Should I see an acute lymphoblastic leukaemia specialist?

It can be very difficult for GPs to decide who may have a leukaemia and who may have something much more minor that will go away on its own. With many symptoms, it is perfectly right that your GP should ask you to wait to see if they get better or respond to treatment, such as antibiotics. If GPs referred everyone who came to see them to a specialist immediately, the system would get overloaded and people needing urgent appointments wouldn't be able to get them. But it is very important for ALL to be diagnosed and treated quickly.

Your GP may do a blood test. If the results show signs of acute lymphoblastic leukaemia you should be referred immediately to a blood specialist (haematologist).

The National Institute of Health and Clinical Excellence (NICE) has produced guidelines to help GPs decide who needs to see a specialist for suspected acute lymphoblastic leukaemia (ALL), and how soon they should see them. According to the guidelines, an urgent referral means you should get an appointment with a specialist within 2 weeks. If you have a combination of some of the symptoms below, your GP should take blood tests and make an urgent referral to a blood specialist (haematologist)

• Swollen spleen for no obvious reason
• Extreme tiredness for no obvious reason
• Weight loss
• Night sweats that drench you
• Itching all over
• Breathlessness
• Bruising easily
• Infections that keep coming back
• Bone pain
• Bleeding
• Pain in the tummy (abdomen)
• Swollen lymph glands

Your GP will look at your symptoms and decide which blood tests you need. Some of these symptoms can be caused by other less serious medical conditions and do not always mean that you have acute leukaemia. The doctor’s experience helps them to work out who may have a serious illness and who is more likely to have something more minor that will go away on its own. Your doctor will take into account whether you have any of the risk factors for acute lymphoblastic leukaemia.

The guidelines suggest that some people should have more in depth blood tests. These are for particular symptoms such as

• Unexplained tiredness that doesn't go away or get better
• Bruising or bleeding for no reason
• Bone pain that doesn't go away

If the tests don't show anything the first time round, your GP may repeat them if your symptoms don’t improve. We can’t give details of the blood tests here because they depend on your symptoms. You can talk to your GP about what the guidelines recommend in your case.

If you have swollen lymph glands, you should have more specialised blood tests. And possibly referral to a specialist if the enlarged lymph glands are

• Getting bigger
• Widespread in your body
• Still there after 6 weeks or more
• Bigger than 2cm across

Or if you also have

• An enlarged spleen
• Bad night sweats
• Weight loss

If you are concerned that your GP is not taking your symptoms as seriously as you think they should, you could print this page and take it along to an appointment. Ask your GP to talk it through with you and then you may be able to decide together whether you need to see a specialist and if so, how soon.