Transcript fast track referrals - Walsall Healthcare NHS Trust

FAST TRACK REFERRALS
Haematology
Dr.V Tandon
Consultant Haematologist
14.4.15
Role of FT referral
Some examples of appropriate FT referrals
Some examples of inappropriate FT referrals
What do we do with referrals in general
Common scenario.. Suspected myeloma
New FT referral form
Some appropriate FT referrals
•Suspected or confirmed myeloma
•Blood film comment suggesting FT referral
•Cell marker report in keeping with haematological cancer
( except CLL )
•UNEXPLAINED, persistent weight loss, drenching night
sweats and fevers
•Generalized, persistent, unexplained lymphadnopathy,
specially in presence of above symptoms
Some Inappropriate FT referrals
• Mild thrombocytopenia
• Iron deficiency anaemia.. Needs to go to gastro / Gynae based on
clinical scenario
• High haemoglobin / Suspected Polycythamia
• Mild leucopenia or mild leucocytosis
• Solitary Neck Lump.. Needs to go to ENT
• Solitary lump at other site with no symptoms to suggest lymphoma…
needs to go to appropriate surgical speciality
• Solitary raised ESR in absenc of other features to suspect myeloma
• POLYCLONAL Immunoglobulins or Light chains in blood or
polyclonal light chains in BJPU report
What do we do when we receive a referral ?
• Myself or my colleague go through all referrals received and prioritise
them
• Fast tracks. We instruct booking appointment within 2 weeks of
receiving referral ( currently not allowed to downgrade without seeing
patient , even if they appear to be inappropriate FT referral )
• Others.. We mark them as either … new Routine ( <7 weeks), New
Soon ( <4 weeks ), New Urgent ( <2 weeks ) .. We im to stick to these
timescales
• Rarely.. Contact the referring GP to query any issue with the referral
Investigation for Suspected Myeloma
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Unexplained Normocytic Anaemia, Renal Impairment, Generalized bone
pains, Hypercalcemia, High ESR with no explaination
Request Myeloma screen.. Lab will perform Immunoglobulins and Serum
Protein electrophoresis. If needed, Immunofixation to assess presence or
absence of Paraprotein ( Monoclonal rise in Ig and not Polyclonal ) . Beta 2
microgloblin.. More useful for prognosis , if myeloma confirmed, hence not
much role in Primary care
Serum Light Chains.. Lab should automatically do if Myeloma screen
requested. Much better value than Urinary BJPU
Mild rise in both kappa and lambda light chains can happen in inflammation ,
renal impairment itself and does not necessarily indicate myeloma
Several results of Monoclonal Igs ( Paraprotein ) will end up being MGUS
rather than Myeloma and need normal referral rather than FT.. If in doubt, we
can be contacted for advice on the type of referral needed
Skeletal survey, MRI spine, Bone marrow aspirate
Walsall Healthcare NHS Trust
SUSPECTED HAEMATOLOGICAL CANCER 2 WEEK WAIT REFERRAL
Patient Details
Referrer details
Surname:
Forename:
Address:
Postcode:
Home Tel:
Daytime Tel:
Date of Birth
NHS Number:
Referring GP:
Usual GP:
Address:
Postcode:
Tel:
Fax:
Referral Information
Condition suspected: Please note: only conditions listed below should be referred through the 2WW system,
also please note – Chronic Lymphocytic Leukaemia (CLL) is not included. It is an indolent disease and rarely
requires urgent referral.
Suspected Haematology Malignancy – Please TICK
Acute Myeloid Leukaemia
Chronic Myeloid Leukaemia
Lymphoma
Acute Lymphoblastic Leukaemia
Myeloma
Signature
Immediate Referral – (by admission under the Medics in first instance)
Patient with a blood count/film suggestive of acute leukaemia or chronic myeloid leukaemia
Patient with spinal cord compression or acute renal failure suspected of being caused by
myeloma
Urgent referral (2 week wait)
Lymphoma: (isolated cervical lymphadenopathy should be referred to Head and Neck team)
Lymphadenopathy (>1cm)
persisting for 6 weeks
Splenomegaly
1 or more of the following symptoms:
Unexplained Weight Loss
Drenching Night Sweats
Persistent unexplained fevers
Itching (generalised)
Myeloma:
Significant paraproteinaemia
(IgG>20g/l, IgA>10g/l) or presence
of Bence-Jones Proteinuria – Not
Polyclonal Light Chains or
Immunoglobulins
Bone pain associated with raised plasma
viscosity
Bone x-rays suggestive of myeloma
Investigations
Haemoglobin
White Blood Count
Neutrophils
Platelets
Calcium
Creatinine
Immunoglobulins
Additional Information ( please include significant PMH, Medications and Allergies ), plus
any other relvant information :
Name of Referring Doctor
Referral Date
Questions ?