Immediate Paediatric referral

Unexplained petechiae or hepatosplenomegaly in children and young people [Leukaemia]

Very Urgent referral to Paediatrician within 48 hours

Unexplained lymphadenopathy or splenomegaly in children [non‑Hodgkin's lymphoma]

Unexplained lymphadenopathy in children [Hodgkin's lymphoma]

Very Urgent Full Blood Count within 48 hours [Leukaemia]

In adults, children and young people who present with any:

• pallor

• persistent fatigue

• unexplained fever

• unexplained persistent or recurrent infection

• generalised lymphadenopathy

• persistent or unexplained bone pain [in children]

• unexplained bruising, bleeding

• unexplained petechiae [in adults]

• Hepatosplenomegaly [in adults]

Urgent 2ww Haematology referral

Results of protein electrophoresis or a Bence‑Jones protein urine test suggest myeloma [Myeloma]

Adults with unexplained lymphadenopathy or splenomegaly [non‑Hodgkin's lymphoma]
Adults with unexplained lymphadenopathy [Hodgkin's lymphoma]

When considering referral, take into account any associated symptoms of lymphoma:

Fever
Night sweats
Shortness of breath
Pruritus
Weight loss
Alcohol‑induced lymph node pain [Hodgkin’s lymphoma in adults]

Myeloma screening: FBC, Calcium, plasma viscosity, ESR, serum protein electrophoresis, urine Bence‑Jones protein test

≥60y + persistent bone pain, particularly back pain, or unexplained fracture

≥60y + hypercalcaemia or leukopenia and a presentation that is consistent with possible myeloma (very urgent <48hr testing)

Plasma viscosity or ESR and clinical presentation are consistent with myeloma(very urgent <48hr testing)