Polycythaemia
Adult

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Emergency Referrals

Useful Management Information

Refer to local HealthPathways or local guidelines
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 <0.51 for 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.
JAK2 V617F and BCR-ABL testing should be considered as part of a diagnostic work-up under specialist oversight. Please note that these tests may incur costs if not requested in alignment with Medicare criteria.

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1 (appointment within 30 calendar days)	Hb > 200g/L and asymptomatic HCT > 0.6 (men), >0.56 (women) and asymptomatic Hb (upper limit of normal) with thrombosis or symptoms of hyper viscosity
Category 2 (appointment within 90 calendar days)	Hb > upper limit of normal with: JAK2 V617F or exon 12 mutation and/or suppressed EPO (no thrombosis symptoms)
Category 3 (appointment within 365 calendar days)	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)
If your patient does not meet the minimum referral criteria Assessment and management information may be found on a range of conditions at HealthPathways If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested: 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

Standard Referral Information

Reason for request

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

Relevant clinical information about the condition

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
All conservative options that have been pursued unsuccessfully prior to referral
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
Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient's Demographic Details

Full name (including aliases)
Date and country of birth
Residential and postal address including whether patient resides at an aged care facility
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Name of delegate and contact details (Department of Corrective Services)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander
Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature
Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

Willingness to have surgery (where surgery is a likely intervention)
Choice to be treated as a public or private patient
Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

Essential Referral Information

Serial FBC
E/LFT
Smoking history

Additional Referral Information

JAK2 V617F PCR*
Erythropoietin 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

* JAK2 V617F and BCR-ABL testing should be considered as part of a diagnostic work-up under specialist oversight. Please note that these tests may incur costs if not requested in alignment with Medicare criteria.

Send Referrals To

Smart Referrals

Preferred Method
About Smart Referrals

Secure Web Transfer

Send to: Gold Coast Health Service District

Internal Referrals

Haematology (E-Blueslips)

Fax

(07) 5687 4497

Post

Cancer Referrals Centre
Gold Coast University Hospital
1 Hospital Boulevard
Southport QLD 4215

Enquiries

(07) 5687 2708

Related HealthPathways

No directly related pathways found

HealthPathways home page

Service Availability

Dr Rachel Wooldridge

Medical Director Haematology

Facilities

Gold Coast University Hospital

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

PolycythaemiaAdult