Rapid Referral Guidelines for haematological cancer

Here you will find referral guidelines for the different types of blood cancer, which include leukaemia, myeloma and lymphoma.

About these guidelines

We have developed Rapid Referral Guidelines to support GPs with practical referral recommendations for children, young people and adults with symptoms of suspected cancer. The guidelines are endorsed by NICE and summarise the NG12 guidelines for suspected cancer. They can help you decide if a referral is:


Non urgent

Non urgent

Requires routine referral or tests.


Urgent

Urgent

Required within two weeks.


Very urgent

Very urgent

Required within 48 hours.


Please note, these guidelines aim to share learning and good practice but, out of necessity, they are brief in nature. They are not a substitute for your own clinical judgement or advice provided to you by a specialist.

Macmillan and NICE will not accept any liability for any type of loss caused by someone acting on information contained in the guidelines, unless liability is enforced by law.

We have recommendations on patient support, safety netting and the diagnostic process.

You can also download a copy of the guidelines (PDF).

Leukaemia referral guidelines

Very urgent

Very urgent investigation


Refer children and young people for immediate specialist assessment for leukaemia if they have:

  • unexplained petechiae
  • OR hepatosplenomegaly.

Offer a very urgent full blood count (within 48 hours) in children and young people with any of the following unexplained signs or symptoms:

  • pallor
  • persistent fatigue
  • fever
  • persistent infection
  • generalised lymphadenopathy
  • persistent or unexplained bone pain
  • bruising
  • bleeding.

Consider a very urgent full blood count (within 48 hours) in adults with any of the following unexplained signs or symptoms:

  • pallor
  • persistent fatigue
  • fever
  • persistent or recurrent infection
  • generalised lymphadenopathy
  • bruising
  • bleeding
  • petechiae
  • hepatosplenomegaly.

Accompanying notes

Immediately refer adults, children and young people with a blood count or blood film reported as acute leukaemia.

Lymphoma referral guidelines

Very urgent

Immediate specialist assessment


Consider very urgent referral (appointment within 48 hours) in children and young people with:

  • unexplained lymphadenopathy
  • OR splenomegaly.

Take in to account associated symptoms, particularly:

  • fever
  • night sweats
  • shortness of breath
  • pruritus
  • weight loss.
Very urgent

Urgent referral


Consider urgent referral (appointment within two weeks) for adults presenting with:

  • unexplained lymphadenopathy
  • OR splenomegaly.

Take into account associated symptoms, particularly:

  • fever
  • night sweats
  • shortness of breath
  • pruritus
  • weight loss
  • alcohol-induced lymph node pain.

Myeloma referral guidelines

Very urgent

Urgent investigation


Offer a full blood count, blood tests for calcium and plasma viscosity, or erythrocyte sedimentation rate (ESR) to people aged 60 and over with:

  • persistent bone pain (particularly back pain)
  • OR an unexplained fracture.
Very urgent

Very urgent investigation


Offer a very urgent protein electrophoresis and a Bence-Jones protein urine test (within 48 hours) to people aged 60 and over with:

  • hypercalcaemia or leukopenia
  • AND presentation consistent with possible myeloma.
Very urgent

Very urgent investigation


Consider a very urgent protein electrophoresis and Bence-Jones protein urine test (within 48 hours) for people with:

  • raised plasma viscosity or ESR at levels
  • consistent with possible myeloma
  • AND presentation consistent with possible myeloma.
Very urgent

Urgent referral


Urgently refer people (appointment within two weeks) if the results of their protein electrophoresis or Bence-Jones protein urine test suggest myeloma.

Glossary

In these guidelines, we use the below terms in the way they are described.

This is consistent with NICE's NG12 guidance for suspected cancer.

  • Children – from birth to 15 years
  • Young people – people aged 16–24
  • Direct access – when a test is performed and primary care retain clinical responsibility throughout, including acting on the result
  • Immediate – an acute admission or referral occurring within a few hours, or even more quickly, if necessary
  • Suspected cancer pathway referral – the patient is seen within the national target for cancer referrals (two weeks).