Anemia — a low level of red blood cells — affects up to 70 percent of people at the time of their multiple myeloma diagnosis. Anemia is often found during routine blood tests or while investigating symptoms of multiple myeloma.

“My red blood cell count has been low throughout my journey with multiple myeloma,” one MyMyelomaTeam member wrote. “It causes so much fatigue. Along with the bone pain, it’s exhausting.”

Anemia in multiple myeloma can have several causes. It may result from the myeloma itself, kidney damage caused by myeloma, nutritional deficiencies, or as a side effect of myeloma medications.

Read on to learn what causes anemia in multiple myeloma, how to manage it, and what anemia symptoms to watch out for.

Anemia From Multiple Myeloma

Blood cells are made in the bone marrow, the spongy tissue inside certain bones. One of these types of blood cells is plasma cells, which are a part of the body’s immune system. Plasma cells are a type of white blood cell that make antibodies, immune proteins that fight off infections in the body. In addition to plasma cells, the bone marrow makes other white blood cells, red blood cells, and platelets.

In multiple myeloma, cancerous plasma cells grow rapidly and uncontrollably in the bone marrow. As these cancer cells take over the bone marrow, there is less space for healthy blood cells to grow. This overcrowding makes it hard for the bone marrow to produce enough red blood cells, leading to anemia.

Anemia From Kidney Issues

The kidneys help produce hemoglobin, a protein in red blood cells that carries oxygen through your body. When red blood cell counts drop, the kidneys release a hormone called erythropoietin, which signals the bone marrow to make more red blood cells.

However, multiple myeloma often causes damage to the kidneys that may be reflected in blood test results. Abnormal protein buildup can prevent the kidneys from working properly. As the kidneys become damaged, they produce less erythropoietin. As a result, the bone marrow makes fewer red blood cells, leading to anemia.

Anemia From Treatment

There are many different treatment options available for multiple myeloma. These medications include chemotherapy, immunomodulating drugs, proteasome inhibitors, and monoclonal antibodies. While these medications work in different ways to treat myeloma, they can sometimes cause anemia as a side effect.

For example, pomalidomide (Pomalyst), an immunomodulatory drug, has been known to cause anemia in some people. Anemia may also occur in people who take isatuximab (Sarclisa), a monoclonal antibody.

Anemia From Nutritional Deficiencies

Anemia can also be caused by other factors, such as low levels of vitamin B12 or folate. These nutritional deficiencies may happen if you’re eating less or if your body isn’t absorbing nutrients properly through the digestive system.

Impact and Symptoms of Anemia

Anemia can significantly affect how you feel and can cause a variety of symptoms. Hemoglobin helps red blood cells carry oxygen throughout the body. When hemoglobin levels are low, your body may not get enough oxygen, leading to symptoms like:

• Fatigue
• Dizziness
• Weakness
• Shortness of breath
• Pale skin
• Rapid or irregular heart rate
• Headache

Many MyMyelomaTeam members have shared how anemia has impacted their quality of life:

• “I’m so tired all the time now.”
• “I sleep really well but still feel tired.”
• “My breathing is labored when I walk.”
• “I’m tired and drained all the time … but I do have good days.”

Anemia Treatment

Treating anemia associated with multiple myeloma depends on the cause of the anemia. If your anemia is severe, a blood transfusion may be needed to quickly improve red blood cell levels. During a blood transfusion, you receive donated blood to quickly boost your low blood counts.

If the underlying cause of anemia isn’t treated, you may need multiple blood transfusions.

Treating Anemia From Multiple Myeloma

If anemia is caused by multiple myeloma cells crowding out the bone marrow, treating the myeloma itself can help improve the anemia. When the treatment begins working, the abnormal plasma cells start to die. After that, space opens up in the bone marrow for healthy red blood cells to grow.

Treating Anemia From Treatment Side Effects

If anemia develops as a side effect of multiple myeloma treatment, your body may need time to recover and allow the bone marrow to heal. If your anemia is severe, your oncology team may adjust your medications to help improve your red blood cell levels.

In some cases, your oncologist might also recommend that you get erythropoietin injections weekly or every other week to boost red blood cell production. These injections are commonly recommended for people with myeloma who are on chemotherapy.

Treating Anemia From Vitamin Deficiencies

If your anemia is caused by nutritional deficiencies, your doctor may suggest changing your diet to ensure you get more of these nutrients. They may also recommend that you get iron infusions or take oral medication to boost your iron levels. One MyMyelomaTeam member shared, “I received six iron infusions two years ago that took away my shortness of breath and chest pain. I am still low on iron, still anemic, but my symptoms have improved.”

In addition, your doctor may prescribe folate or vitamin B12 supplements to help increase your levels. “Anemia has been my constant side effect,” one MyMyelomaTeam member wrote. “I started taking B12 this summer.”

If you aren’t sure whether your current diet provides enough of these nutrients, ask your oncologist or another health care provider for a referral to a dietitian. Always check with your health care team before starting any new supplements or making significant changes to your diet, since some can interact with your medications.

Talk With Others Who Understand

MyMyelomaTeam is the social network for people with multiple myeloma and their loved ones. On MyMyelomaTeam, more than 27,000 members come together to ask questions, give advice, and share their stories with others who understand life with multiple myeloma

Have you experienced anemia along with multiple myeloma? How has it affected you? Share your experience in the comments below, or start a conversation by posting on your Activities page.