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The page below is a sample from the LabCE course Malaria. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Diagnosis of Malaria

The standard tool for diagnosis of malaria is smear examination. Rapid diagnostic testing should be used if microscopy is not available. The preparation of smears consists of applying a drop of blood to a glass microscopy slide, followed by drying and staining. There are two types of blood smears made: thin and thick smears. Smears are generally stained with the Wright/Giemsa stain.
Thin smears maintain the integrity and morphology of red blood cells so that the parasites are visible within the cells. They allow for identification of the infecting parasites species and can be used to measure parasite density.
Thick smear preparation involves mechanical lysis of RBCs so that malaria parasites can be visualized independent of cell structures. It is typically used as a screen for the presence or absence of parasites.
Parasites are best seen under 1000X magnification using oil immersion objective lens. It is necessary to screen at least 200 to 500 fields or examination for 20 to 30 minutes. If malaria is suspected but the initial smear is negative, then additional smears should be prepared and examined over 48 to 72 hours. CDC recommendations are to repeat a thick and thin smear every 12 to 24 hours for a total of three sets before ruling out malaria.