What are the current guidelines for referring a patient with suspected aplastic anaemia to a specialist?

For a patient with suspected aplastic anaemia, referral guidelines are primarily linked to the severity and uncertainty of the anaemia, and specific underlying causes such as Parvovirus B19 infection.

• If a person develops symptoms of suspected severe or aplastic anaemia, further management information should be sought ³.
• People with haematological disorders are at an increased risk of transient aplastic crisis, particularly those with reticulocytopenia, which can be life-threatening if not treated ³.
• Immunocompromised individuals are at increased risk of persistent Parvovirus B19 infection, leading to chronic, severe anaemia (pure red cell aplasia) that may require intravenous immunoglobulin G (IVIG) treatment in secondary care ³.
• If there is uncertainty about ongoing management related to Parvovirus B19 infection, advice should be sought from the local virology, microbiology, or infectious diseases department ³.
• Referral is also indicated when the type of anaemia is in doubt or when further haematological investigations are required that cannot be carried out in primary care, such as bone marrow examination or an investigation of a bleeding state ¹,².
• For adults presenting with symptoms such as pallor, persistent fatigue, unexplained fever, unexplained persistent or recurrent infection, generalized lymphadenopathy, unexplained bruising, unexplained bleeding, unexplained petechiae, or hepatosplenomegaly, a very urgent full blood count (within 48 hours) should be considered to assess for leukaemia ⁴,⁵. These symptoms can overlap with aplastic anaemia.
• For children and young people with unexplained petechiae or hepatosplenomegaly, an immediate specialist assessment for leukaemia is required ⁴,⁵.