RCH Clinical Haematology Department guidance for referring clinicians

If your referral does not meet the criteria listed below but you feel that the patient needs to be seen by haematology or for advice, please do not hesitate to contact the outpatient haematology registrar through hospital switchboard.

All referrals MUST contain the following elements:

• Sufficient clinical information including a clearly stated reason they are being referred to our service
• Attached pathology report, particularly with referrals for cytopenias
  • Pathology results should be recent (within last 3 months)

Please note that your referral may be rejected if these elements are not included.

Conditions we see include (but are not limited to):

Iron Deficiency

• Iron deficiency (ferritin <10) with anaemia (Hb <90g/dL) or reduced MCV for age
• Persistent iron deficiency despite adequate oral therapy (minimum 3 month trial) 
      

Royal Children's Hospital Iron Deficiency Clinical Practice Guideline.

Referrals for children with iron deficiency who have not received an adequate trial of oral iron supplementation and/or who have normal red cell indices will not be accepted unless this has been discussed with the haematology team.

Cytopenias

• Haemoglobin <100g/dL (excluding iron deficiency anaemia)
• Persistent neutropenia <1.0 x 10^9 of >2 weeks duration
• Thrombocytopenia <50 x 10^ at any time OR 50-149 x 10^9 if >2 weeks duration
• Unexplained red cell macrocytosis with or without cytopenias
• Children with mild, unexplained cytopenias (above the range listed above) of >3 months duration

Bone marrow disease

• Suspected congenital bone marrow disease
• Significant cytopenias affecting more than one lineage

Haemoglobin disorders

• Thalassemias
• Sickle cell disease

Haemolytic anaemia

incudes conditions such as hereditary spherocytosis

Bleeding disorders

 Haemophilia Treatment Centre

• Haemophilia
• Von Willebrand Disease
• Platelet function disorders
• Persistent abnormal coagulation profile

Anticoagulation/Thrombosis

 Anti Coagulation Service

• Post-thrombosis follow up
• RCH anticoagulation clinic  
  
• Thrombophilia

Splenomegaly

Vascular malformations (multi-disciplinary clinic)

Haemochromatosis

Exclusions:

• Iron deficiency with normal red cell indices OR iron deficiency +/- anaemia without prior trial of oral iron therapy Please see Royal Children's Hospital Iron Deficiency Clinical Practice Guideline
• Borderline/mild cytopenias of <3 months duration
• Lymphadenopathy (please address referrals to paediatric oncology)
• Persistent lymphopenia (please address referrals to paediatric immunology)

Thrombocytosis <

Please follow this link for an RCH referral form and information as to where to send in your referral