Leukaemias – Acute and Chronic

Availability

North South North West Statewide

Pre-referral work-up

History

All referrals should comply to referral standards and include in particular:

  • Relevant investigations, including previous results to assess temporal pattern.

Chronic Lymphocytic Leukaemia (CLL) is generally an indolent lymphoproliferative disorder and will be triaged accordingly.

  • Traditional indications for treatment of CLL include the following and are an indication of the need to discuss the case for a more prompt review:
    • Symptomatic lymphadenopathy
    • Auto-immune cytopenias (Autoimmune haemolytic naemia, Immune Thrombocytopenia Purpura)
    • Lymphocyte doubling time of <six months
    • Presence of disabling "B Symptoms" (fevers, loss of >10% body weight, drenching night sweats)

Interim/GP management

To refer a patient with this condition, please see the Haematology clinic page for the full referral process and templates.

Any newly diagnosed acute leukaemia should be discussed with the Haematologist/Registrar On-Call and may be referred directly to the Emergency Department for assessment, stabilisation and investigation.

For more information please see the Tasmanian Health Pathways website.

Emergency

Suspected acute leukaemia (evidenced by blood film report)

Severe cytopenias if patient is unwell (i.e. infection, symptomatic anaemia, active bleeding):

  • Neutrophils < 0.5 x 10^9/L
  • Haemoglobin < 80g/L
  • Platelets <20 x 10^9/L

Rapidly progressive leucocytosis (white cell count > 75 x 10^9/L) in the absence of infection/inflammation where there may be a risk of leucostasis/hyperviscosity

Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

Emergency:

Proceed to Emergency Department (ED). Please contact ED Medical Officer in Charge:
LGH ED – Phone: (03) 6777 6405  Fax: (03) 6348 7382
MCH ED – Phone: (03) 6478 5120  Fax: (03) 6441 5923
NWRH ED – Phone: (03) 6493 6340  Fax: (03) 6464 1926
RHH ED - Phone: (03) 6166 6100  Fax: (03) 6173 0489 - Discuss with the on call Haematologist/Registrar via switch (03) 6166 8308

Urgent:

Urgent Referrals generally need to be seen in the next one to two weeks

Please discuss these with the Haematology Registrar/Haematologist on call via switchboard on 6166 8308

Semi-urgent:

Triaged by medical staff and generally seen in the next six to eight weeks

Routine:

Triaged by medical staff and given the next available appointment