Multiple Myeloma and Anemia

Anemia is a common challenge for people with multiple myeloma, and it often develops because myeloma cells affect the bone marrow's ability to produce healthy blood cells. It is usually the first symptom of the disease, with at least 60% to 70% of people living with myeloma having anemia at the time of diagnosis. However, individuals can still develop anemia at any point as the disease progresses.

What Is Anemia?

Anemia is a medical condition that occurs when your body doesn't have enough healthy red blood cells to deliver oxygen to your tissues and organs. Red blood cells contain a protein called hemoglobin, which carries oxygen throughout your body. When your hemoglobin levels are low, you may experience symptoms such as fatigue, weakness, dizziness, or shortness of breath.

In multiple myeloma, anemia is especially common. Doctors may define anemia as a hemoglobin level below 10 grams per deciliter (g/dL), or as a significant drop of 2 g/dL or more from what's normal for you. Your normal level may vary based on factors like age, sex, and overall health, but in general, normal hemoglobin ranges are:

• 13.5-17.5 g/dL for men
• 12.0-15.5 g/dL for women

Causes of Multiple Myeloma Anemia

Anemia in patients with multiple myeloma can have several causes. Sometimes, anemia is a direct result of the disease itself. Other times, it's linked to the treatments used to control multiple myeloma. 

Bone Marrow Overcrowding and Suppression

One of the primary causes of anemia in multiple myeloma is overcrowding in the bone marrow. Myeloma cells multiply and spread within the bone marrow, where your body normally produces new blood cells. When myeloma cells grow out of control, they crowd out the healthy red blood cells. The overcrowding leads to a situation where your body can't replace older red blood cells fast enough. Without enough healthy red blood cells, anemia symptoms set in.

In addition, even if they are not truly crowding the marrow, myeloma cells interfere with the usual hormonal environment that allows red blood cell production in the marrow. In this way, they may inhibit or suppress red cell production, resulting in anemia.

Kidney Dysfunction and Hormonal Signals

Kidney issues are another common reason for anemia in myeloma patients. The "R" in the CRAB criteria for diagnosing multiple myeloma stands for "renal" or kidney problems. Healthy kidneys produce a hormone called erythropoietin (EPO), which tells your bone marrow when it's time to make more red blood cells.

When multiple myeloma affects the kidneys, the kidneys may not produce enough EPO. The bone marrow makes fewer red blood cells without this key hormone signal, leading to anemia.

Myeloma Treatment

Nearly all treatments for myeloma, especially traditional chemotherapy, can cause anemia. If you develop anemia during treatment, your healthcare team will monitor your blood counts regularly and may adjust your therapy or recommend supportive treatments to manage symptoms.

Signs and Symptoms of Myeloma-Related Anemia

One of the most common and noticeable symptoms of anemia is fatigue. Other signs to watch out for include:

• Shortness of breath
• Dizziness or light-headedness
• Pale skin (pallor)
• Irregular, rapid heartbeat
• Chest pains
• Weakness
• Cold hands and feet
• Headaches

It's important to monitor these symptoms and speak to your care team to ensure timely management of myeloma-related anemia and prevent complications.

How Healthcare Professionals Diagnose and Monitor Anemia

Doctors use routine blood tests to diagnose and track anemia in people with multiple myeloma. They mainly use a Complete Blood Count (CBC) test to assess the number of blood cells in a blood sample. A CBC test measures the levels of different blood cells, including red blood cells, white blood cells, and platelets. For anemia, the focus is mainly on hematocrit and hemoglobin levels. Lower-than-normal levels often indicate anemia.

These tests are a routine part of checkups for people with myeloma. Your healthcare team will order them regularly because anemia can develop or change throughout the course of myeloma. Ongoing monitoring helps your doctor adjust your care as needed.

Anemia Treatment Options and Management Strategies 

The most effective way to manage anemia in people with multiple myeloma is often to treat the underlying cause. Treatment options include:

• Blood transfusions: Ideal for those with more severe symptoms or dangerously low red blood cell counts. They can provide rapid relief by replacing lost red blood cells and improving oxygen delivery throughout the body. You may need regular transfusions to maintain normal levels.
• Erythropoiesis-Stimulating Agents (ESAs): If your treatment is causing anemia while your myeloma is improving, your doctor may prescribe an ESA to stimulate the production of red blood cells. ESAs are used only when there is also a chemotherapy agent in use.
• Nutritional support: Healthcare providers may also recommend iron, vitamin B12, or folic acid supplements if your blood tests show a specific deficiency.
• Adjusting myeloma therapy or dosing: There may be a need to reduce the dose of certain therapies or switch to other treatments.

The International Myeloma Foundation (IMF) Is Here to Help

Anemia is a common and manageable part of living with multiple myeloma. By understanding what causes anemia in myeloma and how it can be detected, monitored, and treated, individuals and their loved ones can play an active role in their care. At the International Myeloma Foundation, we have resources and support available to help you navigate myeloma-related anemia.