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2ww Haematology

Immediate Paediatric referral

Unexplained petechiae or hepatosplenomegaly in children and young people [Leukaemia]


Very Urgent referral to Paediatrician within 48 hours

Unexplained lymphadenopathy or splenomegaly in children [non‑Hodgkin's lymphoma]

Unexplained lymphadenopathy in children [Hodgkin's lymphoma]


Very Urgent Full Blood Count within 48 hours [Leukaemia]

In adults, children and young people who present with any:

  • pallor

  • persistent fatigue

  • unexplained fever

  • unexplained persistent or recurrent infection

  • generalised lymphadenopathy

  • persistent or unexplained bone pain [in children]

  • unexplained bruising, bleeding

  • unexplained petechiae [in adults]

  • Hepatosplenomegaly [in adults]


Urgent 2ww Haematology referral

Results of protein electrophoresis or a Bence‑Jones protein urine test suggest myeloma [Myeloma]

Adults with unexplained lymphadenopathy or splenomegaly [non‑Hodgkin's lymphoma]
Adults with unexplained lymphadenopathy [Hodgkin's lymphoma]


When considering referral, take into account any associated symptoms of lymphoma:

Fever
Night sweats
Shortness of breath
Pruritus
Weight loss
Alcohol‑induced lymph node pain [Hodgkin’s lymphoma in adults]


Myeloma screening: FBC, Calcium, plasma viscosity, ESR, serum protein electrophoresis, urine Bence‑Jones protein test

≥60y + persistent bone pain, particularly back pain, or unexplained fracture

≥60y + hypercalcaemia or leukopenia and a presentation that is consistent with possible myeloma (very urgent <48hr testing)

Plasma viscosity or ESR and clinical presentation are consistent with myeloma(very urgent <48hr testing)