Although rare, general practitioners should be mindful of CAYA who present with the symptoms described above. It is important that there is a thorough clinical examination because the finding of significant lymphadenopathy or hepatosplenomegaly with petechiae/significant pallor and bruising will be an alert to the potential diagnosis.

A full blood count and blood film should be performed immediately.

If the patient is unwell with fever, bleeding, sepsis, respiratory distress (particularly orthopnoea and dyspnoea) or signs of hyperviscosity (respiratory distress or neurological signs) they should be referred immediately to a specialist centre, without waiting for laboratory blood results.

If CAYA acute leukaemia is suspected by pathology laboratories (e.g. high white cell count, pancytopenia or presence of blasts on the blood film), the pathology laboratory should contact the general practitioner by telephone immediately.

If the CAYA acute leukaemia diagnosis is suspected but not confirmed or the results are inconsistent or indeterminate, the general practitioner must immediately refer the patient via telephone to an appropriate specialist (paediatric or adult haematologist/oncologist) to make the diagnosis.