From the Guidelines

Anemia is a common complication in multiple myeloma (MM) and a comprehensive workup is essential for its diagnosis and management.

The initial diagnostic workup for MM should include a complete blood count (CBC) with differential and platelet counts to evaluate anemia, as well as other baseline laboratory studies such as blood urea nitrogen, serum creatinine, and serum electrolytes 1.
A peripheral blood smear may show abnormal distribution of red blood cells, such as Rouleaux formation, due to elevated serum proteins 1.
Serum lactate dehydrogenase (LDH) and beta-2 microglobulin levels should also be measured, as they reflect tumor cell characteristics and are important prognostic factors 1.
Additionally, serum protein electrophoresis (SPEP) and serum immunofixation electrophoresis (SIFE) should be performed to detect and evaluate monoclonal proteins (M-proteins) in the serum 1.
The serum free light chain (FLC) assay is also a valuable tool in the diagnosis and management of MM, particularly in patients with light chain amyloidosis or oligosecretory myeloma 1.
A bone marrow aspiration and biopsy should be performed to evaluate bone marrow plasma cell infiltration and to detect quantitative and/or qualitative abnormalities of bone marrow plasma cells 1.
It is essential to note that the workup for anemia in MM should be comprehensive and include a thorough evaluation of the patient's overall clinical condition, as well as the presence of other MM-related complications such as renal insufficiency, hypercalcemia, and infections 1.

From the Research

Anemia is a common complication in patients with multiple myeloma (MM), occurring in more than two thirds of all patients 2.
The most frequent underlying pathophysiological mechanisms of anemia in MM include anemia of chronic disease, relative erythropoietin (EPO) deficiency, and myelosuppressive effects of chemotherapy 2, 3.
Other factors that may contribute to anemia in MM include marrow replacement by malignant cells, chronic renal failure, and shortening of the half-life of erythrocytes 3.

The diagnosis of MM is difficult and requires the use of bone marrow biopsy, laboratory testing technologies, and imaging technology 4.
Clinical characteristics, serological tests, and imaging investigations are used to determine the diagnosis of MM 4.
Differential diagnosis is important in MM, and recent advances in diagnosis and treatment have improved patient outcomes and quality of life 5.

Treatment options for anemic MM patients include red blood cell (RBC) transfusions and recombinant human erythropoietin (rHuEPO) 2.
RBC transfusions can provide an immediate effect, but their effects are only transient and can be associated with risks such as infections and immunologic reactions 2.
rHuEPO can increase hemoglobin levels over an extended time without the risks of blood transfusions and has been shown to improve quality of life and reduce transfusion needs 2, 6.
Epoetins, such as epoetin alfa and epoetin beta, have been shown to be effective in treating anemia in MM patients, with a high response rate and minimal toxicity 6.