Referral to a specialist

Find out when GPs refer people to see a specialist doctor called a haematologist for chronic myeloid leukaemia (CML).

The National Institute for Health and Care Excellence (NICE) have produced referral guidelines to help GPs decide who needs to see a specialist and how soon they should see them. 

Your GP should arrange for you to have an urgent blood test, that is within 2 days, if you have symptoms of chronic myeloid leukaemia. 

It is important to remember that many of these symptoms are likely to be caused by other less serious medical conditions. They do not always mean that you have chronic leukaemia.

Seeing your GP

Most patients who see a GP do not have cancer and have symptoms due to a more minor condition. For some symptoms, your doctor may ask you to wait to see if the symptoms get better or respond to treatment, such as antibiotics.

There are guidelines for GPs to help them decide who needs a referral.

Urgent referral

The National Institute for Health and Care Excellence (NICE) and the Scottish Government have produced referral guidelines for cancer. These guidelines help GPs decide who needs to see a specialist and how soon they should see them. 

If you are an adult

According to the guidelines you should be referred for an urgent full blood count, within 2 days if you 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 
  • red or purple spots on your skin - petechia 
  • an enlarged spleen or liver on examination 

If you are aged 24 or under

Your GP should refer you immediately - within a few hours - to a specialist if you have: 

  • unexplained red or purple spots on the skin - petechia 
  • an enlarged liver or spleen on examination 

Your GP should offer you an urgent full blood count within 2 days if you have any of the following symptoms: 

  • look unusually pale :
  • extreme tiredness (fatigue) 
  • high temperature (fever) 
  • infections that won't go away 
  • swollen lymph glands 
  • bone pain that won't go away 
  • bruising or bleeding for no reason

While reading these guidelines, do remember that

  • Most people diagnosed with CML are over 60, but you can be diagnosed at any age
  • Risk factors include having had radiotherapy or chemotherapy before
  • Most people are diagnosed with leukaemia after going to their doctor with symptoms such as tiredness, breathlessness, bruising, bleeding, repeated infections and looking pale
  • Infections, bleeding and bruising are not early symptoms of CML
  • CML can cause an enlarged liver and enlarged spleen – doctors call this hepatosplenomegaly
  • Enlarged lymph nodes are a later symptom of CML, but can be a symptom of other types of leukaemia

If you're still worried

Sometimes you might feel that your GP is not concerned enough about your symptoms. If you think they should be more concerned, print this page and the symptoms page. Ask your GP to talk it through with you. Then you might be able to decide together whether you should see a specialist.