What are the key clinical features that should raise suspicion for leukaemia in a primary care setting?

In a primary care setting, key clinical features that should raise suspicion for leukaemia include:

• Unexplained pallor, which may indicate anaemia ¹,².
• Persistent fatigue that is unexplained ¹,².
• Unexplained fever or persistent/recurrent infections without clear cause ¹,².
• Generalised lymphadenopathy that is unexplained ¹,².
• Unexplained bruising or bleeding, including petechiae ¹,²,³.
• Hepatosplenomegaly (enlarged liver and/or spleen) without an obvious cause ¹,².
• In children and young people, persistent or unexplained bone pain may also be a feature ¹,².

When these features are present, NICE guidelines recommend considering a very urgent full blood count within 48 hours to assess for leukaemia ¹,². In children and young people, unexplained petechiae or hepatosplenomegaly warrant immediate specialist assessment ²,³.