Symptom/Finding	Notes
Persistent back or bone pain	Especially if not responding to analgesics
Normocytic normochromic anemia	Hb < 10 g/dL, no clear cause
Elevated ESR or CRP	ESR > 60 mm/h may raise suspicion
Hypercalcemia	Ca > 11 mg/dL
Unexplained fatigue and weight loss	Constitutional symptoms
Renal impairment	eGFR < 60 mL/min with no other cause
Monoclonal protein in SPEP/UPEP	If performed incidentally or due to above symptoms
If ≥ 2 criteria present → consider serum protein electrophoresis (SPEP), serum free light chains, and referral to hematology. Note: MM is rare. Avoid overtesting in young patients with isolated mechanical back pain or iron-deficiency anemia due to menstrual bleeding or GI losses.