Diagnosis of Multiple Myeloma Complete blood count (CBC) with platelets, peripheral blood smear, and chemistry panel (blood urea nitrogen [BUN], creatinine, calcium, uric acid, lactate dehydrogenase [LDH]) Serum and urine protein (on a 24-hour urine collection) electrophoresis followed by immunofixation; quantitative immunoglobulins; serum free light chains X-rays (skeletal survey) and either a positron emission tomography (PET) - CT scan or whole-body MRI Bone marrow examination, including conventional cytogenetics and fluorescent in situ hybridization studies (FISH) Multiple myeloma is suspected in patients > 40 years with persistent unexplained bone pain, particularly at night or at rest, other typical symptoms, or unexplained laboratory abnormalities (such as elevated blood protein or urinary protein, hypercalcemia, renal insufficiency, or anemia) or x-rays showing a pathologic fracture or lytic lesions.