The Laboratory Investigation of Tiredness
|Key points and Introduction|
|Causes of tiredness presentation|
|A suggested clinical framework|
|Approach to laboratory investigations|
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- The investigation of tiredness is a clinical rather than laboratory task.
- A focused approach to the laboratory investigation of tiredness is usually determined by clinical findings.
- When tiredness is the sole clinical finding, investigations are determined by patient demographics, presence of risk factors and duration of tiredness.
Tiredness represents one of primary care’s most difficult challenges; it is a common presentation that is usually self-limiting but may, on occasions, have more sinister causes. This is demonstrated by the results of a Dutch study in which 12,292 people, who presented to Dutch general practitioners with tiredness as the reason for consultation, yielded the final diagnoses presented in the following table (Kenter, 2003). In this study 72% of the patients who presented with tiredness did not require a follow up consultation.
|Upper respiratory tract infections||8.7|
|Viral disease – NOS||6.4|
|Lower respiratory tract infections||3.6|
|Iron deficiency anaemia||3.0|
|Adverse effect medical agent in proper dose||1.7|
|Presumed GI infection||0.7|
|Malignant neoplasm digestive system||0.2|
|Note: Adapted from, Kenter, 2003|
Although this document is about laboratory testing for tiredness, the investigation of tiredness is a clinical rather than laboratory task. Patient, clinician and contextual factors make every consultation different. Clinicians will have developed an approach to tiredness, which suits them, their practice and their patients. In this document, we make some suggestions that clinicians could incorporate into their own approach if they are not already part of it. When investigating tiredness, sound clinical judgement is important and laboratory tests should be guided by your judgement.
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