Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Tiredness/fatigue in adults - Management
What first-line investigations should I offer to an adult with tiredness?

  • Offer investigations as indicated by the history and physical examination — see Assessment and Red flags.
  • If a physical cause is not evident clinically:
    • Consider delaying routine investigations until tiredness has lasted for 1 month.
    • Offer the following routine first-line investigations:
      • Full blood count.
      • Erythrocyte sedimentation rate or C-reactive protein.
      • Thyroid stimulating hormone.
      • Random blood glucose.
      • IgA tissue transglutaminase for coeliac disease (provided the person consumes gluten-containing foods).
    • Also consider offering the following additional investigations:
      • Liver function tests — particularly if the person is obese, or is 60 years of age or older.
      • Creatinine and electrolytes — particularly if the person is 60 years of age or older.
      • Bone biochemistry — particularly if the person is 60 years of age or older.
      • Serum ferritin — in women of child-bearing age, as there is limited evidence that iron supplementation is effective even in the absence of anaemia.
      • Testing for vitamin D deficiency, by bone biochemistry and serum 25–hydroxycholecalciferol concentration — if the person is at risk because of failure to spend time outdoors or regular use of sunscreens, inadequate diet, or reduced gut absorption.
      • Testing for glandular fever (infectious mononucleosis), such as by the monospot test — if the person is younger than 40 years of age.
      • HIV test — if the person is at risk.
      • Hepatitis serology — if the person is at risk.
      • Testing for tuberculosis (chest radiography and sputum samples) pending referral — if the person is at risk (see the CKS topic on Tuberculosis).
    • If tiredness/fatigue lasts for 3 months or longer, offer second-line investigations.

© NHS Institute for Innovation and Improvement