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.

  • platelet count >1000 x 109 /L, associated with any of the associated features
    • deep vein thrombosis (DVT)
    • pulmonary embolism (PE)
    • transient ischaemic attack
    • cerebral vascular accident
    • myocardial infarction
    • unstable angina
    • other non-specified thrombotic event
    • clinically significant bleeding

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

Inclusions

  • persistently elevated (over 3 months) platelet counts above 450 X 109/L that are not associated with iron deficiency, post splenectomy or active/chronic inflammation

Exclusions

  • isolated elevated platelet count due to iron deficiency, infections or inflammation

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • persistent platelet count >1000 x 109/L regardless of symptoms
  • persistent platelet level > 600 X 109/L
    • without iron deficiency or post splenectomy, and
    • recent thrombosis or symptoms of hyperviscosity

Category 2 (appointment clinically indicated within 90 days)

  • persistent platelet level > 600 X 109/L, asymptomatic

Category 3 (appointment clinically indicated within 365 days)

  • persistent platelet level >450-600 x 109/L

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.

  • blood results:
    • complete blood examination (CBE), showing previous blood counts to help assess chronicity
    • blood film examination
    • liver function tests (LFTs)
    • lactase dehydrogenase (LDH)
    • electrolytes, urea, creatinine (EUC)
    • estimated glomerular filtration rate (eGFR)
    • iron studies
    • c-reactive protein (CRP)
    • JAK2 V617F mutation, if available
  • history of smoking
  • history of malignancies, recent trauma or surgeries

Additional information to assist triage categorisation

  • myeloproliferative leukaemia (MPL) mutation, not medicare rebatable
  • calreticulin (CALR), not medicare rebatable

Clinical management advice

Thrombocytosis is defined as platelet count >450 x 109/L. Thrombocytosis may be associated with iron deficiency, reactive or inflammatory conditions. Thrombocytosis is also commonly seen post splenectomy. Occasionally, thrombocytosis may be associated with bone marrow disorders such as a myeloproliferative neoplasm (MPN), chronic myeloid leukaemia or myelodysplasia. In myeloproliferative disorders, very high platelet counts can be associated with both thrombosis and bleeding risk (due to platelet dysfunction).

Clinical 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.