Fast Five Quiz: Key Aspects of Multiple Myeloma

Emmanuel C. Besa, MD


September 26, 2019

Presenting signs and symptoms of multiple myeloma include bone pain, pathologic fractures, weakness, anemia, infection (often pneumococcal), hypercalcemia, spinal cord compression, and renal failure. Bone pain is the most common presenting symptom. The lumbar spine is one of the most common sites of pain.

Occasionally, a patient may come to medical attention for bleeding resulting from thrombocytopenia. Rarely, monoclonal protein may absorb clotting factors and lead to bleeding.

Hyperviscosity may be associated with a number of symptoms, including generalized malaise, infection, fever, paresthesia, sluggish mentation, and sensory loss. Patients may report headaches and somnolence, and they may bruise easily and have hazy vision. Patients typically experience these symptoms when their serum viscosity is greater than four times that of normal serum. Epistaxis may be a presenting symptom of multiple myeloma with a high tumor volume. Occasionally, patients may have such a high volume of monoclonal protein that their blood viscosity increases, resulting in complications such as stroke, myocardial ischemia, or infarction.

Carpal tunnel syndrome is a common complication of myeloma. Meningitis (especially that resulting from pneumococcal or meningococcal infection) is more common in patients with multiple myeloma. Some peripheral neuropathies have been attributed to multiple myeloma. Long-term neurologic function is directly related to the rapidity of the diagnosis and the institution of appropriate therapy.

Read more about the presentation of multiple myeloma.


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