HNY Policy and Pathway Repository - Humber

The clinical haematology consultant team review all A&G requests and referrals.  Referrals are booked to the correct clinic with a priority determined by the clinical information provided.  The team urge primary care colleagues to discuss ALL cases via A&G in the first instance.

To assist you in evaluating the potential risk for cancer the QCancer assessment can be beneficial.  QCancer has been developed for the UK with risk algorithms.  This tool will only provide a level of risk of cancer and is not a diagnosis tool.

Abnormal blood tests suggesting haematological malignancy:

• Suspected acute leukaemia MUST be discussed directly with the on call haematologist.
• Chromic Myeloid Leukaemia – check blood film comments
• Chronic lymphocytic leukaemia – if Hb / Plt <100

Myeloma:

• Paraproteinaemia IgG>15g/l, IgA>10g/l, any serum IgD or IgE paraprotein.
• Deranged serum free light chain ratio <0.1 or >100
• Imaging suggestive of myeloma

Lymphoma:

• Persistent progressive painless large volume lymphadenopathy +/- clinically palpable splenomegaly
• IgM paraprotein >10g/l

Please discuss every USC case via A&G and allow the hospital team the option to convert directly to a referral.

Please ensure that your patient is aware of your clinical concern, the possibility of review at the Queen’s Centre, Castle Hill Hospital and a potential cancer diagnosis.  Please check that patient contact details are up to date and they are available to attend an appointment in the next 28 days.

• All referrals will be reviewed by a consultant and placed in an appropriate clinic as required.  Patients will be contacted and informed of their appointment by the Hospital.

Exclusions:

• Children <16 – refer to services listed under ‘Children & Adolescents’
• Young adults >16 and <19 requiring a USC referral MUST be referred directly to the principal treatment centres in either Leeds or Sheffield.
• Iron Deficiency Anaemia – refer to UGI of Colorectal according to history.
• Haemochromatosis – refer to hepatology after confirmatory genetic testing.

Minimum dataset required:

• Patient name, DoB, NHS number, current contact details
• Clinical history including medications, allergies and past medical history
• Blood results need only be attached if analysis has NOT been done by HUTH or NLAG laboratories
• Any relevant imaging reports
• GPs name and direct dial telephone number

Required clinical details:

• Current symptomatology
• Examination findings inc. palpable lymph nodes, clinically palpable splenomegaly
• Basic blood tests:
  • Full blood count
  • Biochemical Profile (UE, LFT, Bone profile)
  • Serum protein electrophoresis (Serum free light chains if appropriate).
  • Deficiencies of iron, B12 and folate already excluded

Additional clinical information and guidance is available in the repository

• Hull University Teaching Hospitals