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The Laboratory Investigation of Tiredness

Key points and Introduction tiredness PDF
Causes of tiredness presentation
A suggested clinical framework
Approach to laboratory investigations

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Key Points

  • 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.

Final Diagnosis Percentage
General weakness/tiredness 43.2
Upper respiratory tract infections 8.7
Viral disease – NOS 6.4
Psychological disorders 6.2
Lower respiratory tract infections 3.6
Iron deficiency anaemia 3.0
Social problems 2.7
No disease/prevention 2.2
Adverse effect medical agent in proper dose 1.7
UTI 1.0
Heart disease 0.8
Infectious mononucleosis 0.7
Presumed GI infection 0.7
Diabetes mellitus 0.3
Anaemia other/unspecified 0.3
Malignant neoplasm digestive system 0.2
Menopausal symptoms/complaints 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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Comments recieved about this article

14 November 2011
Comment from:
Mark Dennison
A useful summary , and I will use the evidence to reduce the number of blood tests I order, at least when a patient presents with a relatively short history