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Planned Care Services

Haematology

Referral Acceptance

Haematology referrals are prioritised by senior medical officers based on the information contained within. Additional information should be attached where available. The prioritisation tool used to grade referrals can be found under the Access Criteria listed below.

All accepted referrals will be seen as indicated by the clinical priority, with a maximum waiting time of 4 months.

Referral acceptance is a follows:

First Specialist Assessments:

Waiting priority 1

Accepted

Waiting priority 2

Accepted

Waiting priority 3

Accepted

Waiting priority 4

Declined

National Access Criteria for First Assessment (ACA)

Bay of Plenty Variation (Jan 2015)

Category Criteria Examples (not an exhaustive list)

 1. Immediate
  • Major risk of/from infection
  • Neutropenic sepsis
  • Newly diagnosed acute leukaemia/lymphoma
  • Major risk of/from bleeding

 
  • Haemophilia
  • ITP with Platelets <20+ bleeding
  • Severe symptomatic anaemia
  • Autoimmune haemolytic anaemia
  • Aplastic anaemia
  • Hyperviscosity

 
  • Walderstrom’s macroglobulinaemia
  • CML with very high WBC count
  • Polycythaemia with cerebrovascular symptoms
  • Cord compression
  • Acute renal failure
  • Hypercalcaemia
  • Tumour lysis syndrome
  • Multiple myeloma
  • High-grade Non-Hodgkins lymphoma
  • Burkitts lymphoma

 2. Urgent
  • Bone Pain
  • Risk of bone fracture
  • Renal impairment
  • Multiple Myeloma
  • Moderate risk of infection
  • Neutropenia <1 x 109/L
  • Moderate risk of bleeding
  • Moderate/severe Thrombocytopenia < 50 x 109/L
  • New Haemophilia
  • Progressive symptomatic anaemia
  • Some Myelodysplasia
  • Some Autoimmune Haemolytic Anaemia
  • Severe symptomatic leucocytosis
  • Chronic Myeloid Leukaemia
  • Headaches/hyperviscosity
  • Some Polycythaemia Rubra Vera (PRV)
  • Some Walderstrom’s macroglobulinaemia
  • Lymphadenopathy/Lymphocytosis
  • Stage C Chronic Lymphocytic Leukaemia

 3. Semi Urgent
  • Moderate anaemia
  • Thrombotic Risk
  • Mild risk of spontaneous bleeding
  • Autoimmune Haemolytic anaemia
  • Anaemia refractory to iron/B12/folate
  • Myeloproliferative conditions
  • PRV/Myelofibrosis/Essential
  • Thrombocythaemia
  • Thrombotic disorders for investigation
  • Walderstrom’s macroglobulinaemia
  • Stage B Chronic Lymphocytic Leukaemia
  • Bleeding Diathesis for investigation

 4. Routine
(Not accepted)
  • Mild bleeding risk
  • No Pain/No impairment of function
  • Mild infection risk
  • Mild anaemia
  • Stable/mild Thrombolytopenia patients in the category may not need to be seen but specialist input may be given through management guidelines
  • Possible platelet function defect
  • Monoclonal Gammopathy of uncertain significance
  • Stage A Chronic Lymphocytic Leukaemia
  • Some Immunodeficiency
  • Macrocytosis for investigation
  • Erythrocytosis (not PRV)
  • Early myelodysplasia
  • Haemoglobinopathy for investigation/review
  • Chronic haemolytic anaemia (hereditary spherocytosis enzymopathies)


Additional Information

  • Categorisation must take account of the patient’s social situation, the severity of the haematological abnormalities and other co-morbid conditions
  • Acute referrals may be admitted directly to the inpatient unit having been assessed in the Emergency Department or telephone conversation with the specialist.