When should I refer a patient with suspected AML to a haematologist, and what information should I include in the referral?

When to refer: Refer adults with suspected acute myeloid leukemia (AML) for a very urgent specialist haematology assessment if they present with any of the following clinical features: pallor, persistent fatigue, unexplained fever, unexplained persistent or recurrent infection, generalized lymphadenopathy, unexplained bruising, unexplained bleeding, unexplained petechiae, or hepatosplenomegaly. This referral should be made urgently, ideally within 48 hours, following a very urgent full blood count that suggests leukemia.

For children and young people, immediate specialist assessment is required if they have unexplained petechiae or hepatosplenomegaly. A very urgent full blood count (within 48 hours) should be offered if they present with pallor, persistent fatigue, unexplained fever, unexplained persistent infection, generalized lymphadenopathy, persistent or unexplained bone pain, unexplained bruising, or unexplained bleeding.

Information to include in the referral: The referral should include the patient's clinical features and symptoms that prompted suspicion of AML, results of the very urgent full blood count (including any abnormalities such as cytopenias or blasts), relevant blood test results, and any other pertinent clinical findings such as lymphadenopathy or hepatosplenomegaly. Also include patient demographics and any relevant medical history or medications that may impact diagnosis or management.