Hypoalbuminemia has been reported as common in patients with symptomatic Waldenström macroglobulinemia (WM), but it is not typically mentioned as a manifestation of the disease in review articles or articles discussing indications for treatment. We present the case of a patient with WM for whom symptomatic hypoalbuminemia was the primary reason for initiating treatment. Except in rare cases of WM with renal or gastrointestinal involvement, hypoalbuminemia is thought to be due to the effects of elevated levels of inflammation-associated cytokines, and it has been associated with greater likelihood of progression of asymptomatic to symptomatic disease, greater disease severity, and poorer prognosis. Hypoalbuminemia in WM may become symptomatic, and it may be a reason to initiate treatment if symptoms affect quality of life.