What are the key clinical features that should raise suspicion for leukaemia in a primary care setting?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

In a primary care setting, key clinical features that should raise suspicion for leukaemia include:

  • Unexplained pallor, which may indicate anaemia ,.
  • Persistent fatigue that is unexplained ,.
  • Unexplained fever or persistent/recurrent infections without clear cause ,.
  • Generalised lymphadenopathy that is unexplained ,.
  • Unexplained bruising or bleeding, including petechiae ,,.
  • Hepatosplenomegaly (enlarged liver and/or spleen) without an obvious cause ,.
  • In children and young people, persistent or unexplained bone pain may also be a feature ,.

When these features are present, NICE guidelines recommend considering a very urgent full blood count within 48 hours to assess for leukaemia ,. In children and young people, unexplained petechiae or hepatosplenomegaly warrant immediate specialist assessment ,.

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