Lymphocytosis
Emergency referrals
All urgent cases must be discussed with the on call Haematology registrar or after hours the on call consultant. Contact through Royal Brisbane and Women's Hospital switch (07) 3646 8111 or The Prince Charles Hospital switch on (07) 3139 4000 to obtain appropriate prioritisation and treatment.
Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.
Red flags
Consider urgent referral for patients with the following
- HIV
- Positive hepatitis screen
- Autoimmune disease
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
- High lymphocyte count associated with any cytopenias (including autoimmune haemolytic anaemia – AIHA)
- High lymphocyte count with
- Weight loss >10%
- Night sweats
- Bulky (>2cm) lymphadenopathy
Category 2
Appointment within 90 days is desirable
- Chronic lymphocytic leukaemia
- Aberrant T cell lymphocytosis including T-LGL (T-cell large granular lymphocyte leukaemia)
Category 3
Appointment within 365 days is desirable
- Monoclonal B lymphocytosis (MBL)
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
A polyclonal lymphocytosis seldom has a haematological cause and other causes (esp. infective) should be excluded before referring to haematology
Monoclonal B lymphocytosis is a common cause of persistent mild/borderline lymphocytosis and does not usually require haematology referral as this rarely progresses to CLL and is suitable for monitoring in primary care. This is characterised by:
- A clonal B cell population of CLL immunophenotype [CD5+, CD19+, CD20 (weak), CD23+, restricted light chain (weak)] in peripheral blood of <5 X 109/l B cells
- No other signs of a lymphoproliferative disorder (splenomegaly, lymphadenopathy by CT imaging)
- Absence of any red flags
Referral requirements
A referral may be rejected without the following information.
- Presence of any red flags
- General referral information
- Serial FBC
- Flow cytometry and lymphocyte subsets
- E/LFTs
Additional useful information (useful for processing the referral)
- Immunoglobulins
- Protein electrophoresis
- B2 microglobulin
- HIV serology
- Hepatitis B and C serology
- Autoimmune screen
- Ultrasound or CT scan if done
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
Medical Objects ID: MQ40290004P
HealthLink EDI: qldmnhhs
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.