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Blood tests

Blood tests are important tests in helping to diagnose myeloma.

Blood tests can:

  • check your general health, including how well your liver and kidneys are working
  • check numbers of blood cells
  • help diagnose cancer and other conditions

For myeloma, you have blood tests and urine tests looking for an abnormal protein (the myeloma protein is called monoclonal protein, M-protein or paraprotein).

Your blood sample is sent to the laboratory. A blood doctor looks at your sample under a microscope.

They can see the different types of cells and can count the different blood cells.

Preparing for your blood tests

You can eat and drink normally before most blood tests. For fasting blood tests you need to stop eating and drinking beforehand. Your doctor will tell you for how long.

What happens

You sit or lie down to have the test.

A doctor, nurse or phlebotomist (person specialised in taking blood) chooses the best vein to use. This is usually from your arm or hand. Let them know if you are afraid of needles, get unwell with the sight of blood or are allergic to plasters or latex. 

They put a tight band (tourniquet) around your arm above the area where they take the sample. You may need to clench your fist to make it easier to find a vein.

They clean your skin and then put a small needle into your vein. Next, they attach a small bottle or syringe to the needle to draw out some blood. They might fill several small bottles.

Once they have all the samples, they release the band around your arm. They then take the needle out and put pressure on the area with a cotton wool ball or small piece of gauze for a few minutes. This helps to stop bleeding and bruising.

Look away when they’re taking the blood if you prefer. Tell your doctor, nurse or phlebotomist if you feel unwell.

Getting your results

Ask the phlebotomist, doctor or nurse when and how you will get your results. Some results might be available quickly, such as a full blood count. But some other tests might take several weeks.

Possible risks

Blood sampling (phlebotomy) is a safe test. There is a possibility of:

  • bleeding and bruising - pressing hard when the needle is removed can help to stop it
  • pain - this is normally mild and can last for a few minutes
  • swelling (oedema) - ask your nurse, doctor or phlebotomist to avoid an arm that is swollen or has a risk of swelling
  • feeling faint or fainting - tell the person doing your blood test if you're feeling lightheaded or dizzy at any time
  • infection - this is very rare

Types of blood tests

Full blood count

A full blood count (FBC) measures the number of red cells, white cells and platelets in your blood.

  • Red cells carry oxygen around our bodies. Haemoglobin is the part of the cell that carries oxygen. If you have a low red cell count, your doctor might say you’re anaemic (pronounced a-nee-mic). This can make you feel tired, short of breath and dizzy.
  • White cells fight infections. There are several different types of white cells, including neutrophils and lymphocytes.
  • Platelets help clot the blood. Symptoms of a low platelet count include abnormal bleeding, such as bleeding gums and nosebleeds.

There isn’t an exact range of normal for blood counts. The range of figures quoted as normal varies slightly between laboratories and also differs between men and women.

Diagram of table showing the normal values of men and women

Serum protein electrophoresis

Serum protein electrophoresis (SPEP) measures the amount of immunoglobulins (antibodies) in the blood. This test looks for abnormal proteins found in myeloma. The myeloma protein is called monoclonal protein (also called M-protein, light chain, abnormal antibody or paraprotein). Another test called immunofixation electrophoresis shows the exact type of abnormal antibody (also called M protein or paraprotein), such as IgG or IgA.

Doctors can also use these tests to monitor how well treatment for myeloma is working. By measuring the amount of protein in the blood you can find out how active the myeloma is and how well treatment is working.

Serum free light chain (SFLC) assay

The serum free light chain (SFLC) assay picks up tiny amounts of small proteins called free light chains in the blood. This is a smaller part of the myeloma protein called light chain that is also made by myeloma cells. It is particularly useful for diagnosing and monitoring light chain myeloma (where light chain is the only abnormal protein), and some non secretory myelomas. 

Calcium level

Your doctor will also check your blood calcium level. The calcium level can be raised if the myeloma cells are speeding up the breakdown of bone.

Urea and electrolytes

These blood tests show how well your kidneys are working. Waste chemicals called urea and creatinine are produced by the body. Our kidneys remove them from our blood and get rid of them in our urine.

Electrolytes are substances such as sodium, potassium, chloride and bicarbonate.

Beta 2 microglobulin (ß2-microglobulin)

This blood test measures the level of a protein called beta 2 microglobulin. The level is raised in myeloma. This test can help the doctor know how advanced your myeloma is (the stage).

Albumin level

Albumin is a protein in your blood that is produced by your liver. If you have myeloma your albumin level can be low. This test can help your doctor know more about the stage of your myeloma.

Liver function tests (LFTs)

Liver function tests (LFTs) check how well your liver is working. LFTs look for levels of enzymes and proteins made by the liver or which are cleared by the liver. They include:

  • alanine aminotransferase (ALT)
  • aspartate aminotransferase (AST)
  • alkaline phosphatase (ALP)
  • gamma-glutamyl transferase (Gamma GT)

They might be raised if you have a blockage in your liver or bile duct, or if you drink a lot of alcohol.

LFTs also look at the amount of bilirubin in the blood. This is a chemical in bile. 

Bilirubin can be raised if you have a problem with your liver or gallbladder. Bilirubin can cause yellowing of your skin and eyes (jaundice). 

LFTs also measure albumin. This is a protein in the blood that can be low in some types of cancer. You can also have low albumin if you’ve been eating small amounts and are malnourished.

Erythrocyte sedimentation rate (ESR)

This test shows the doctor whether the red blood cells (erythrocytes) are sticking together, forming clumps. An abnormal ESR can be a sign of many illnesses or conditions, such as arthritis, infections and inflammation. But it can also be raised in myeloma, so an abnormal ESR may prompt your doctor to do further tests, particularly if there's no obvious reason for the ESR to be raised.

LDH levels (lactic dehydrogenase)

Your doctor may also want to find out the levels of LDH in your blood. This can tell them more about how advanced the myeloma is and what treatment you need. 

Last reviewed: 
23 Mar 2020
Next review due: 
23 Mar 2023
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    British Journal of General Practice 2018 18X698357

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    BMJ Best Practice, last updated Dec 2018 (https://bestpractice.bmj.com/topics/en-gb/179

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