Haematology

If clinical concerns but doesn't appear to fit criteria, consider using A&G through ERS.

For blood count or blood film suggestive of Acute Leukaemia or Chronic Myeloid Leukaemia, discuss immediately with Duty Haematology Consultant or STs.

Significant Lymphadenopathy

IF:

  • Persisting for > 6 wks
  • > 2 cm
  • Widespread
  • Associated splenomegaly, night sweats or weight loss

Before referring, please ensure glandular fever test is negative if patient < 30 years and localised infections treated. Also consider HIV infection.

Combination of Following Symptoms

  • Drenching night sweats
  • Fever
  • Weight loss (>10% of body weight in 3 months)
  • Unexplained recurrent infections
  • Bone Pain
  • Lymphadenopathy
  • Splenomegaly (ensure splenomegaly is not secondary to chronic liver disease)

Results

  • Anaemia (exclude Iron deficiency and megaloblastic anaemia
  • Bone X-ray suggestive of myeloma
  • Paraprotein found in blood or urine - Request serum free light chain analysis. Consider using Advice & Guidance
  • FBC/ film abnormal (Isolated lymphocytosis/ CLL is not 2ww indication unless anaemic and/ or thrombocytopenic). Please refer through normal channels.

For interpretation and management please see:

Derbyshire Shared Care Pathology Guidelines

Significant Weight Loss Only?

Non Site-Specific Pathway