Thrombocytopenia
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
- Any evidence of pancytopenia (Hb <100g/L, Neut <1.0 and thrombocytopenia)
- Raised LDH (seen in TTP)
- Associated new renal impairment
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
- Persistent platelet level < 30 X 109/l
Category 2
Appointment within 90 days is desirable
- Persistent platelet level 30-75 X 109/l
Category 3
Appointment within 365 days is desirable
- Persistently low platelet level > 75 X 109/l
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
Given spurious thrombocytopenia due to collection, storage or in vitro clumping of platelets is not uncommon, all low results should be confirmed with repeat testing with a FBC, coagulation screen and ELFT within at least a week of initial recognition of thrombocytopenia.
All patients with low platelets and active bleeding should be referred to DEM.
All patients with a platelet level of < 10 X 109/l should be urgently referred to DEM.
Thrombocytopenia can be caused by:
- Decreased production
- Leukaemia
- Viral infections
- Chemotherapy drugs
- Heavy alcohol consumption
- Increased breakdown
- Pregnancy
- Immune ITP
- Sepsis (bacteraemia, haemolytic uraemic syndrome, DIC)
- Thrombotic thrombocytopenic purpura (TTP)
- Drugs (quinine, sulpha drugs, anti-epileptics)
- Sequestration
- Splenomegaly (PLT usually 50-100 x 109/L)
- Spurious – artefactual
- Collection issues (difficult venepuncture, activated sample)
- Storage issues (delays between collection and testing)
- In vitro clumping (repeat testing with EDTA & citrate tube)
Referral requirements
A referral may be rejected without the following information.
- Presence of any red flags
- General referral information
- E/LFT including LDH
- HIV serology
- Hepatitis C serology
- Drug history
Additional useful information (useful for processing the referral)
- Ultrasound upper abdomen
- Autoimmune screen
- Coagulation screen
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@brisbanenorthphn.org.au
Login to Brisbane North Health Pathways:
brisbanenorth.healthpathwayscommunity.org