Multiple myeloma is a complicated disease that can cause many symptoms. You may feel bone pain, restlessness, confusion, fatigue, and loss of appetite, among other things.

These symptoms may compel you to speak with a doctor, leading to a multiple myeloma diagnosis.

People with multiple myeloma experience fatigue due to the low red blood cell count caused by the cancer. “Anemia” is the term used to describe a low count of these cells.

According to the Multiple Myeloma Research Foundation (MMRF), about 60 percent of people with multiple myeloma have anemia at the time of diagnosis.

Anemia results from a reduction of red blood cells in the body. There are different causes of this condition. Some people develop anemia because they have a disease that causes bleeding. Others develop it due to a condition that causes a decrease in the production of red blood cells from their bone marrow.

Anemia and multiple myeloma go hand in hand. Multiple myeloma triggers an overgrowth of plasma cells in the bone marrow. Plasma cells are white blood cells that produce and secrete antibodies. Too many of these cells in the bone marrow crowd and decrease the number of normal blood-forming cells. This response causes a low red blood cell count.

The condition can be mild, moderate, severe, or life-threatening. Red blood cells contain hemoglobin. Hemoglobin carries oxygen from the lungs to different parts of the body. Your doctor may diagnose anemia if your hemoglobin level is below normal. For women, a normal hemoglobin level is 12 to 16 grams per deciliter (g/dL). For men, a normal level is 14 to 18 g/dL.

Symptoms of anemia may include:

  • dizziness
  • shortness of breath
  • headache
  • coldness
  • chest pain
  • pale skin
  • low energy
  • arrhythmia

Anemia can also develop as a side effect of certain cancer treatments. Some medications reduce the number of red blood cells produced by the body.

Speak with your doctor to understand possible complications of different therapies. Cancer treatments that may cause a low blood count include:

  • Chemotherapy.
    This treatment can also kill healthy cells along with malignant cells. These
    healthy cells include the cells in the bone marrow that make red blood cells.
  • Radiation.
    This therapy uses high-energy X-rays to shrink tumors and damage cancer cells.
    It can also damage bone marrow when carried out over large areas of the body
    (bones, chest, abdomen, or pelvis). Such damage leads to a lower production of
    red blood cells.

Anemia is usually temporary. As your cancer improves, your production of red blood cells should normalize.

Anemia can cause many symptoms including low energy, dizziness, headaches, and organ damage. Your doctor may suggest treatment to help restore a normal red blood cell count while you complete cancer therapy.

Your doctor may monitor your blood cell counts with blood tests. This can detect anemia, as well as assess the effectiveness of a particular treatment. Treatment options for anemia vary, but may include:

Vitamin supplementation

A vitamin deficiency can cause anemia in multiple myeloma. Your doctor may order a blood test to determine if you have a deficiency. If you do, they will recommend supplementation to correct this deficiency.

Vitamin supplements may include iron, folate, or vitamin B-12. Your doctor may recommend over-the-counter supplements and dietary changes. Depending on the severity of the anemia, your doctor may prescribe a supplement or vitamin B-12 shots.


Medication is also available to trigger your bone marrow’s production of red blood cells. This can resolve anemia and its symptoms. Such drugs include epoetin alfa (Procrit or Epogren) and darbepoetin alfa (Aranesp).

Although effective, these drugs aren’t for everyone. There’s a risk of blood clots when combined with some drugs that treat multiple myeloma. Your doctor can determine whether it’s safe to take one of the above drugs with your current therapy.

When anemia is severe or life-threatening, your doctor may recommend a blood transfusion.

Living with anemia and multiple myeloma can be challenging, but treatment is available.

Speak with your doctor as soon as you show signs of anemia. You may need vitamin supplementation to boost your production of red blood cells. Or you may also be a candidate for medication.

Anemia may improve as you achieve remission and your bone marrow becomes healthier.