Fatigue

Referral criteria for fatigue (including Chronic Fatigue Syndrome (CFS), Myalgic Encephalomyelitis (ME), Post Covid 19 syndrome and post viral fatigue):

Referral will be accepted if the person meets the following criteria

• Persistent fatigue symptoms for at least 3 months
• Fatigue is significantly affecting the ability to engage with usual daily activities
• Cannot be explained by another specific health condition
• The following blood tests results are normal, or abnormalities have been fully treated and have been excluded as a causes for fatigue (please send results in referral letter):
  • FBC
  • ferritin
  • CRP
  • LFT
  • U+E
  • TFT
  • HbA1c
  • IgA tissue transglutaminase (coeliac antibodies)
  • Creatinine kinase
  • Calcium and phosphate (Bone profile)
  • urinalysis for protein, blood and glucose

Use clinical judgement to decide on additional investigations to exclude other diagnoses for example

• vitamin D
• vitamin B12
• folate levels
• serological tests if relevant e.g. EBV or Lymes disease
• multiple myeloma
• and 9am cortisol for adrenal insufficiency

If the person is experiencing breathlessness, consider adding

• B-type natriuretic peptide
• Chest X-ray
• BP and heart rate
• Oxygen saturations

Additional referral guidelines:

• Please note PLWS is not a diagnostic service
• There is no diagnostic test for CFS or post-viral fatigue, but diagnosis is made on an assessment of typical symptoms and exclusion of other causes by examination and routine tests in primary care.

If CFS/ME, Post- Covid 19 syndrome or post viral fatigue are suspected we ask referrers to assess and make a provisional diagnosis according to the following guidance.

https://www.nice.org.uk/guidance/ng206

https://www.nice.org.uk/guidance/ng188.

CFS

Typical symptoms for CFS include debilitating fatigue, worsened by activity, with typical post-exertional fatigue patterns that are disproportionate to the activity with a prolonged recovery time. Sleep is unrefreshing and there are cognitive difficulties (brain fog).

Post Covid 19 syndrome

Suspect post-Covid 19 syndrome after an infection consistent with Covid -19, and symptoms and signs continue for more than 12 weeks not explained by alternative causes.

When excluding other causes for CFS/Post Covid-19 syndrome or post-viral syndrome, please check that any menopausal symptoms are treated and assess for fatigue as a side effect of medication.

Please consider referring to relevant secondary care professionals if there is diagnostic uncertainty.