What criteria should I use to refer a patient with CLL for specialist management?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

The provided UK guidelines outline criteria for the recognition and referral of suspected leukaemia, which would lead to specialist assessment and management, rather than specific criteria for the ongoing management of a patient already diagnosed with chronic lymphocytic leukaemia ,.

For adults, consider a very urgent full blood count (within 48 hours) to assess for leukaemia if they present with any of the following:

  • Pallor
  • Persistent fatigue
  • Unexplained fever
  • Unexplained persistent or recurrent infection
  • Generalised lymphadenopathy
  • Unexplained bruising
  • Unexplained bleeding
  • Unexplained petechiae
  • Hepatosplenomegaly

For children and young people, an immediate specialist assessment for leukaemia should be arranged if they have unexplained petechiae or hepatosplenomegaly . Additionally, offer a very urgent full blood count (within 48 hours) to assess for leukaemia in children and young people with any of the following:

  • Pallor
  • Persistent fatigue ,
  • Unexplained fever ,
  • Unexplained persistent infection ,
  • Generalised lymphadenopathy ,
  • Persistent or unexplained bone pain
  • Unexplained bruising
  • Unexplained bleeding

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