When should I refer a patient with suspected bleeding disorders to a specialist haematologist?

Refer a patient with suspected bleeding disorders to a specialist haematologist if:

• They are an adult with a low platelet count or an abnormal clotting screen.
• They have normal blood results in primary care but a bleeding disorder is still suspected.
• Children and young people with unexplained petechiae, hepatosplenomegaly, or full blood count results suggestive of leukaemia should be referred immediately for specialist assessment.
• Children with periorbital bruising and a palpable abdominal mass or unexplained enlarged abdominal organ should be referred urgently (within 48 hours) for specialist assessment for neuroblastoma.
• Adults with full blood count results suggestive of leukaemia require immediate specialist assessment.
• Patients with significant active bleeding not responding to simple measures should be admitted and referred urgently.
• If non-accidental injury is suspected in children, young people, elderly, or vulnerable adults, refer immediately to appropriate agencies and ensure hospital awareness if admission is needed.

Referral urgency depends on clinical judgement but should be prompt when bleeding disorders are suspected despite normal initial tests or when abnormal results are found.