Polycythaemia

ADULT

  • 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.

    • History of amaurosis fugax or TIA
    • Symptoms of hyper viscosity
    • 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.
    • Refer to local HealthPathways or local guidelines
    • Polycythaemia may be defined as primary or secondary based on the presence or absence of suppressed erythropoietin (EPO) and/or an acquired mutation of the JAK2 gene (JAK2 V617F and exon 12). Patients with primary polycythaemia (polycythaemia vera or inherited polycythaemia) have a JAK2 mutation in more than 97% of cases. Low EPO levels are also a common characteristic of primary polycythaemia.
    • Patients with secondary polycythaemia rarely benefit from venesection however it is important to define the cause in such a circumstance as polycythaemia may be an epiphenomenon of a more sinister non-haematological disorder such as renal cell carcinoma, OSA or advanced pulmonary disease (COPD) that requires its own specific management.
    • It is reasonable to not refer patients for haematology review if polycythaemia is transient or mild (HCT <0.51for men, <0.48 for women) and primary polycythaemia has been excluded (JAK2 negative with high EPO) however appropriate investigation and follow up for important secondary causes must be undertaken.
    • 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.
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Hb > 200g/L and asymptomatic
  • HCT > 0.6 (men), >0.56 (women) and asymptomatic
  • Hb (upper limit of normal) with thrombosis or symptoms of hyper viscosity
Category 2
(appointment within 90 calendar days)
  • Hb > upper limit of normal with:
    • JAK2 V617F or exon 12 mutation and/or
    • suppressed EPO (no thrombosis symptoms)
Category 3
(appointment within 365 calendar days)
  • Hb > upper limit of normal to 200g/L or HCT 0.51 to 0.60 (men) with no red flags
  • Hb > upper limit of normal to 185g/L or HCT 0.48 to 0.56 (women)

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
  • E/LFT
  • Smoking history

3. Additional referral information Useful for processing the referral

  • JAK2 V617F PCR*
  • Erythropoietin level (EPO)
  • JAK2 exon 12 mutation testing (if JAK2 V617F negative and EPO below normal range)
    USS abdomen (renal or hepatic tumour)
  • CXR (malignancy/COPD)
  • BMI
  • History of OSA
  • Testosterone replacement

    • * 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

  • 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.)

  • 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

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