14q32.3 by FISH IGH Gene Rearrangement (ALL, NHL) Bone Test: Booking, Price, and Results

The 14q32.3 by FISH IGH gene rearrangement bone test is a specialised genetic test that checks for abnormal rearrangements of the IGH (immunoglobulin heavy chain) gene, located on chromosome 14. This gene plays a role in producing antibodies. When it is abnormally rearranged, it can contribute to the development of certain blood cancers.

The test uses a technique called FISH (Fluorescence In Situ Hybridisation), which uses fluorescent probes to visualise the gene under a microscope. It is commonly ordered by haematologists and oncologists when investigating conditions such as acute lymphoblastic leukaemia (ALL) and non-Hodgkin lymphoma (NHL). It is also known as the IGH break-apart FISH test or the FISH for IGH gene rearrangement test.

Doctors order this test to investigate symptoms suggestive of blood cancers and to confirm or rule out specific chromosomal abnormalities that drive these conditions.

Common Symptoms That May Require This Test

The following symptoms are common reasons a doctor may request this 14q32.3 by FISH IGH gene rearrangement test.

• Swollen lymph nodes in the neck, armpit, or groin
• Persistent or unexplained fever
• Drenching night sweats
• Unexplained weight loss
• Fatigue that does not improve with rest
• Bone pain
• Anaemia (low red blood cell count)

Conditions This Test Can Help Detect

This test helps identify chromosomal abnormalities linked to several blood cancers. The conditions below are associated with IGH gene rearrangements.

• Acute lymphoblastic leukaemia (B-ALL)
• Non-Hodgkin lymphoma, including follicular lymphoma, mantle cell lymphoma, and diffuse large B-cell lymphoma
• Multiple myeloma
• Plasma cell leukaemia

IGH gene rearrangements are found in roughly 50% of B-cell non-Hodgkin lymphomas and 60 to 70% of multiple myeloma cases.

No special preparation is required for this test. The steps below explain what you can expect before and during sample collection.

Do You Need to Fast?

No fasting is required. You may eat and drink normally on the day of the test.

Practical Tips Before Your Test

The following tips will help your appointment go smoothly.

• Bring a detailed clinical history, including your symptoms, previous test results, and any relevant family history, as this is required for the test.
• Tell your doctor about all current medications, especially blood-thinning medicines, as these may need to be paused before a bone marrow procedure.
• Inform your doctor of any underlying health conditions or allergies.
• Wear comfortable, loose-fitting clothing on the day.

Step-by-Step Procedure

This test can be performed on three different sample types. The procedure for each is described below.

Bone Marrow Aspirate (Most Common)

1. You will be asked to lie on your side or front; a trained specialist cleans the skin over the back of the hip bone (pelvis) or breastbone (sternum).
2. A local anaesthetic is injected to numb the area.
3. A needle is passed through the skin into the bone, and the liquid portion of the bone marrow is drawn out by gentle suction into a sodium heparin (green-top) collection tube.
4. The site is covered with a dressing; you will be observed briefly before leaving.
5. The 3 ml sample is stored at 2 to 8°C and sent to the laboratory, where fluorescent probes are applied to the IGH gene region.
6. A specialist examines the stained sample under a fluorescence microscope and reports the findings.

Peripheral Blood

1. A phlebotomist cleans a vein in your arm, usually at the inner elbow.
2. A needle is inserted, and 3 ml of blood is collected into an EDTA (lavender-top) tube.
3. The sample is labelled, stored at 2 to 8°C, and dispatched to the laboratory for FISH analysis.
4. This option may be suitable in certain clinical situations; your doctor will confirm whether peripheral blood is appropriate for your case.

FFPE Tissue Block (Lymph Node or Tumour Tissue)

1. Tissue is collected during a biopsy or surgical procedure at a hospital by a trained specialist.
2. The tissue is fixed and embedded in paraffin wax to form an FFPE (formalin-fixed paraffin-embedded) block, which is packaged and sent to the laboratory.
3. Laboratory staff section the block, apply fluorescent probes, and assess the IGH gene under a fluorescence microscope.

Factors That Can Affect Accuracy

The following factors may influence the reliability of the test result.

• Poor sample quality or insufficient sample volume
• A low percentage of malignant cells in the sample (specimens with at least 10% plasma cells are optimal)
• Decalcification of bone specimens, which can reduce probe hybridisation
• Prior treatment, which may alter the proportion of detectable abnormal cells
• Technical variables in the FISH procedure itself

Because this is a diagnostic test for chromosomal abnormalities, lifestyle changes do not directly affect IGH gene rearrangement status. The following general tips support overall well-being.

• Attend all follow-up appointments recommended by your doctor.
• Report new or worsening symptoms, such as unexplained fatigue, bone pain, or recurrent infections, promptly.
• Follow your haematologist's guidance on monitoring schedules if you have a known blood disorder.