Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
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 NICE CKS,NICE NG12.
- For children and young people, refer for immediate specialist assessment for leukaemia if they have: unexplained petechiae or hepatosplenomegaly NICE CKS,NICE NG12.
- 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 NICE CKS,NICE NG12.
- 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 NICE CKS.
- 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 NICE CKS.
- 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 NICE CKS.
- 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 NICE CKS,NICE CKS. Specialist advice should also be sought if there is any uncertainty regarding the diagnosis NICE CKS,NICE CKS.