Myeloma is a rare type of blood cancer that can initially have few or no symptoms. This means that a diagnosis may sometimes be delayed.

Anyone who is suspected of having myeloma should be referred to a haematologist for further tests and investigations. Myeloma is a complex cancer and therefore its diagnosis can involve multiple tests. 

The aims of the tests and investigations are to:

  • establish a diagnosis
  • gain an in-depth picture of the exact characteristics of the myeloma
  • detect any problems, so that they can be effectively managed
  • help define a treatment plan.

There are a variety of blood tests are used to diagnose and monitor myeloma.

Full blood count
A full blood count measures the levels of the different cells in your blood. The most important are:

  • Haemoglobin. A low count indicates anaemia.
  • White blood cells. A low counts of some or all of the different white blood cells indicate a greater risk of infection.
  • Platelets. A low count indicates an increased risk of bleeding or bruising.

Routine biochemistry

  • Kidney function tests. This is measured using the creatinine level, and can be abnormal in myeloma.
  • Calcium levels can be elevated in myeloma.


Specialist biochemistry

Myeloma cells usually produce an abnormal protein (“paraprotein”), which needs testing for using two different tests:

  • Protein electrophoresis
  • Serum-free light chains. (This test can also be done by looking for "Bence-Jones" protein in the urine.)

A detectable paraprotein can be a marker of myeloma, but is also commonly found in pre-myeloma conditions (eg MGUS and Smouldering Myeloma), which do not require any treatment.

If a diagnosis of myeloma is made, then the paraprotein level can be used to monitor response to treatment, and also look for evidence of later relapse or progression.

If myeloma is suspected, a bone marrow biopsy is used to confirm the diagnosis.

A needle will be used to take a small sample of liquid bone marrow ("aspirate") and a small bone biopsy from the top of the pelvis. This is a short, day-case procedure, which is carried out using a local anaesthetic.

The sample of bone marrow and bone will be examined in a laboratory to check for the presence of myeloma cells.

Because myeloma often affects the bones, most people who have confirmed or suspected myeloma will need scanning that will check the whole skeleton for bone damage or fractures. This is done using on of the following:

  • MRI scan    
  • PET scan    
  • CT scan.

In addition, some people may require a specific scan looking in more detail at one are of the skeleton, such as an MRI scan of the spine.