- Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
- Body mass index (BMI)
- Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
- Current medications and dosages
- Drug allergies
- Alcohol, tobacco and other drugs use
Reason for request
- To establish a diagnosis
- For treatment or intervention
- For advice and management
- For specialist to take over management
- Reassurance for GP/second opinion
- For a specified test/investigation the GP can't order, or the patient can't afford or access
- Reassurance for the patient/family
- For other reason (e.g. rapidly accelerating disease progression)
- Clinical judgement indicates a referral for specialist review is necessary
Clinical modifiers
- Impact on employment
- Impact on education
- Impact on home
- Impact on activities of daily living
- Impact on ability to care for others
- Impact on personal frailty or safety
- Identifies as Aboriginal and/or Torres Strait Islander
Other relevant information
- Willingness to have surgery (where surgery is a likely intervention)
- Choice to be treated as a public or private patient
- Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
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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.
- Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
- A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.
- Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.
Last updated: 2 June 2025
© State of Queensland (Queensland Health) 2023
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