Because CAYA acute leukaemia is rare it represents a major diagnostic challenge for primary healthcare professionals including GPs and emergency physicians. It is important to recognise parental concern and the need to escalate investigations, particularly after repeated visits to healthcare professionals.

The following signs and symptoms should be investigated and may warrant the consideration of a full blood count and peripheral blood film examination:

• persistent unexplained fever
• diffuse bone pain with no obvious trauma and/or refusal to walk in children
• generalised lymphadenopathy
• hepatosplenomegaly
• pallor
• unexplained bruising, unexplained bleeding or petechiae
• extreme fatigue
• recurrent infections.

Children can sometimes have only mild symptoms so the medical practitioner should be alert to the diagnosis, particularly when there is a constellation of the symptoms/signs above.

Initial investigations include a thorough clinical examination full blood count and blood film (performed immediately).

Referral options

A clinical suspicion or laboratory findings that suggest CAYA acute leukaemia warrants immediate telephone referral and presentation to the nearest specialist service. The patient and their family and/or carer should be warned they may need to transfer to a more specialised service after initial assessment.

At the referral stage, the patient’s GP or other referring doctor should advise the patient and their family and/or carer about their options for referral, waiting periods, potential out-of-pocket costs and the range of services available. This will enable patients to make an informed choice of specialist and health service.

Communication

The GP’s responsibilities include:

• explaining to the patient, family and/or carer who they are being referred to and why
• informing the patient, family and/or carer that they can contact Camp Quality 1300 662 267, Cancer Council 13 11 20, Canteen 1800 835 932, Leukaemia Foundation 1800 620 420 and Redkite 1800 733 548.

Checklist

• Signs and symptoms recorded
• Supportive care needs assessed and referrals to allied health services actioned as required
• Patient notified of support services such as Camp Quality 1300 662 267, Cancer Council 13 11 20, Canteen 1800 835 932, Leukaemia Foundation 1800 620 420 and Redkite 1800 733 548
• Referral options discussed with the patient, family and/ or carer including cost implications

Timeframe

If there is suspicion of CAYA acute leukaemia, patients should be referred to a specialist immediately.

Test results should be provided to the patient, family and/or carer immediately.