Referral to a specialist for acute lymphoblastic leukaemia (ALL)

Your GP should arrange for you to have a blood test or see a blood specialist if you have symptoms that could be due to acute lymphoblastic leukaemia (ALL). Depending on your symptoms and other factors, this might be an urgent referral.

Seeing your GP

It can be hard for GPs to decide who may have leukaemia and who might have a more minor condition just based on symptoms. Minor conditions are common and leukaemia is rare. So it would not be the first diagnosis that comes to mind when you are in your GP surgery.

For some symptoms, your doctor may ask you to wait to see if the symptoms get better or respond to treatment, such as antibiotics. This is not uncommon. The important thing is to go back to your GP if you’re not getting better.

UK referral guidelines

There are guidelines for GPs to help them decide who needs to have a blood test and who needs to be a referred to see a specialist. This is usually a blood specialist called a haematologist.

Your GP will use these guidelines as well as their experience and judgement.

Some of the guidelines have targets around how quickly you are referred. For example, you might have blood tests very urgently within 2 days. Or you may see a specialist immediately (within a few hours).

These guidelines vary slightly between the different UK nations. The following is a summary.

Urgent referral to a specialist for leukaemia

Adults over 24 years should be referred for a full blood count blood test if they have any of the following symptoms:

  • look unusually pale
  • extreme tiredness (fatigue)
  • unexplained high temperature (fever)
  • unexplained infections that won't go away or keep coming back
  • swollen lymph glands
  • bruising or bleeding for no reason
  • unexplained red and purple dots on the skin (petechia rash)
  • an enlarged spleen or liver on examination

Your GP will refer you immediately to a blood specialist if blood test results show that you might have leukaemia.

Children and young adults (under 24 years)

Your GP should refer you or your child immediately to a specialist if you or your child have:

  • unexplained red and purple dots on the skin (petechia rash)
  • an enlarged liver or spleen on examination

If you are a child or young adult, your GP should offer a very urgent full blood count if they have any of the following:

  • look unusually pale
  • extreme tiredness (fatigue)
  • a high temperature (fever)
  • unexplained infections that won't go away
  • swollen lymph glands
  • bone pain that won't go away and can't be explained
  • bruising or bleeding for no reason
Remember most people with one or more symptoms of ALL don't have leukaemia. But it's important to get any symptoms checked out by your GP.

If you are still worried

Go back to your GP if your symptoms have not improved, are getting worse or are happening more often. 

If you feel your GP is not taking your symptoms as seriously as you'd like, print this page and take it along to the appointment. Ask your GP to explain why they think you should or shouldn’t have a referral.

  • Suspected cancer: recognition and referral
    The National Institute for Health and Care Excellence (NICE), June 2015 (updated January 2021)

  • Scottish referral guidelines for suspected cancer
    Health Improvement Scotland, January 2019 (Updated November 2020)

  • Pan-London Haemato-Oncology Clinical Guidelines Acute Leukaemias and Myeloid Neoplasms Part 1: Acute Lymphoblastic Leukaemia
    RM Partners, South East London Cancer Alliance, North Central and East London Cancer Alliance, January 2020

Last reviewed: 
01 Jun 2021
Next review due: 
01 Jun 2024

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