Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • suspected spinal cord compression, superior vena cava syndrome (SVC), high corrected calcium (>3.0mmol/L)

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Category 1 (appointment clinically indicated within 30 days)

If any of the following are present:

  • symptomatic lymphadenopathy
  • markedly elevated lactase dehydrogenase (LDH) (> 300U/L)
  • bulky disease (>3cm diameter of LN mass)
  • marked B symptoms:
    • presence of persistent high-grade fever (>38C), drenching night sweats, unexplained weight loss (>10% weight loss in 6 months) or new onset severe intractable pruritus
  • concurrent unexplained cytopenia's (for example, anaemia (haemoglobin < 105g/L), thrombocytopenia (platelets < 120 x 109/L)
  • extra nodal masses
  • clinical history of rapid growth

If in doubt over whether to refer urgently or observe, discuss with the duty haematologist regarding the optimal timing and route for referral.

Category 2 (appointment clinically indicated within 90 days)

  • patients who are clinically well with stable minor enlargement of LN (<2cm) persisting for >6 weeks with no obvious infective precipitant
  • if all the following are present. 
    • asymptomatic or minimally symptomatic lymphadenopathy
    • normal FBC and stable creatinine and liver function
    • clinical history of slow growth
    • non bulky disease
    • clinically well with absence of the fevers, night sweats and weight loss or pruritus

If the patient’s situation changes, re-refer for urgent review.

Category 3 (appointment clinically indicated within 365 days)

  • minor borderline but persistent lymphadenopathy which is non-progressive with stable chronic lymphocytic leukaemia (CLL) phenotype

Essential referral information

Completion required before first appointment to ensure patients are ready for care. 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.

  • current medications and allergies
  • past medical history
  • detailed history of present signs and symptoms
    • duration of lymphadenopathy
    • weight loss
    • night sweats
    • fevers
    • pruritus +/- rash
  • blood results:
    • complete blood examination (CBE)
    • blood film examination
    • liver function tests (LFTs)
    • electrolytes, urea, creatinine (EUC)
    • estimated glomerular filtration rate (eGFR)
    • lactate dehydrogenase (LDH)
    • calcium
    • serum electrophoresis (EPG)
  • prior imaging, including computed tomography (CT) staging scans of the neck, chest, abdomen and pelvis with contrast
  • biopsy results confirming presence of a lymphoproliferative disorder
    • a core or excisional biopsy is required for the definitive diagnosis and histological subtyping of a lymphoproliferative disorder. If lymphoma is suspected, it is preferable to obtain 2 x 18G core biopsies (one core sent in formalin for histology and the second sent fresh for flow cytometry). A fine needle aspiration (FNA) should only be performed if required to exclude a solid organ malignancy.

Additional information to assist triage categorisation

  • angiotensin converting enzyme (ACE), viral serologies, as clinically indicated
  • lymphocyte surface markers

Clinical management advice

Lymphadenopathy may occur in infective, inflammatory, or malignant conditions and may be isolated or widespread involving more than one nodal group. Concerning features associated with lymphadenopathy are:

  • progressive, persistent lymphadenopathy
  • constitutional symptoms (night sweats, unexplained weight loss, fevers)
  • hepatosplenomegaly.

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient 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

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.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • 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 pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.