In primary care, there are no specific diagnostic criteria for myelodysplastic syndromes (MDS) that are applied to definitively diagnose the condition NICE NG47. The definitive diagnosis of myelodysplastic syndromes, like other haematological cancers, is undertaken by specialist integrated haematological malignancy diagnostic services (SIHMDS) and managed by a haemato-oncology multidisciplinary team (MDT) NICE NG47. These specialist services use the current World Health Organization (WHO) classification for diagnosis and sub-typing NICE NG47.
The key role of primary care is to recognise general symptoms that may indicate a haematological malignancy and prompt appropriate initial investigations and referral NICE NG47. For adults, symptoms such as unexplained bruising, pallor, unexplained petechiae, persistent fatigue, unexplained fever, unexplained persistent or recurrent infection, generalized lymphadenopathy, unexplained bleeding, or hepatosplenomegaly should prompt consideration of a very urgent full blood count (within 48 hours) NICE NG12,NICE CKS. While these symptoms are specifically listed as indicators for leukaemia, they represent general haematological red flags that would necessitate further investigation and potential referral to secondary care for any suspected haematological cancer, including MDS NICE NG12,NICE CKS,NICE NG47.
Clinicians in primary care are advised to refer any patient with suspected haematological cancer to an appropriate haemato-oncology MDT NICE NG47. Written referral policies are disseminated to primary care teams to promote prompt and appropriate referral NICE NG47.