Haematology 2ww Care Pathway

Review in progress

Disclaimer: The guidance contains helpful primary care information for management of referrals and up to date referral criteria. These guidelines are locality specific to best reflect local services. This guidance does not override or replace the individual responsibility of healthcare and social care professionals involved in the delivery of care to make informed professional judgements appropriate to the circumstances of the individual.

Scope

REFERRAL GUIDELINES FOR SUSPECTED HAEMATOLOGICAL CANCER (All patients will be seen within 2 weeks of referral)

  • Refer a patient who presents with symptoms suggesting haematological cancer as detailed in the NICE guidance below.
  • Only refer when patient is available to attend an appointment within the next 14 days

Assessment

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

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)

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

Please refer to NICE referral guidelines for suspected cancer

Referral

Referral Criteria

Immediate referral as an emergency:

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

Urgent 2ww:

  • Refer urgently patients with persistent unexplained splenomegaly.

*Lymphoma

  • Patients with one or more neck lumps, who do not have a lymphocytosis, but in whom a diagnosis of lymphoma is suspected should be referred to the neck lump clinic via the Head & Neck 2ww referral form If there are enlarged lymph nodes elsewhere in the body, or a significant lymphocytosis is present, please refer these patients via the Haematological malignancy referral form

Referral Instructions

Supporting Information

Assurance & Governance

  • This guidance was developed on: 05.2017
  • This guidance was ratified by: OSCAR Assurance Group
  • Date ratified: 05.2017
  • Publication Date: 05.2017
  • Review Date: 05.2019
  • Ref No: CA5 – 05.2017
Any feedback or suggestions to improve this guidance should be sent to: oscaradmin@this.nhs.uk
Only the electronic version is maintained, once printed this is no longer a controlled document

 

Home > Care Pathways > Cancer* > Haematology 2ww Care Pathway