Blood smear

History (previous crises, previous medications, recreational drug use), physical examination (mandatory fundoscopic examination, blood pressure on all limbs), urinalysis, and electrolytes, blood urea nitrogen, creatinine, peripheral blood smear, complete blood count, electrocardiogram (ECG), chest X-ray, and head CT... 

The peripheral blood smear demonstrates sickle forms (see Fig. 65-2). 

To ensure a positive diagnosis, blood smears (both thick and thin films) should be obtained every 12 to 24 hours for 3 consecutive days. 

The primary goal in the management of malaria is the rapid identification of the Plasmodium species by blood smears (both thick and thin smears repeated every 12 hours for 3 days). Antimalarial therapy should be initiated promptly to eradicate... 

Following treatment of falciparum malaria, TW has remained well for 2 months. However, 2 days ago, he started developing fever and chills, nausea, and abdominal pain. When seen in the emergency department he has a fever of 38.4°C and complains of severe headache. Examinations of a thick and thin blood smear of the patient s blood identified P. vivax infection. TW received a course of chloroquine and primaquine. In a follow-up 2 weeks later, a repeat blood smear was negative for parasites and the patient was asymptomatic. 

Blood smears should be checked every 12 hours until parasitemia is less than 1%. 

Fig. 5. Spiculed red blood cells (echinocyte) in peripheral blood smear of a splenectomized patient with pyruvate kinase deficiency.

Fig. 6. Basophilic stippling in peripheral blood smear of a patient with pyrimidine 5 -nucleotidase deficiency.

Figure 8.5 Monitoring the in vivo time course of P. yoleii malaria infection in mice inoculated with live parasites at day 0.15 (Upper trace) Parasite count obtained by microscopy of blood smear, folded with anemia model from the literature (para-sites/vol) = (parasites/RBC) x (RBC/vol). (Lower trace) Integrated LDMS heme signal from 300 shots across three consecutive sample wells each sample (30 pil) is processed following protocol C, and examined on a commercial LD TOF instrument. Infection is more easily and more rapidly discerned both at earlier and later times by LDMS, compared to the traditional optical microscopy examination.

In the first LDMS-based detection of malaria in human subjects (unpublished), lOOpl P. falciparum or P. v/vax-infected blood samples, grouped into three different parasitemia ranges—low (10-150 parasites/pl), mid (2 x 103 parasites/pl), and high (25 x 103-60 x 103 parasites/pl)—have been examined using both sample preparation protocols. Parasitemia levels in these samples were previously determined independently for each sample by optical microscopy examination of blood smears. The LDMS data clearly indicate that... 

A 27-year-old female has just returned from a trip to Southeast Asia. In the past 24 hours, she has developed shaking, chills, and a temperature of 104°E A blood smear reveals Plasmodium vivax. Which of the following agents should be used to eradicate the extraerythrocytic phase of the organism ... 

Macrocytic anemias are characterized by increased mean corpuscular volume (110 to 140 fL). One of the earliest and most specific indications of macrocytic anemia is hypersegmented polymorphonuclear leukocytes on the peripheral blood smear. Vitamin B12 and folate concentrations can be measured to differentiate between the two deficiency anemias. A vitamin B12 value of less than 150 pg/mL, together with appropriate peripheral smear and clinical symptoms, is diagnostic of vitamin B12-deficiency anemia. A decreased RBC folate concentration (less than 150 ng/mL) appears to be a better indicator of folate-deficiency anemia than a decreased serum folate concentration (less than 3 ng/mL). 

Bacterial infections are associated with elevated granulocyte counts (neutrophils, basophils), often with increased numbers of immature forms (band neutrophils) seen in peripheral blood smears (left-shift). With infection, peripheral leukocyte counts may be very high, but are rarely higher than 30,000 to 40,000/mm3. Low neutrophil counts (neutropenia) after the onset of infection indicate an abnormal response and are generally associated with a poor prognosis for bacterial infection. 

Gram-positive bacilli on unspun peripheral blood smear or CSF... 

Fig. 3. Micrograph demonstrating die effect of NaSal on morphological changes in eosinophils (W16). After eosinophils were treated for 12 h (a) without or (b) with 20 mM NaSal, which is an apoptosis-inducing agent, cells were harvested and stained with Hemacolor Rapid blood smear staining set. The stained cells were examined by light microscopy. The arrows depict the apoptotic eosinophils...

Effective treatment of malaria depends on early diagnosis. Since the patient s symptoms are often relatively nonspecific, it is crucial to examine stained blood smears for the presence of the parasite. Even this procedure may be inconclusive during the early stages of the infection, since the levels of parasitemia can be quite low. Thus, it is important to repeat the blood smear examination several times if malaria is suspected. 

Diethylcarbamazine is the drug of choice for certain filarial infections, such as Wuchereria bancrofti, Brugia malayi and Loa loa. Since diethylcarbamazine is not universally active against hlarial infections, a specihc diagnosis based on blood smears, biopsy samples, and a geographic history is important. Dosage should be adjusted in patients with renal impairment. 

The polished surfaces of polycrystalline Al, Cu, Ni and Si(p) and monocrystalline samples of Mo, Si(m) and W were tested to choose the best substrate providing maximal colour contrast. The surface of the substrate was chemically polished to provide mirror reflection. Thin blood smears of the same patient were deposited under the same experimental conditions. After air drying for 10 min, blood samples were placed on the microscope holder. The images were taken by a digital camera. 

Most of the reported in vivo data presented in the literature involves the infection of donor mice with a strain of P. berghe [61]. After a parasitemia of circa 30% is achieved in the donor mice, a blood sample is taken, diluted, and injected into experimental and control mice. The parasitemia load is regularly monitored for 3 to 7 days after infection by blood smear analysis as a function of drug dose. While in vivo efficacy assays reveal the true scope of a potential antimalarial s efficacy, the methods are very expensive. Consequently, additional assays have been developed to rapidly assess the effectiveness of lead heme aggregation inhibitors. 

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