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Signs and Symptoms

In the early stages of myeloma, some patients have no signs or symptoms of the disease. It is sometimes detected before symptoms appear, when results of laboratory tests done as part of a routine medical examination show abnormalities in the blood and/or urine. When symptoms are present, the most common ones are bone pain and fatigue.

Signs of Myeloma 

Doctors sometimes refer to the acronym, CRAB, to describe signs of myeloma. The letters stand for

  • C - Calcium elevation (high levels of calcium in the blood; also known as “hypercalcemia”)
  • R- Renal insufficiency (poor function of the kidneys that may be due to a reduction in blood-flow to the kidneys)
  • A - Anemia (low red blood cell counts)
  • B - Bone abnormalities (lesions).

Patients with one or more of the CRAB signs and/or symptoms and at least 10% of the bone marrow with by malignant plasma cells, as seen on a bone marrow biopsy test, are considered to have active myeloma that needs treatment.

Patients with 60% of the bone marrow with malignant plasma cells but no CRAB signs and/or symptoms are also diagnosed with myeloma since there is a high risk for organ damage.

Other signs and symptoms of myeloma include​:

  • Bone thinning or holes in the bones: This can cause cause bone fractures and pain
    • Bone destruction can also lead to high levels of calcium in the blood. This can cause cause confusion, elevated blood pressure, nausea and/or vomiting, constipation and feeling very thirsty 
  • Low blood cell counts 
    • A low number of red blood cells (anemia) can cause fatigue and/or pale skin. 
    • A low number of white blood cells can cause recurrent infections.
    • A low number of platelets can cause easy bruising and bleeding. 
  • Other effects 
    • Damage to kidneys from high levels of antibodies (proteins), causing foamy urine and swelling in the legs  
    • Numbness, tingling, burning or pain in the hands or feet (peripheral neuropathy)
    • Abnormal protein buildup (amyloidosis) most often in the heart and kidneys
    • In rare cases, patients can have hyperviscosity syndrome, when the blood thickens. Symptoms of hyperviscosity syndrome are abnormal bleeding, headaches, chest pain, decreased alertness or shortness of breath. 


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