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.

  • injury or bleeding in a person with a known bleeding disorder (for example, haemarthrosis)

Please contact the duty haematologist via switchboard so the referral may be expedited, and the patient reviewed as soon as possible

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Inclusions

  • a patient with a suspected bleeding disorder that requires the development of a primary care management plan. Urgency of review will be influenced by;
    • any planned surgical intervention
    • the severity of abnormal blood results

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • nil

Category 2 (appointment clinically indicated within 90 days)

  • pregnant and suspected Von Willebrand Disease or other bleeding disordera patient with a suspected bleeding disorder with
    • any planned surgical intervention
    • moderately to markedly abnormal blood results

Patients may be seen in less than 90 days depending on the clinical information provided.

Category 3 (appointment clinically indicated within 365 days)

  • any patient with a suspected bleeding disorder not meeting the above criteria. Usually seen within 3 to 6 months.

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 medication list
  • past medical history
  • if appropriate, Von Willebrand Disease screen OR coagulation assays appropriate to family history, for example factor assays for haemophilia
  • history of bleeding diathesis
    • gum bleeding post brushing, menorrhagia, spontaneous haematomas, bleeding post-surgical intervention (including minor and major surgery), hemarthrosis, gastrointestinal and intracranial bleeding
    • bleeding requiring blood transfusion or inpatient hospital admission
  • family history of bleeding disorders

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)
  • coagulation studies, including:
    • international normalised ratio (INR)
    • activated partial thromboplastin time (APTT)
    • fibrinogen

Clinical management advice

Any patient with a known severe bleeding disorder and active bleeding should be referred urgently to emergency.

Serious bleeding disorders, for example, severe haemophilia A and B, will be diagnosed in early life. Less serious disorders, for example, mild von Willebrand’s disease (vWD), may present in adulthood (type 1 & 2). A form of vWD can be acquired later in life associated with autoimmune disease. Type 3 vWD can cause severe bleeding problems. Other inherited clotting factor deficiencies are very rare.

Treatment options in mild vWD include tranexamic acid and desmopressin.

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.