FISH - PML/RARA Test: Booking, Price, and Results
About FISH - PML/RARA Test: Booking, Price, and Results
| Field | Value |
|---|---|
| Also Known As | FISH t(15;17), APL FISH Test, PML-RARA Translocation FISH, LSI PML/RARA Test |
| Sample Type | Bone marrow aspirate (preferred) or peripheral blood |
| Fasting Required | No |
| Report Time | 3 Days |
| Recommended For | All ages, both genders; ordered when acute promyelocytic leukaemia (APL) is suspected |
| Price | Starting at ₹4,600 |
What is a FISH - PML/RARA Test?
The FISH - PML/RARA test detects a specific genetic change associated with acute promyelocytic leukaemia (APL), a rare subtype of blood cancer. It uses fluorescence in situ hybridisation (FISH), a technique that uses fluorescent dye-labelled probes to identify whether the PML and RARA genes have fused abnormally. Also known as the APL FISH Test or PML-RARA Translocation FISH, this test is ordered by doctors when APL is clinically suspected based on symptoms and blood results. The sample collected is usually a bone marrow aspirate, though peripheral blood may be used in some cases.
What Does a FISH - PML/RARA Test Measure?
The FISH PML/RARA test looks for specific genetic abnormalities at the chromosomal level. The key findings it examines are listed below.
| Parameter | What It Detects |
|---|---|
| PML::RARA Fusion Gene | An abnormal gene is formed when the PML gene (chromosome 15) fuses with the RARA gene (chromosome 17), confirming APL |
| t(15;17) Translocation | A chromosomal swap between chromosomes 15 and 17, seen in around 95% of APL cases |
| Variant RARA Translocations | Abnormal fusions involving RARA and genes other than PML, which may indicate drug-resistant forms of APL |
Why is a FISH - PML/RARA Test Done?
Doctors order the PML/RARA test when a patient's clinical picture points to a possible blood or bone marrow disorder, particularly APL. The test helps confirm the diagnosis and guide treatment decisions quickly.
Common Symptoms That May Require This Test
The following symptoms may prompt a doctor to order this test.
- Unexplained fever or persistent infections
- Severe fatigue that does not improve with rest
- Unexplained weight loss
- Unusual or excessive bleeding, such as from the gums or nose
- Easy bruising
- Signs of abnormal blood clotting (coagulopathy), including a tendency to bleed and clot simultaneously
Conditions This Test Can Help Detect
This test helps identify or rule out the following conditions.
- Acute promyelocytic leukaemia (APL), a type of acute myeloid leukaemia in which too many immature blood cells accumulate in the bone marrow and blood
- Disseminated intravascular coagulation (DIC), a serious clotting disorder frequently associated with APL
- Excessive breakdown of blood clots (primary hyperfibrinolysis) linked to APL
- Variant RARA translocations that may indicate resistance to standard APL therapies
FISH - PML/RARA Test for Chronic Disease Monitoring
Once APL is confirmed, PML/RARA molecular testing may be used at intervals to monitor how well treatment is working. It helps detect any leukaemic cells that remain after treatment, a state known as minimal residual disease, and can identify signs of disease returning. Doctors may use FISH alongside other methods, such as quantitative PCR, for ongoing monitoring.
How to Prepare and What to Expect
Preparing properly for this test helps ensure the sample is of good quality. The steps below explain what is involved before and during the procedure.
Do You Need to Fast?
No, fasting is not required before the FISH - PML/RARA test. You may eat and drink as usual on the day of the test.
Practical Tips Before Your Test
The following steps will help you prepare and stay comfortable.
- Bring a detailed clinical history, including your symptoms, previous test results, and medical records, as this is required for the test
- Tell your doctor about all medications you are currently taking; do not stop any medicine without being told to do so
- Inform your doctor if you have a bleeding disorder or are on blood-thinning medicines
- Arrange for someone to take you home after the procedure, as sedation may be given to help you relax
- Wear comfortable, loose clothing that allows easy access to the hip area
Step-by-Step Procedure
Bone Marrow Aspiration (Primary Sample):
The following steps describe how the bone marrow sample is collected:
- You will be asked to lie on your side or stomach to allow access to the hip bone, which is the usual site for collection.
- The doctor cleans the skin and injects a local anaesthetic to numb the area and the surface of the bone.
- A specialised needle is carefully inserted into the bone, and a small amount of bone marrow fluid is drawn out using gentle suction.
- Once the sample is collected, the needle is removed, and firm pressure is applied to the site to control any bleeding.
- A clean bandage is placed over the area to protect it.
- The sample is placed in a green-top sodium heparin tube and mixed immediately to prevent clotting, then stored at 2 to 8°C for transport to the laboratory.
Peripheral Blood (Alternative Sample):
In some cases, a peripheral blood sample may be collected instead, particularly when circulating blast cells are present in the bloodstream. A standard blood draw from a vein in the arm is performed, and the sample is collected in a lavender-top EDTA tube.
Factors That Can Affect Accuracy
Several factors may influence the reliability of the PML/RARA test procedure.
- Poor sample quality or low cell viability in the bone marrow aspirate
- Specimens older than 48 hours, which may compromise cell integrity
- Insufficient mixing with the anticoagulant, causing clot formation in the sample
- The presence of atypical or masked rearrangements that standard probes may not detect
- Fewer circulating blast cells in peripheral blood samples compared with bone marrow
Understanding Your FISH - PML/RARA Test Results
Results from this test are reviewed by a specialist and reported as either positive (fusion detected) or negative (not detected). The table below summarises the reference range.
| Parameter | Normal Result |
|---|---|
| PML::RARA Fusion | Not detected (Negative) |
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.
A positive result means the PML::RARA fusion gene was found in a proportion of cells examined, typically after analysing 200 or more cells.
A negative result suggests the fusion is absent, though rare masked rearrangements may still require further testing if clinical suspicion remains.
Results During Special Conditions
Certain conditions can influence how results are interpreted.
- Some patients have atypical PML::RARA rearrangements that standard FISH probes may not detect. In these cases, alternative or smaller probes, or a different testing method such as RT-PCR, may be used.
- Additionally, many APL patients also develop disseminated intravascular coagulation (DIC), a serious clotting disorder. DIC severity is related to the proportion of leukaemic cells in the bone marrow and may affect the overall clinical picture alongside the test result.
How to Maintain Healthy Levels
Because this is a diagnostic test for a blood cancer, there are no lifestyle changes that alter the test result itself. The key points to keep in mind are below.
- APL is considered a medical situation requiring prompt attention; early diagnosis supports better outcomes
- With early and appropriate treatment, cure rates for APL exceed 90%, making it one of the more treatable forms of leukaemia
- Follow your doctor's advice closely regarding treatment, follow-up, and monitoring schedules
Lupin Diagnostics FISH - PML/RARA Test Price
The FISH - PML/RARA test is available at Lupin Diagnostics starting at ₹4,600. This test requires a visit to a Lupin Diagnostics centre, as bone marrow aspiration is a specialised procedure that must be performed in a clinical setting. Home collection is not available for this test.
| City | Approximate Price (₹) |
|---|---|
| BHOPAL | 4600 |
| CHENNAI | 4600 |
| HYDERABAD | 4600 |
| KOLKATA | 4600 |
| NAVI MUMBAI | 4600 |
| PUNE | 4600 |
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 to book the PML/RARA test online at Lupin Diagnostics.
- 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 3 days.
Frequently Asked Questions
This test detects the PML::RARA fusion gene, which confirms the diagnosis of acute promyelocytic leukaemia (APL). APL is a rare but highly treatable subtype of acute myeloid leukaemia. Identifying this fusion helps doctors confirm the condition and begin appropriate treatment promptly.
The preferred sample is bone marrow aspirate, collected by inserting a needle into the hip bone under local anaesthetic. In some situations, peripheral blood may be used if there are enough circulating blast cells. The PML/RARA test procedure is carried out by a trained medical professional at a clinical centre.
No, fasting is not required. You can eat and drink normally before your appointment. Do inform your doctor about any medications you are taking, particularly blood thinners.
Results are delivered within 3 days. This allows sufficient time for the laboratory to analyse the cells and report findings accurately.
A positive result indicates that the PML::RARA fusion gene is present, which is the diagnostic hallmark of APL. Patients with this fusion generally respond well to specific therapies, and early treatment is associated with very high cure rates.
In rare cases, masked or cryptic rearrangements may not be detected by standard FISH probes. If clinical suspicion remains despite a negative result, your doctor may request additional testing using alternative probes or a different method, such as RT-PCR.
Bone marrow aspiration requires a specialised procedure carried out by a trained clinician in a controlled environment. It cannot be performed at home. If peripheral blood is collected, a centre visit is still necessary to ensure correct sample handling and timely dispatch to the laboratory.
FISH - PML/RARA Test: Booking, Price, and Results
