Borders Ref Help Toolkit
How to refer- Referral should be made via SCI Gateway.
Who to refer
Refer a person with any of the following to the Haematology Service as a USC:
Lymphocyte count >5 x 109/l and any of the following features:
- weight loss, fever, or drenching night sweats
- lymphadenopathy and/or splenomegaly
- cytopenia (haemoglobin less than 100g/l, neutrophils less than 1.0 x 109/l, platelets less than 100 x 109/l)
- Test results reported as suggestive of a diagnosis of myeloma (raised paraprotein concentrations, paraprotein bands, or abnormal sFLC or urinary Bence Jones proteins) with one or more CRAB criteria (Raised Calcium, Renal impairment, Anaemia, or Bone pain)
- Generalised lymphadenopathy particularly with systemic upset (g. drenching night sweats or unintentional weight loss) and/or hepatomegaly and/or splenomegaly
Refer the following for consideration of assessment and / or biopsy via local pathways as a USC:
- Unexplained isolated lymphadenopathy (2cm or more in size, persisting for six weeks or more, or increasing in size)
Good Practice Points:
CLL in an older person should be discussed with a haematologist but many cases do not require detailed haematological review.
Asymptomatic monoclonal gammopathy may be followed up in primary care – consider discussion with a haematologist if any concern
Lymphocytosis or raised paraproteins:
Blood test results showing lymphocytosis or raised paraprotein levels without the additional features outlined in the referral criteria above, should not be referred as USC. Local guidelines should be followed for non-USC referral or primary care management.
Myeloma is a difficult cancer to identify, especially in its early stages as it often presents with vague symptoms which could also have many other alternative causes. If blood tests are normal, myeloma is unlikely and other causes of the symptoms should be considered, investigated or referred via non-specific pathways as appropriate.
Detailed clinical information submitted at the time of request for a blood test helps to improve advice and onward referral for patients.
Safety netting:
Baseline tests and investigations should be repeated if a person’s condition remains concerning and unexplained following investigation for other causes. This should be combined with safety netting advice for the patient. For people presenting with non-specific symptoms, the clinician should always consider checking HIV status along with other routine investigations.
Splenomegaly:
Splenomegaly can be identified on imaging (e.g. USS or Computed Tomography (CT) abdomen). When assessing splenomegaly, the spleen size calculator could be a useful resource.
Rarer blood cancers:
Further information on blood cancers including rarer cancers such as myeloproliferative neoplasms and myelodysplastic syndromes can be found via Blood Cancer UK or Cancer Research UK resources.
Children and young people:
The SRG for haematological cancers in children and young people has different criteria than the adult guideline. Please check the relevant section when considering children and young people.