Diagnosis of Macroglobulinemia Complete blood count (CBC) with platelets, red blood cell indices, and a peripheral blood smear Serum protein electrophoresis followed by serum and urine immunofixation, quantitative immunoglobulin levels, and serum free light chain levels Plasma viscosity assay Bone marrow examination, including tests for specific mutations such as MYD88 and CXCR4 Sometimes a lymph node biopsy Macroglobulinemia is suspected in patients with symptoms of hyperviscosity or other typical symptoms, particularly if anemia is present.