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.

  • new suspected chronic myeloid leukaemia or leucocytosis (neutrophilia, eosinophilia, basophilia, monocytosis) with EITHER:
    • white cell count >100 x 109/L OR
    • symptoms of hyperviscosity (headaches, visual changes, acute thrombosis, unexplained dyspnoea).
  • lymphocytosis with blasts/immature cells on blood film examination

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

Category 1 (appointment clinically indicated within 30 days)

  • suspected chronic myeloid leukaemia. Please arrange for BCR::ABL1 PCR via SA Pathology
  • unexplained leucocytosis white cell count (WCC) > 50 x 109/L (for example neutrophilia, eosinophilia, monocytosis) in the absence of reactive or inflammatory conditions
  • leucoerythroblastic blood film examination
  • lymphocytosis in association with:
    • anaemia, neutropenia, or thrombocytopenia
    • constitutional symptoms such as unexplained weight loss >10%, night sweats or unexplained fevers
    • splenomegaly or progressive lymphadenopathy

Category 2 (appointment clinically indicated within 90 days)

  • lymphocytosis >20 x 109/L
  • rapidly rising lymphocyte count, doubling time <3months with WCC >50 x 109/L. Usually seen within 6 weeks

Category 3 (appointment clinically indicated within 365 days)

  • asymptomatic persistent lymphocytosis >5 x 109/L. not fulfilling the above criteria
  • persistent leucocytosis not meeting the above criteria in the absence of reactive or inflammatory conditions

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
  • 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)
    • c-reactive protein (CRP)
    • lymphocyte surface markers performed on peripheral blood, only for lymphocytosis
    • serum immunoglobulin levels and direct antiglobulin test (Coombs test)
  • BCR::ABL1 polymerase chain reaction (PCR) via SA Pathology laboratories for suspected chronic myeloid leukaemia
  • any prior stool culture results for parasitic infections if there is eosinophilia
  • history and assessment for ‘reactive’ causes for example smoking, infection, inflammation or neoplasm
  • examination for lymphadenopathy, hepatosplenomegaly including careful palpitation of all lymph node areas, spleen and liver
  • any prior imaging
  • prior biopsy results

Additional information to assist triage categorisation

  • Antineutrophil Cytoplasmic Antibodies (ANCA)
  • extractable nuclear antigen (ENA) test
  • antinuclear antibody (ANA) test
  • strongyloides serology

Clinical management advice

Leucocytosis is defined as white cell count >11 x 109/L. The leucocytosis (neutrophilia or eosinophilia), may be reactive for example due to an allergy or parasitic infections or may indicate a primary bone marrow disorder such as chronic myeloid leukaemia, chronic eosinophilic leukaemia. It has a wide differential diagnosis ranging from normal response to infection through to haematological malignancies including acute leukaemia. Detection of a leucocytosis should prompt scrutiny of the differential white cell count, other complete blood examination parameters and blood film examination.

Lymphocytosis is associated with lymphocyte counts > 4 x 109/L Lymphocytosis can be seen in reactive conditions such as acute viral infections, post splenectomy, smoking or lymphoproliferative conditions for example, monoclonal B lymphocytosis (MBL), chronic lymphocytic leukaemia. Chronic lymphocytosis is characteristic of chronic lymphocytic leukaemia (CLL), the incidence of which peaks between 60 and 80 years of age. In its early stages, this condition is frequently asymptomatic, with treatment only being required on significant progression.

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.