Laboratory Findings

Laboratory Findings
Microscopic Diagnosis
 This technique remains the gold standard for laboratory confirmation
of malaria. Malaria parasites can be identified by examining under the microscope a drop
of the patient's blood, spread out as a "blood smear" on a microscope slide. This is
possible because each of the four major parasite species has distinguishing
characteristics.
 Prior to examination, the specimen is stained (most often with the Giemsa stain) to give
the parasites a distinctive appearance.
 Two types of blood films are traditionally used:[3]
 Thin films - similar to usual blood films and allow species identification since the
parasite's appearance is best preserved in this preparation.
 Thick films - allow the microscopist to screen a larger volume of blood, and are
about eleven times more sensitive than the thin film, so picking up low levels
of infection is easier on the thick film, but the appearance of the parasite is much
more distorted and therefore distinguishing between the different species can be
much more difficult.
This test has the limitation of depending on the quality of the reagents, of the microscope, and
on the experience of the laboratories.[1]
Antigen Detection
 Considered a "Rapid Diagnostic Tests" (RDTs), this test offers a useful alternative to
microscopy in situations where reliable microscopic diagnosis is not available.[1]
 Detects the antigens derived from malaria parasites. It most often uses a dipstick or
cassette format, and provides results in 2-15 minutes. [1]
 Although they may be used in some settings, before malaria RDTs can be widely
adopted, several issues remain to be addressed, including:[1]
 Improving their accuracy

 Lowering their cost
 Ensuring their adequate performance under adverse field conditions
 In 2007, the U.S. Food and Drug Administration (FDA) approved the first RDT
for use in the United States. This RDT is approved for use by hospital and
commercial laboratories, not by individual clinicians or by patients themselves. It
is recommended that all RDTs are followed-up with microscopy to confirm the
results and if positive, to quantify the proportion of red blood cells that are
infected. The use of this RDT may decrease the amount of time that it takes to
determine that a patient is infected with malaria.[1]
Molecular Diagnosis
PCR
 Parasite nucleic acids are detected using polymerase chain reaction (PCR).
 Although this technique may be slightly more sensitive than smear microscopy,
it is of limited utility for the diagnosis of acutely ill patients in the standard
healthcare setting.
 PCR results are often not available quickly enough to be of value in establishing
the diagnosis of malaria infection.[1]
 PCR is most useful for confirming the species of malarial parasite after
the diagnosis has been established by either smear microscopy or RDT.[1]
 Levels of parasitemia are not necessarily correlative with the progression of
disease, particularly when the parasite is able to adhere to blood vessel walls.[4]
Serology
 Serology detects antibodies against malaria parasites, using either
indirect immunofluorescence (IFA) or enzyme-linked immunosorbent
assay (ELISA).
 Serology does not detect current infection but rather measures past exposure. [1]
Drug Resistance Tests
 Drug resistance tests must be performed in specialized laboratories to assess
the susceptibility to antimalarial compounds of parasites collected from a
specific patient.
 Two main laboratory methods are available:[1]
 In vitro tests - The parasites are grown in culture in the presence of increasing
concentrations of drugs; the drug concentration that inhibits parasite growth is
used as endpoint.
 Molecular characterization - Molecular markers assessed by PCR or gene
sequencing also allow the prediction, to some degree, of resistance to
some drugs. CDC recommends that all cases of malaria diagnosed in the United
States should be evaluated for evidence of drug resistance.
Shown below is a table summarizing nonspecific laboratory abnormalities associated
with malaria.[1][5]
Laboratory findings
Test Findings
Decreased hemoglobin
Complete blood Decreased hematocrit
count Microcytosis
Decreased haptoglobin
White blood cell Elevated or
count Decreased Leukocyte Count
Hypoglycemia
Elevated creatinine
Elevated LDH
Biochemistry
Possible hyponatremia
Acidosis: High lactate;
Low bicarbonate
Coagulation Thrombocytopenia
Proteinuria
Urinalysis
Hemoglobinuria
Malaria laboratory findings - wikidoc. (n.d.).

https://www.wikidoc.org/index.php/Malaria_laboratory_findings

Laboratory Findings

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Laboratory Findings

 Two types of blood films are traditionally used:[3]

 Improving their accuracy

Malaria laboratory findings - wikidoc. (n.d.).

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