When should I consider referring a patient with acquired bleeding disorders to a hematologist?

Consider referring a patient with acquired bleeding disorders to a hematologist when:

• There is a known or suspected diagnosis of an acquired bleeding disorder requiring specialist input for diagnosis, management, or monitoring.
• In women with bleeding disorders during pregnancy or childbirth, to plan individualized care including active management of the third stage of labour and postpartum monitoring.
• When platelet counts are significantly low (e.g., below 50×10⁹/L) in conditions such as immune thrombocytopenic purpura, to discuss and agree on intrapartum care and treatment options like steroids or intravenous immunoglobulin.
• When there is a need to manage or reverse anticoagulation in the context of bleeding or emergency surgery, including the use of prothrombin complex concentrates or other reversal agents.
• In cases of major or severe bleeding, or bleeding associated with hemodynamic instability, where specialist haematological assessment and management are critical.

Referral ensures multidisciplinary planning, appropriate monitoring of haematological parameters, and tailored treatment to reduce bleeding risks and complications.

References: NICE NG121, NICE NG24