STEP 2: Presentation, initial investigations and referral

Signs and symptoms

Symptoms at presentation are usually non-specific and may include:

  • fatigue, pallor or other symptoms of anaemia
  • symptoms of serious infection, such as tachycardia, high fevers, rigors
  • unresolving or unusual infection/fever
  • abnormal bleeding or bruising
  • sore gums or mouth ulcers
  • unexplained bone pain
  • unintentional weight loss
  • unexplained fevers.

The following signs and symptoms require consultation as a medical emergency:

  • sepsis
  • symptomatic anaemia
  • severe thrombocytopenia < 20 × 109/L
  • major laboratory abnormalities
  • very high white cell count (> 50 × 109/L) or signs of hyperviscosity
  • spontaneous/uncontrolled bleeding
  • coagulopathy
  • Initial investigations

If a serious blood disorder is suspected a focused medical history and thorough clinical assessment should be undertaken. Full blood count and film should be performed immediately.

If the patient is clinically unwell (presents with symptomatic anaemia, spontaneous bleeding, sepsis or has symptoms of hyperviscosity), immediate referral to an emergency facility is recommended without waiting for blood results.

Morphologic evidence of APL, disseminated intravascular coagulation, severe thrombocytopenia and any organ dysfunction (renal/liver failure) should be considered a medical emergency.

Referral options

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


The GP’s responsibilities include:

  • explaining to the patient and/or carer who they are being referred to and why
  • supporting the patient and/or carer while waiting for specialist appointments
  • informing the patient and/or carer that they can contact Cancer Council on 13 11 20.



The GP should start investigations immediately if AML is suspected. Laboratory results should be actively followed up and progressed on the same day.

Patients with sepsis, bleeding or severe symptoms should be regarded as a medical emergency and be referred immediately to an appropriate emergency facility without necessarily waiting for results of laboratory tests (same day).

Patients with a laboratory diagnosis of possible AML should be referred for an urgent assessment by a haematologist at an appropriate facility within 24 hours (unless advised otherwise by a haematologist).