Percentages below correspond to clinical presentations in newly diagnosed disease
Bone (plasma cell proliferation in marrow) lesions in ~80%
Pathologic fractures
Due to lytic lesions and osteopenia
”Punched-out” lytic lesion on x-ray
Frequently involve spine, as well as ribs, skull, extremities
Bone pain (even in absence of fracture) in ~60%
Commonly in back, ribs, extremities, often worse with movement
Renal impairment in 20-40%
Ranges from mild creatinine elevation to ESRD
Due to light-chain deposition,<unk>  cast nephropathy and/or amyloidosis
Hypercalcemia exacerbates
Vulnerable to further damage from nephrotoxic mediations/contrast
Hematologic
Anemia in ~70%
Due to plasma cell infiltration in marrow +/- renal failure
Hyperviscosity syndrome 
Increase serum viscosity due to paraproteins  poor capillary flow and organ congestion
Cryoglobulinemic vasculitis
Altered mental status, syncope, stroke
Rouleaux formation on peripheral smear
Neuro
Spinal cord compression due to vertebral fracture or collapse or plasmacytoma
Intracranial plasmacytoma (rare)
Peripheral neuropathy, radiculopathy
Hypercalcemia
Due to local osteolysis
Though overall uncommon as first presentation finding
Infection
Most common cause of death in patients with<unk> 
Impaired plasma cell function decreased effective antibody production
Often on immunosuppressive chemotherapy or bone marrow transplant meds
Splinting due to rib pain/fractures increased pneumonia risk
Coagulopathy can occur due to dysfibrinogenemia
Pathologic fractures
Due to lytic lesions and osteopenia
”Punched-out” lytic lesion on x-ray
Frequently involve spine, as well as ribs, skull, extremities
Bone pain (even in absence of fracture) in ~60%
Commonly in back, ribs, extremities, often worse with movement
Due to lytic lesions and osteopenia
”Punched-out” lytic lesion on x-ray
Frequently involve spine, as well as ribs, skull, extremities
Commonly in back, ribs, extremities, often worse with movement
Ranges from mild creatinine elevation to ESRD
Due to light-chain deposition,<unk>  cast nephropathy and/or amyloidosis
Hypercalcemia exacerbates
Vulnerable to further damage from nephrotoxic mediations/contrast
Anemia in ~70%
Due to plasma cell infiltration in marrow +/- renal failure
Hyperviscosity syndrome 
Increase serum viscosity due to paraproteins  poor capillary flow and organ congestion
Cryoglobulinemic vasculitis
Altered mental status, syncope, stroke
Rouleaux formation on peripheral smear
Increase serum viscosity due to paraproteins  poor capillary flow and organ congestion
Cryoglobulinemic vasculitis
Altered mental status, syncope, stroke
Altered mental status, syncope, stroke
Spinal cord compression due to vertebral fracture or collapse or plasmacytoma
Intracranial plasmacytoma (rare)
Peripheral neuropathy, radiculopathy
Due to local osteolysis
Though overall uncommon as first presentation finding
Most common cause of death in patients with<unk> 
Impaired plasma cell function decreased effective antibody production
Often on immunosuppressive chemotherapy or bone marrow transplant meds
Splinting due to rib pain/fractures increased pneumonia risk
Multiple myeloma
Hemorrhage
Myelofibrosis
Hereditary
Non-Hodgkin's lymphoma
Acquired
Chronic lymphocytic leukemia
Microangiopathic Hemolytic Anemia 