Polycythaemia

Emergency referrals

All urgent cases must be discussed with the on call Haematology registrar or after hours the on call consultant. Contact through Royal Brisbane and Women's Hospital switch (07) 3646 8111 or The Prince Charles Hospital switch on (07) 3139 4000 to obtain appropriate prioritisation and treatment.

Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.

Red flags

Consider urgent referral for patients with the following

JAK2 mutation
Supressed EPO (below normal)
Unexplained pruritis
History of amaurosis fugax or TIA
Symptoms of hyperviscosity

GP Haematology referral advice line

For advice regarding laboratory results and clinical questions regarding patients that may require referral to Haematology – please phone (07) 3646 1353.

This number diverts to the on call Haematologist between 8.00 am and 5.00pm Monday to Friday.

After hours this number is diverted to the hospital switch board, please ask to speak to the on call Haematologist.

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

Hb > 200g/L and asymptomatic
HCT > 0.6 (men), >0.56 (women) and asymptomatic
Hb (upper limit of normal) with thrombosis or symptoms of hyperviscosity

Category 2

Appointment within 90 days is desirable

Hb > upper limit of normal with:
- JAK2 V617F or exon 12 mutation and/or
- suppressed EPO (no thrombosis symptoms)

Category 3

Appointment within 365 days is desirable

Hb > upper limit of normal to 200g/L or HCT 0.51 to 0.60 (men) with no red flags
Hb > upper limit of normal to 185g/L or HCT 0.48 to 0.56 (women) with no red flags

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Polycythaemia may be defined as primary or secondary based on the presence or absence of suppressed erythropoietin (EPO) and/or an acquired mutation of the JAK2 gene (JAK2 V617F and exon 12). Patients with primary polycythaemia (polycythaemia vera or inherited polycythaemia) have a JAK2 mutation in more than 97% of cases. Low EPO levels are also a common characteristic of primary polycythaemia.

Patients with secondary polycythaemia rarely benefit from venesection however it is important to define the cause in such a circumstance as polycythaemia may be an epiphenomenon of a more sinister non-haematological disorder such as renal cell carcinoma, OSA or advanced pulmonary disease (COPD) that requires its own specific management.

It is reasonable to not refer patients for haematology review if polycythaemia is transient or mild (HCT <0.51for men, <0.48 for women) and primary polycythaemia has been excluded (JAK2 negative with high EPO) however appropriate investigation and follow up for important secondary causes must be undertaken.

Referral requirements

A referral may be rejected without the following information.

Essential referral information

Presence of any red flags
General referral information
Serial FBC
E/LFT
Smoking history

Additional useful information (useful for processing the referral)

JAK2 V617F PCR
Erythropoetin level (EPO)
JAK2 exon 12 mutation testing (if JAK2 V617F negative and EPO below normal range)
USS abdomen (renal or hepatic tumour)
CXR (malignancy/COPD)
BMI
History of OSA
Testosterone replacement

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Clinical Modifiers (where relevant)

Impact on employment
Impact on education
Impact on home
Impact on activities of daily living
Impact on ability to care for others
Impact on personal frailty or safety
Identifies as Aboriginal and/or Torres Strait Islander

Reason for Referral (essential)

To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can’t order, or the patient can’t afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary

Clinical Information (essential)

Presenting symptoms (evolution and duration)
Physical findings
Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use