Please see the haematology section of the Scottish Referral Guidelines for Suspected Cancer for more detail.
There are 3 main groups of haematological cancers, with many subtypes. They are generally commoner in older people, but can occur any age, with some, such as Hodgkin’s Lymphoma, being commoner in young adults:
- Leukaemias (acute and chronic) – 70% are usually diagnosed in people aged ≥ 60, though any age can be affected
- Lymphoma:
- Non-Hodgkin’s – 75% aged ≥ 60
- Hodgkin’s – almost half diagnosed aged <40
- Multiple myeloma – most in those aged ≥ 60.
Please note in terms of presentation and diagnosis:
- Chronic Lymphocytic Leukaemia (CLL) is the commonest leukaemia in adults – often an indolent disease with the incidental finding of asymptomatic lymphocytosis. Please see advice on assessing lymphocytosis.
- Myeloma is a difficult cancer to identify, especially in its early stages, often presenting with vague symptoms which could also have many other alternative causes. For key symptoms and assessment advice, see the myeloma page (to follow). If blood tests are normal, myeloma is unlikely and other causes of the symptoms should be considered, including HIV. There is a higher incidence of myeloma in people of black ethnicity.
- MGUS (monoclonal gammopathy of undetermined significance) – Isolated paraproteins are a common incidental finding in the elderly and are not a blood cancer. See the myeloma (to follow) and paraprotein pages for further advice.
- Baseline tests and investigations should be repeated if a person’s condition remains concerning and unexplained following investigation for other causes – combined with safety netting advice for the patient
- Splenomegaly can be identified on imaging (e.g. USS or CT abdomen).
Other blood cancers
Further information on less common cancers such as myeloproliferative neoplasms and myelodysplastic syndromes can be found via Blood Cancer UK or Cancer Research UK resources, and via the Ref Help guidelines for thrombocytosis and polycythaemia.
NS & CM 6/3/26
Please also see the guidance about the individual haematological cancers for more detail. Patients can be referred to the Western General Hospital or St John’s.
Who to refer
EMERGENCY SAME DAY REFERRAL – please phone haematology on call:
- Blood count/film reported as suggestive of Acute Leukaemia or Chronic Myeloid Leukaemia (CML)
- Blood tests or imaging suggestive of myeloma with significant acute kidney injury
If malignant spinal cord compression is suspected please refer via the Malignant Spinal Cord Compression pathway.
Refer to haematology as Urgent Suspicious of Cancer:
A Lymphocyte count >5 x 109 /l and any of the following features:
- weight loss, fever, or drenching night sweats
- lymphadenopathy and/or splenomegaly
- cytopenia (haemoglobin less than 100 g/l, neutrophils less than 1.0 x 109 /l, platelets less than 100 x 109 /l).
Multiple myeloma
- The patient has one or more CRAB criteria (raised corrected calcium, unexplained renal impairment, unexplained anaemia, or bone pain)
- AND test results suggest that suggest the diagnosis: raised paraprotein bands, or abnormal serum Free Light Chain ratio, or urinary Bence Jones proteins.
Generalised lymphadenopathy particularly with systemic upset (e.g. drenching night sweats or unintentional weight loss) and/or hepatomegaly and/or splenomegaly – please also see the lymphadenopathy page.
Unexplained isolated lymphadenopathy (2 cm or more in size, persisting for six weeks or more, or increasing in size, or with size-significant lymphadenopathy AND drenching night sweats, weight loss, fever, alcohol-induced pain) as a USC. See lymphadenopathy guidance for more advice about who to refer.
For patients not meeting USC pathway criteria
Patients with lymphadenopathy, lymphocytosis, or paraproteins without the additional features for USC referral can be managed as per RefHelp guidelines.
