Which is the most common clinical sign of multiple myeloma?

The most common clinical feature of multiple myeloma is anemia. Hb <120g/L occurs in 40 to 73% of patients at presentation and contributes to the weakness and fatigue The anemia is normochromic, normocytic ,but macrocytosis may be observed as well. When there are high concentrations of serum Ig, rouleaux formation occurs. The combination of anemia and hyper-proteinemia leads to a marked increase of the ESR in more than 90% of cases. The next most common clinical problem in patients with myeloma is susceptibility to bacterial infections.