1. FAST TRACK REFERRALS Haematology Dr.V Tandon Consultant Haematologist 14.4.15

2. Role of FT referral Some examples of appropriate FT referrals Some examples of inappropriate FT referrals What do we do with referrals in general Common scenario.. Suspected myeloma New FT referral form

3. Some appropriate FT referrals Suspected or confirmed myeloma Blood film comment suggesting FT referral Cell marker report in keeping with haematological cancer ( except CLL ) UNEXPLAINED, persistent weight loss, drenching night sweats and fevers Generalized, persistent, unexplained lymphadnopathy, specially in presence of above symptoms

4. Some Inappropriate FT referrals Mild thrombocytopenia Iron deficiency anaemia.. Needs to go to gastro / Gynae based on clinical scenario High haemoglobin / Suspected Polycythamia Mild leucopenia or mild leucocytosis Solitary Neck Lump.. Needs to go to ENT Solitary lump at other site with no symptoms to suggest lymphoma… needs to go to appropriate surgical speciality Solitary raised ESR in absenc of other features to suspect myeloma POLYCLONAL Immunoglobulins or Light chains in blood or polyclonal light chains in BJPU report

5. What do we do when we receive a referral ? Myself or my colleague go through all referrals received and prioritise them Fast tracks. We instruct booking appointment within 2 weeks of receiving referral ( currently not allowed to downgrade without seeing patient, even if they appear to be inappropriate FT referral ) Others.. We mark them as either … new Routine ( <7 weeks), New Soon ( <4 weeks ), New Urgent ( <2 weeks ).. We im to stick to these timescales Rarely.. Contact the referring GP to query any issue with the referral

6. Investigation for Suspected Myeloma Unexplained Normocytic Anaemia, Renal Impairment, Generalized bone pains, Hypercalcemia, High ESR with no explaination Request Myeloma screen.. Lab will perform Immunoglobulins and Serum Protein electrophoresis. If needed, Immunofixation to assess presence or absence of Paraprotein ( Monoclonal rise in Ig and not Polyclonal ). Beta 2 microgloblin.. More useful for prognosis, if myeloma confirmed, hence not much role in Primary care Serum Light Chains.. Lab should automatically do if Myeloma screen requested. Much better value than Urinary BJPU Mild rise in both kappa and lambda light chains can happen in inflammation, renal impairment itself and does not necessarily indicate myeloma Several results of Monoclonal Igs ( Paraprotein ) will end up being MGUS rather than Myeloma and need normal referral rather than FT.. If in doubt, we can be contacted for advice on the type of referral needed Skeletal survey, MRI spine, Bone marrow aspirate

7. Signature Name of Referring Doctor Referral Date

8. Questions ?