Referral to a chronic myeloid leukaemia (CML) specialist

If you are over 24 years old

Your GP should consider a full blood count blood test within 48 hours if you have any of the following:

• look unusually pale

• extreme tiredness (fatigue) that won’t go away

• unexplained high temperature (fever)

• unexplained infections that won't go away or keep coming back

• swollen lymph nodes

• bruising or bleeding for no reason

• unexplained red, purple or dark spots on the skin (petechia)

• an enlarged spleen or liver on examination

Your GP should then refer you to a blood specialist if blood test results show that you might have leukaemia.

If you are aged 24 or under

Your GP should refer children and young adults immediately (within a few hours) to a specialist if they have either:

• unexplained red, purple or dark spots on the skin (petechia)

• an enlarged liver or spleen

Your GP should consider a full blood count blood test for children and young adults within 48 hours if they have any of the following:

• look unusually pale

• extreme tiredness (fatigue) that won’t go away

• unexplained high temperature (fever)

• unexplained infections that won't go away

• swollen lymph nodes

• bone pain that won't go away and can't be explained

• bruising or bleeding for no reason

Your GP should then refer you to a blood specialist if blood test results show that you might have leukaemia.

Your GP should refer you immediately to see a specialist if:

• your blood test results show you have acute leukaemia

• you have either spinal cord compression or kidney failure which your GP thinks could be caused by myeloma

Your GP should refer you urgently if you have unexplained enlarged spleen that doesn’t get smaller.

Your GP should do further tests and consider referring you to a specialist if you have a combination of some of the symptoms listed below. The urgency of the referral depends on how severe your symptoms are and your test results.

Symptoms include:

• extreme tiredness (fatigue)

• heavy sweating at night

• high temperature (fever)

• losing a lot of weight

• itching all over the whole body

• feeling breathless

• bruising

• bleeding

• infections that keep coming back

• bone pain

• pain after drinking alcohol

• tummy (abdominal) pain

• swollen lymph nodes

• enlarged spleen

If swollen lymph nodes are your only symptom, you do not usually need to see a specialist.

Same day (emergency referral)

You should have a same day (emergency) referral to a specialist if:

• your blood test result suggests that you have acute leukaemia or chronic myeloid leukaemia (CML)

• your blood test or scan results suggest that you have myeloma. And you have symptoms of spinal cord compression caused by cancer or you have kidney damage that has come on suddenly

Urgent referral

You should have an urgent referral to a specialist if you have a higher than normal number of lymphocytes in your blood and you have any one of the following:

• weight loss, high temperature (fever) or heavy night sweats

• swollen lymph nodes and, or a larger than normal spleen

• blood test results showing low levels of red blood cells, neutrophils or platelets

You should have an urgent referral to a specialist if you have test results suggesting that you have myeloma and one of the following:

• high calcium levels in your blood

• kidney problems

• anaemia

• bone pain

You should have an urgent referral to a specialist if you have lymph node swelling in two or more areas, particularly if you also have heavy night sweats or weight loss and, or:

• a larger than normal liver

• a larger than normal spleen

You should have an urgent referral to a specialist and, or a biopsy for a swollen lymph node that has no obvious cause. And the node is at least 2cm long, doesn’t go away after 6 weeks or is getting bigger.

Leukaemia

There are more guidelines for leukaemia. They say that your GP should consider a clinical assessment including a full blood count (FBC) if you have any of the following without an obvious cause:

• looking pale

• bleeding, bruising or red, purple or dark spots on the skin (petechia)

• feeling very tired (fatigue)

• breathlessness

• infections that don’t go away or keep coming back

• high temperature

• heavy night sweats

• swollen lymph nodes

• a larger than normal spleen and, or a larger than normal liver