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

  • JAK2 mutation
  • Supressed EPO (below normal)
  • Unexplained pruritis
  • History of amaurosis fugax or TIA
  • Symptoms of hyperviscosity

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

  • Hb > 200g/L and asymptomatic
  • HCT > 0.6 (men), >0.56 (women) and asymptomatic
  • Hb (upper limit of normal) with thrombosis or symptoms of hyperviscosity

Category 2

Appointment within 90 days is desirable

  • Hb > upper limit of normal with:
    • JAK2 V617F or exon 12 mutation and/or
    • suppressed EPO (no thrombosis symptoms)

Category 3

Appointment within 365 days is desirable

  • Hb > upper limit of normal to 200g/L or HCT 0.51 to 0.60 (men) with no red flags
  • Hb > upper limit of normal to 185g/L  or HCT 0.48 to 0.56 (women)  with no red flags

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

Polycythaemia may be defined as primary or secondary based on the presence or absence of suppressed erythropoietin (EPO) and/or an acquired mutation of the JAK2 gene (JAK2 V617F and exon 12). Patients with primary polycythaemia (polycythaemia vera or inherited polycythaemia) have a JAK2 mutation in more than 97% of cases. Low EPO levels are also a common characteristic of primary polycythaemia.

Patients with secondary polycythaemia rarely benefit from venesection however it is important to define the cause in such a circumstance as polycythaemia may be an epiphenomenon of a more sinister non-haematological disorder such as renal cell carcinoma, OSA or advanced pulmonary disease (COPD) that requires its own specific management.

It is reasonable to not refer patients for haematology review if polycythaemia is transient or mild (HCT <0.51for men, <0.48 for women) and primary polycythaemia has been excluded (JAK2 negative with high EPO) however appropriate investigation and follow up for important secondary causes must be undertaken.

Referral requirements

A referral may be rejected without the following information.

  • Presence of any red flags
  • General referral information
  • Serial FBC
  • E/LFT
  • Smoking history

Additional useful information (useful for processing the referral)

  • JAK2 V617F PCR
  • Erythropoetin level (EPO)
  • JAK2 exon 12 mutation testing (if JAK2 V617F negative and EPO below normal range)
  • USS abdomen (renal or hepatic tumour)
  • CXR (malignancy/COPD)
  • BMI
  • History of OSA
  • Testosterone replacement

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.)
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