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 ².
• Persistent fatigue that is unexplained and ongoing ².
• Unexplained fever, especially if persistent or recurrent ¹,².
• Unexplained persistent or recurrent infections ¹,².
• Generalised lymphadenopathy without a clear cause ².
• Unexplained bruising or bleeding, including petechiae ²,³.
• Hepatosplenomegaly (enlarged liver and/or spleen) ².

In children and young people, additional features raising suspicion include unexplained petechiae or hepatosplenomegaly, which warrant immediate specialist assessment ².

When these features are present, NICE guidelines recommend offering a very urgent full blood count within 48 hours to assess for leukaemia ¹,².