The recent NICE guidance suggests that the following tests are carried out when diagnosing CFS;
- urinalysis for protein, blood and glucose;
- full blood count;
- urea and electrolytes;
- liver function;
- thyroid function;
- erythrocyte sedimentation rate or plasma viscosity;
- C-reactive protein;
- random blood glucose;
- serum creatinine;
- screening blood tests for gluten sensitivity;
- serum calcium;
- creatine kinase;
- assessment of serum ferritin levels (children and young people only).
The NICE guidance also advises physician to consider the possibility of CFS if a person has:
fatigue with all of the following features-
- new or had a specific onset (that is, it is not lifelong)
- persistent and/or recurrent
- unexplained by other conditions
- has resulted in a substantial reduction in activity level
- characterised by post-exertional malaise and/or fatigue (typically delayed, for example by at least 24 hours, with slow recovery over several days)
And one or more of the following symptoms-
- difficulty with sleeping, such as insomnia, hypersomnia, unrefreshing sleep, a disturbed sleep–wake cycle
- muscle and/or joint pain that is multi-site and without evidence of inflammation
- headaches
- painful lymph nodes without pathological enlargement
- sore throat
- cognitive dysfunction, such as difficulty thinking, inability to concentrate, impairment of short-term memory, and difficulties with
word-finding, planning/organising thoughts and information processing
- physical or mental exertion makes symptoms worse
general malaise or ‘flu-like’ symptoms
- dizziness and/or nausea
- palpitations in the absence of identified cardiac pathology
The guidance reminds physicians that the symptoms of CFS fluctuate in severity and may change in nature over time.
