Multiple myeloma diagnosis

Doctors sometimes find multiple myeloma after a routine blood test. More often, doctors suspect multiple myeloma after an X-ray for a broken bone. Usually though, patients go to the doctor because they are having other symptoms.

To find out whether such problems are from multiple myeloma or some other condition, your doctor may ask about your personal and family medical history and do a physical exam. Your doctor also may order some of the following tests:

Blood tests. Several may be done:

  • Proteins. To check for high levels of proteins in the blood. The lab checks the levels of many different proteins, including M protein and other immunoglobulins (antibodies), albumin and beta-2-microglobulin.
  • Blood count. To check for anemia and low levels of white blood cells and platelets. The lab does a complete blood count to check the number of white blood cells, red blood cells and platelets.
  • Calcium. To check for high levels of calcium.
  • Creatinine. To see how well the kidneys are working, the lab tests for creatinine.

Urine tests
The lab checks for Bence Jones protein, a type of M protein, in urine. The lab measures the amount of Bence Jones protein in urine collected over a 24-hour period. If the lab finds a high level of Bence Jones protein in your urine sample, doctors will monitor your kidneys. Bence Jones protein can clog the kidneys and damage them.

You may have X-rays to check for broken or thinning bones. An X-ray of your whole body can be done to see how many bones could be damaged by the myeloma.

Your doctor removes some bone marrow from your hipbone or another large bone to look for cancer cells, and a pathologist uses a microscope to check the tissue for myeloma cells. A biopsy is the only sure way to know whether myeloma cells are in your bone marrow. Before the sample is taken, local anesthesia is used to numb the area. This helps reduce the pain.

There are two ways your doctor can obtain bone marrow. Some people will have both procedures during the same visit:

  • Bone marrow aspiration: A thick, hollow needle is used to remove samples of bone marrow.
  • Bone marrow biopsy: A very thick, hollow needle is used to remove a small piece of bone and bone marrow.

If a biopsy shows you have multiple myeloma, your doctor needs to determine the stage of the disease to develop a proper treatment plan.