Haematological malignancy (A/P-AFF)
Individual from a family in whom a mutation in a cancer predisposition gene has NOT been identified (Adult and Paediatric Conditions in AFFECTED Patients)
Emergency referrals
If any of the following are present or suspected, refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
- No referrals to emergency relating to genetic testing or review
Does your patient wish to be referred?
Minimum referral criteria
Does your patient meet the minimum referral criteria?
Category 1
Appointment within 30 days is desirable
- Acute leukaemia or high-grade lymphoma and a personal or family history of at least one of the following:
- cytopenias (including ITP), macrocytosis
- immune deficiency
- primary lymphoedema
- lung/liver disease
- premature greying
- skeletal abnormalities
- cancers suggestive of Li Fraumeni Syndrome
- family history of haematological malignancy
Category 2
Appointment within 90 days is desirable
- No Category 2 criteria
Category 3
Appointment within 365 days is desirable
- Patient with low grade and/or previously successfully treated high grade leukaemia/lymphoma and a personal or family history as listed in Category 1
If your patient does not meet the minimum referral criteria
Consider other treatment pathways or an alternative diagnosis.
If you still need to refer your patient:
- Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
- Please note that your referral may not be accepted or may be redirected to another service
Other important information for referring practitioners
Not an exhaustive list
- The offer of an appointment by GHQ does NOT guarantee that the patient will be offered a publicly funded gene test.
- If patient imminently planned for chemotherapy and/or bone marrow transplant please arrange for the following samples to be collected and sent to Pathology Queensland for forwarding to the appropriate laboratory prior to commencement:
- 2 x 4mLs peripheral blood in EDTA to be sent to the Molecular Genetics Laboratory, RBWH requesting “DNA extraction and storage”
- 10-20 hairs with hair follicles attached to be sent to SA (South Australia) Pathology requesting “DNA extraction and storage”
- Consider requesting fibroblast culture if performing BMAT (send sample to cytogenetic laboratory RBWH)
- Consider skin biopsy if surgical procedure planned (send to cytogenetic laboratory RBWH)
- Please contact GHQ or Pathology Queensland for further instructions
- If the patient is an UNTESTED blood relative of a person with an identified mutation in a cancer predisposition gene please refer to the Untested blood relative condition within the Genetics CPC
- If the patient has undergone mainstreamed and/or private genetic testing refer to the Mainstreamed or private testing condition within the Genetics CPC
- For a patient suspected of having a haematological predisposition syndrome who has presented with non-malignant disease please refer to the Haematology genetics condition within the Genetics CPC
- Patients will be asked to provide detailed family information either during a telephone consultation (if urgent) or via a family history questionnaire (Cat 3). One or more Consent to Release information forms may be provided to forward to family members to obtain their consent to confirm details of the reported family history.
Referral requirements
A referral may be rejected without the following information.
- As much detail as possible about the patient’s personal of cancer including the following:
- type/s of cancer
- age at diagnosis
- treatment including outcome
- whether allogeneic stem cell transplant is planned and if a related donor is being considered
- relevant imaging
- relevant pathology including results of any genetic testing if performed (if results are available on Auslab please indicate this on referral)
- known details of relevant family history
Additional useful information (useful for processing the referral)
- If the family is known to GHQ, include the GHQ reference number (GF) if known
Out of catchment
Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.
- Impact on employment
- Impact on education
- Impact on home
- Impact on activities of daily living
- Impact on ability to care for others
- Impact on personal frailty or safety
- Identifies as Aboriginal and/or Torres Strait Islander
- To establish a diagnosis
- For treatment or intervention
- For advice and management
- For specialist to take over management
- Reassurance for GP/second opinion
- For a specified test/investigation the GP can’t order, or the patient can’t afford or access
- Reassurance for the patient/family
- For other reason (e.g. rapidly accelerating disease progression)
- Clinical judgement indicates a referral for specialist review is necessary
- Presenting symptoms (evolution and duration)
- Physical findings
- Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
- Body mass index (BMI)
- Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
- Current medications and dosages
- Drug allergies
- Alcohol, tobacco and other drugs use
- Full name (including aliases)
- Date of birth
- Residential and postal address
- Telephone contact number/s – home, mobile and alternative
- Medicare number (where eligible)
- Name of the parent or caregiver (if appropriate)
- Preferred language and interpreter requirements
- Identifies as Aboriginal and/or Torres Strait Islander
- Full name
- Full address
- Contact details – telephone, fax, email
- Provider number
- Date of referral
- Signature
- Willingness to have surgery (where surgery is a likely intervention)
- Choice to be treated as a public or private patient
- Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
Send referral
Hotline: 1300 364 938
Fax: 1300 364 952
Electronic: eReferral system
Mail: Metro North Central Patient Intake
Aspley Community Centre
776 Zillmere Road
ASPLEY QLD 4034
Health pathways
Access to Health Pathways is free for clinicians in Metro North Brisbane.
For login details email:
healthpathways
Login to Brisbane North Health Pathways:
brisbanenorth.
Resources
Clinical resources
- Named Referral Information Sheet
- Outpatient clinic information
- General referral criteria
- eReferral template