Haematology advice
For non-urgent advice. Haematology aim to respond to Careflow referrals within 24 hours, Monday to Friday. If TTP or acute leukaemia is suspected please bleep 9441 in addition to sending the written referral, as these are Haematological emergencies. Provide your bleep/contact telephone number in case further discussion is required. For all other queries, please ensure you have reviewed Haematology Trust guidelines on LINK (Home Page - LINK (nbt.nhs.uk) and have discussed with your senior team member first. Answers to common Haematology questions can also be found via Guidelines for Primary Care (Remedy BNSSG ICB) and the Buku Medicine app (free to access via Apple Store or Google Play)
Haematology referral - new low level paraprotein detected
If the patient has a normal full blood count, renal function, calcium, negative BJP and normal SFLC ratio, and Monoclonal paraprotein of IgG less than 15g/L, IgA or IgM less than 10g/L and no bone pain then this is likely to be Monoclonal gammopathy of undetermined significance (MGUS). These patients do not need to be seen by a Haematologist and simply need GP monitoring. Please ask the Haematology secretaries for the MGUS GP information document, ask the GP to monitor according to this guideline. If you wish to speak to a Haem registrar, avoid bleeping before 2pm - unless urgent - as they will be in clinic or on a ward round
Haematology referral - new unexplained lymphadenopathy
If the patient has unexplained palpable or radiological lymphadenopathy please request a lymph node biopsy (not FNA) & request CT NCAP to look for other sites of Lymphadenopathy. Please also check FBC, renal and liver function, calcium, serum electrophoresis and LDH. We will be happy to advise on patient management if biopsy shows a haematological malignancy. Feel free to send patient details to us and then update us with biopsy results once available . It remains YOUR responsibility to chase up the biopsy results. If you wish to speak to a Haematology registrar, please avoid bleeping them unless it is urgent before 2pm as they will be in clinic or on a ward round
Haematology referral - suspected new myeloma
If patient has monoclonal paraprotein of IgG more than 15g/L, IgA or IgM more than 10 or IgD/E of any level, then please request FBC, renal function, liver function, Urine for BJP, SFLC, B2M, PV and request CT NCAP and head, and put CT whole body for myeloma in clinical details. We are happy to see/advise on management of these patients. If you wish to speak to a Haem registrar, please avoid bleeping before 2pm - unless urgent - as they will be in clinic or on a ward round