What criteria should I use to refer a patient with CML to a specialist for further management?

The provided guidelines do not explicitly detail criteria for referring a patient with a confirmed diagnosis of chronic myeloid leukaemia (CML) for further management. However, they outline criteria for referring patients with suspected leukaemia or myeloproliferative diseases, which would include CML, to a specialist for investigation and initial management.

• For adults, consider a very urgent full blood count (within 48 hours) to assess for leukaemia if they present with any of the following: pallor, persistent fatigue, unexplained fever, unexplained persistent or recurrent infection, generalised lymphadenopathy, unexplained bruising, unexplained bleeding, unexplained petechiae, or hepatosplenomegaly ¹,⁵.
• For children and young people, refer for immediate specialist assessment for leukaemia if they have: unexplained petechiae or hepatosplenomegaly ¹,⁵.
• For children and young people, offer a very urgent full blood count (within 48 hours) to assess for leukaemia if they have any of the following: pallor, persistent fatigue, unexplained fever, unexplained persistent infection, generalised lymphadenopathy, persistent or unexplained bone pain, unexplained bruising, or unexplained bleeding ¹,⁵.
• Referral to haematology for further investigation and management is indicated for people with abnormal platelet counts, which can be a feature of myeloproliferative diseases like CML:
  • Urgent referral: Platelet counts over 1000 x 10⁹/L ².
  • Urgent referral if associated with other factors: Platelet counts within the range 600–1000 x 10⁹/L in association with recent arterial or venous thrombosis, neurological symptoms, abnormal bleeding, age over 60 years, or other significantly abnormal full blood count (FBC) indices ².
  • Referral for further investigation and management: Persistent and unexplained platelet counts over 450 x 10⁹/L (for more than 3 months) or over 600 x 10⁹/L on at least two occasions (4–6 weeks apart), or within the range 450–600 x 10⁹/L with other haematological abnormalities ².
• Urgent referral to a haematologist is also indicated if a myeloproliferative disease is suspected, even if JAK2 V617F mutation testing is negative, and the person has other suggestive features such as: high platelets and/or white count, enlarged spleen, family history of myeloproliferative disease, previous history of thrombosis, or altered erythropoietin levels ³,⁴. Specialist advice should also be sought if there is any uncertainty regarding the diagnosis ³,⁴.