Bone Marrow Biopsy with Reflex IHC Test
About Bone Marrow Biopsy with Reflex IHC Test
| Field | Value |
|---|---|
| Also Known As | Bone marrow trephine biopsy with reflex immunohistochemistry, BM biopsy with IHC, trephine biopsy with reflex immunostaining |
| Sample Type | Bone marrow trephine biopsy (solid core tissue sample from the posterior iliac crest, preserved in 10% formalin) |
| Fasting Required | Not usually required; if sedation is planned, overnight fasting may be needed — confirm with your doctor |
| Report Time | 4 days (additional time may be needed if further IHC markers are required) |
| Recommended For | All genders and ages, based on clinical need |
| Price | Starting at ₹4,900 |
What is a Bone Marrow Biopsy with Reflex IHC Test?
A bone marrow biopsy with reflex IHC test is a specialised procedure in which a small core of bone marrow tissue is removed from the hip bone and examined under a microscope. When the initial examination reveals abnormal cells, immunohistochemistry (IHC) — a technique that uses chemical stains to identify specific proteins on cells — is automatically applied to help classify the abnormality. The test is also known as a trephine biopsy with reflex immunostaining. Doctors order it when blood tests suggest a possible problem with the bone marrow or blood cell production.
What Does a Bone Marrow Biopsy with Reflex IHC Test Measure?
The test examines several features of the bone marrow tissue. Here is what each measurement tells the doctor.
| Parameter | What It Assesses |
|---|---|
| Cellularity | The proportion of blood-forming cells versus fat cells in the marrow |
| Blast percentage | The share of immature cells; a high percentage points to leukaemia |
| Cell morphology | The shape and appearance of developing blood cells to help spot abnormalities |
| Myeloid to erythroid (M:E) ratio | The balance between white cell and red cell production |
| Megakaryocytes | The number and appearance of platelet-producing cells |
| Fibrosis | Presence of abnormal fibrous tissue replacing normal marrow |
| Dysplasia | Abnormal development of one or more blood cell lines |
| IHC markers (reflex) | Specific proteins such as CD34, CD117, CD20, CD3, and myeloperoxidase, applied when initial microscopy suggests abnormality |
Why is a Bone Marrow Biopsy with Reflex IHC Test Done?
A doctor may request a bone marrow biopsy with reflex IHC for a range of reasons, from investigating unexplained blood count changes to staging a known condition.
Common Symptoms That May Require This Test
The following symptoms can prompt a doctor to order this test.
- Unexplained fatigue or persistent weakness
- Frequent infections that do not resolve easily
- Easy bruising or unusual bleeding
- Persistent fever without a clear cause
- Unexplained weight loss
- Bone pain, particularly in the back or hips
- Night sweats
Conditions This Test Can Help Detect
The bone marrow biopsy with reflex IHC test can help identify the following conditions.
- Blood cancers, including leukaemia, lymphoma, and multiple myeloma
- Cancers that have spread to the bone marrow from another site (metastatic disease)
- Myelodysplastic syndrome (MDS), where blood cells do not develop normally
- Myeloproliferative neoplasm involving abnormal overproduction of blood cells
- Aplastic anaemia, a condition where the marrow stops producing enough blood cells
- Myelofibrosis, where normal marrow is replaced by scar tissue
- Infections affecting the marrow, such as tuberculosis or fungal infections
- Storage disorders and granulomatous diseases
Bone Marrow Biopsy with Reflex IHC Test for Chronic Disease Monitoring
This test is also used to track how well treatment is working in patients with blood cancers. Tissue analysis combined with IHC can show whether cancer cells remain after chemotherapy or whether a patient has achieved remission. It is commonly repeated during and after treatment for leukaemia, lymphoma, multiple myeloma, and MDS.
How to Prepare and What to Expect
Preparation is straightforward for most patients, though certain precautions are important to follow before the bone marrow biopsy with reflex IHC procedure.
Do You Need to Fast?
Fasting is not required for most patients. If your doctor plans to use intravenous sedation, overnight fasting will usually be necessary — always confirm this in advance with your treating doctor.
Practical Tips Before Your Test
Keep the following points in mind before your appointment.
- Bring a detailed clinical history report, including your symptoms, previous test results, and any relevant medical records, as this is required for the test.
- Tell your doctor about all medications, vitamins, and supplements you are taking, especially blood thinners or anticoagulants. Your doctor may advise you to pause these before the procedure.
- Wear comfortable, loose-fitting clothing that allows easy access to the hip area.
- Arrange for someone to accompany you home, particularly if sedation is used.
- Stay well hydrated leading up to the appointment.
Step-by-Step Procedure
Here is what happens during a bone marrow biopsy with reflex IHC collection.
- You will be asked to lie on your side with your knees drawn gently towards your chest.
- The skin over the back of your hip (posterior iliac crest) is cleaned with an antiseptic, and a local anaesthetic injection is given to numb the area.
- A thin needle is used to withdraw a small amount of liquid bone marrow (aspiration) from the numbed site.
- A slightly larger needle is then used to collect a solid core of bone marrow tissue (the trephine biopsy sample).
- Once the sample is collected, a dressing is applied. You will be asked to lie on your back briefly to help reduce bruising.
- The tissue sample is placed in a wide-mouth container with 10% formalin, stored under refrigeration, and dispatched to the NABL-accredited laboratory. If the initial microscopic review identifies abnormal cells, reflex IHC staining is carried out automatically.
Factors That Can Affect Accuracy
Certain factors can influence the quality of the biopsy and how reliably the results are interpreted.
- An inadequate sample length (ideally 15 mm or more is recommended)
- Improper fixation or decalcification of the tissue in the laboratory
- Incorrect IHC staining protocols
- Recent chemotherapy or radiation, which can cause changes that may be difficult to interpret
- Prior blood transfusions, which may affect iron staining
- Use of immunosuppressive or steroid medications
Understanding Your Bone Marrow Biopsy with Reflex IHC Test Results
Results from this test are reported by a haematopathologist — a specialist in blood and bone marrow diseases. Below are the key parameters and their general reference ranges.
| Parameter | Normal Range | Notes |
|---|---|---|
| Cellularity | Age-dependent (approximately 100 minus age, ±10%) | Hypercellular or hypocellular findings indicate possible pathology |
| Blast percentage | Less than 5% of nucleated cells | 20% or more suggests acute leukaemia |
| M:E ratio | 2:1 to 4:1 | Altered ratios are seen in infections, leukaemias, and anaemias |
| Megakaryocytes | 2 to 5 per low-power field | Reduced or abnormal forms indicate platelet production issues |
| IHC markers | Qualitative (positive or negative staining) | Interpreted by a haematopathologist, not as numerical values |
Disclaimer: "These ranges are general guidelines. Your doctor will interpret your results based on your age, health history, and other factors. Always consult a qualified healthcare professional for personalised medical advice."
Results During Special Conditions
Some clinical situations can affect how results are read.
- Patients on immunosuppressive therapy may show altered cellularity and changes in immune cell populations that require careful interpretation.
- Recent blood transfusions can affect iron staining patterns in the marrow.
- Prior chemotherapy or radiation may cause hypocellularity or cell changes that can resemble MDS.
- Steroid use can affect immune cell counts and increase infection risk, which may influence findings.
How to Maintain Healthy Levels
While bone marrow conditions require medical management, the following general habits support blood cell health.
- Eat a diet that includes foods rich in iron, folate, and vitamin B12, all of which are important for blood cell production.
- Report any unusual bleeding, persistent bruising, or prolonged fatigue to your doctor without delay.
- Attend all scheduled follow-up appointments with your haematologist, especially if you are being monitored for a blood disorder.
Lupin Diagnostics Bone Marrow Biopsy with Reflex IHC Test Price
The bone marrow biopsy with reflex IHC test cost at Lupin Diagnostics starts at ₹4,900. This test requires a visit to a Lupin Diagnostics centre; home collection is not available for this procedure.
| City | Approximate Price (₹) |
|---|---|
| BHOPAL | 4900 |
| CHENNAI | 4900 |
| HYDERABAD | 4900 |
| KOLKATA | 4900 |
| NAVI MUMBAI | 4900 |
| PUNE | 4900 |
Disclaimer: Prices are indicative and may vary by location. Please confirm the current price at the time of booking.
How to Book
Follow these steps for bone marrow biopsy with reflex IHC test online booking.
- Select the test on the Lupin Diagnostics website.
- Choose your city and preferred centre location.
- Visit the centre at your scheduled time for sample collection.
- Receive your report via email or WhatsApp within the stipulated turnaround time.
Frequently Asked Questions
This test involves removing a small core of bone marrow tissue from the hip bone and examining it under a microscope. When routine microscopic assessment alone is not enough to reach a clear diagnosis, IHC staining is automatically applied to identify specific proteins on cells. This helps classify the type of abnormality and guides further management.
The procedure is carried out under local anaesthetic, which numbs the area around the hip. You may feel pressure and a brief pulling sensation when the marrow is withdrawn. Some patients describe a moment of sharp discomfort during aspiration. Most people find the procedure manageable, and additional pain relief can be given if needed.
The actual biopsy usually takes around 20 to 30 minutes. You should allow up to one hour in total, accounting for preparation, the consent discussion, the procedure itself, and a short period of post-procedure observation.
Serious complications are uncommon. Mild soreness and bruising at the biopsy site are the most frequent after-effects and typically settle within a few days. Rare risks include significant bleeding or infection at the site, which your medical team will take steps to minimise.
Report delivery at Lupin Diagnostics is 4 days. In some cases, the timeline may be longer if additional IHC markers or supplementary studies are needed. Your doctor will advise you on when to expect the final report.
When the initial microscopic review of the bone marrow tissue reveals abnormal cells, IHC staining is added automatically. IHC helps identify the specific type of abnormal cell present, improves the accuracy of staging, and supports treatment planning for conditions such as leukaemia and lymphoma.
Yes. A detailed clinical history report is required for this test. Bring relevant documents such as previous blood test reports, imaging results, referral letters, and a list of your current medications. This information helps the haematopathologist interpret the biopsy findings accurately.
Bone Marrow Biopsy with Reflex IHC Test
