Chronic fatigue syndrome in the routine hematology practice

Abstract

Purpose. Presentation of clinical signs and laboratory profiles of the patients with chronic fatigue syndrome, and comparison of their symptoms with those of the patients with iron deficiency anemia.
 Materials and methods. Retrospective analysis of the patients symptoms referred to the hematologist outpatient clinic during the period between January 2016 and December 2018.
 Results. There were 560 patients(162 males and 398 females) referred for a primary consultation by a hematologist. Median age was 52.5 (1894) years. The unexplained fatigue was reported by 27 (4.8%) patients (1 male and 26 females), median age 41 (2466) years. Diagnosis chronic fatigue syndrome (CFS) was confirmed based on the criteria in 17 (63%) patients. 10 patients (47%) with symptoms partially meeting the criteria were diagnosed idiopathic fatigue syndrome (SIF). Half of the patients connected the onset of the diseases with emotional trauma (family issues etc.). The prevailing complaints (30%) were represented by: prolonged fatigue, mild memory impairment and distraction, arthralgia and insomnia. The most frequent reason to see a hematologist was fatigue and borderline changes in the blood tests. Five patients with CFS and 2 patients with SIF were known to have previously diagnosed iron deficient anemia (IDA). Median level of hemoglobin in the patients with severe fatigue and IDA was 10.7 (8.411.7) g/dl. Median follow up duration was 28 (640) months. In the observed group (n = 23) 17% of the patients (n = 4) showed spontaneous improvement. The rest of the patients had reported no changes. The comparison group (n = 64) included the patients with IDA. Most of them (n = 38) did not report fatigue as their initial symptoms (median level of hemoglobin was 9.35 (5.511.9) g/dl). Twenty six patients reported fatigue; median level of hemoglobin was 8.15 (5.911.7) g/dl. The difference between the hemoglobin levels in two groups was significant (р 0.05). However, there was no correlation between the level of hemoglobin and fatigue in the patients with CFS and SIF. The correlation was found in the patients with CFS and SIF between fatigue and patients perception.
 Conclusion. The main symptoms accompanying CFS are fatigue and other non-specific symptoms which are often related to patients emotional status. Considering CFS as a differential diagnosis when dealing with fatigue is essential.