Lymphomas and lymphadenopathy

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.

Tests

  • Please avoid arranging FNA (Fine Needle Aspirate) biopsies of enlarged lymph nodes as the diagnostic utility is limited for many lymphomas.
    • Excisional or core biopsies are preferred for diagnostic purposes due to assessment of nodal architecture and sample size.
  • For patients with lymphadenopathy, serology should be considered:  Consider EBV, CMV, hepatitis, HIV and toxoplasmosis.
  • CT neck through pelvis would generally be performed after a tissue diagnosis is made as this is a staging (rather than diagnostic) procedure.

Interim/GP management

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

For more information please see the Tasmanian Health Pathways website.

Emergency

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

Superior vena cava obstruction (secondary to lymph node compression) 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).
LGH ED Reception  – Phone: (03) 6777 6405  Fax: (03) 6777 5201
MCH ED* – Phone: (03) 6478 5120  Fax: (03) 6441 5923
NWRH ED* – Phone: (03) 6493 6351 Fax: (03) 6464 1926
RHH ED Reception – Phone: (03) 6166 6100  Fax: (03) 6173 0489

Advice for medical practitioners can be given by the Medical Officer In Charge (MOIC) - see HealthPathways Tasmania for contact information.
*MCH and NWRH MOICs request GPs call them prior to referring a patient to ensure the patient is being sent appropriately to a safe destination.

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