QSP Newsletter

QSP Newsletter 34 - Malaria

March 2023

Monthly Digital Case Study
March 2023 QSP Slides
(PDF for print)

Monthly Digital Case Study


March 2023 QSP Slide 1:

Platelet clumps

Platelet clumps

Field from RBC section showing numerous monocytes

Field from RBC section showing numerous monocytes

FBC Results

WBC20.7* (10^3/mm3)Neutrophils74.0%
RBC3.59 (10^6/mm3)Lymphocytes9.4%
HGB9.8 (g/dL)Monocytes15.0%
HCT29.4 (%)Eosinophils1.6%
MCV82 (fL)Basophils0.0%
MCH27.3 (pg)Myelocytes0.0%
MCHC33.3 (g/dL)Large PlateletsPresent
PLT432* (10^3/mm3)  

Clinical Details: Female (90 years old)

Slide Information: Polyvalent Post-Emergency Internal Medicine unit. Monocytosis. Platelet aggregates and macroplatelets (++). 


March 2023 QSP Slides

► See case study above

► Polyvalent medicine unit. Follow up of a CLL. (Lymphocyte membrane fragility +++. Cytogenetics: 13q14 deletion.) 

Expert's comments: Typical LLC. Classify "smudge" in lymphocytes otherwise erroneous manual formula or make the results of the analyzer with comment.

► Anisopoikilocytosis (++). Echinocytes (++). Hypochromic (+) RBCs. Schizocytes (+). Band cells/hyposegmented and hypogranulated neutrophils(+). Myelemia. Erythroblastosis. 

Expert's comments: Cytological appearance of Neutrophil and #Neutrophils in favour of MDS/MPS.

► Hemodialysis unit. Anisocytosis (+).


► Clinical Hematology unit. Hyperleukocytosis. Neutropenia (hyposegmented and hypogranulated neutrophils). Blastosis (+++). Aniso-poikilocytosis (++).

► Aniso-poikilocytosis(++). Echinocytes(++). Hypochromic (+) RBCs. Schizocytes(+).  Band cells/hyposegmented and hypogranulated(+) neutrophils. Myelemia. Erythroblastosis.


On the occasion of World Malaria Day in April, this month's issue will once again feature previously delivered content on malaria.

Malaria is a worldwide disease that it is transmitted to humans via the Anopheles Mosquito, through a bite. Malaria is found in tropical and subtropical regions of the world.

The mosquito bite introduces the parasite into the human’s blood via sporozoites in the saliva. The parasites then migrate to the liver, where they mature and reproduce. This is known as the exoerythrocytic phase.

The organisms multiply in the liver in infected hepatocytes. These differentiate into thousands of merozoites, which rupture the host cell, infiltrating the blood and infecting red blood cells. This next stage is known as the erythrocytic stage of the life cycle. The parasite is able to leave the liver undetected as it envelopes itself in the cell membrane of the infected host liver cell.

There are four commonly known types of malaria parasite, Plasmodium falciparum, Plasmodium Vivax, Plasmodium Ovale, and Plasmodium Malariae. The most severe is Plasmodium falciparum, the lesser common is Plasmodium Knowlesi.

  • Plasmodium Falciparum: found mainly in Africa, it's the most common type of malaria parasite and is responsible for most malaria deaths worldwide, though treatment does cure the infection.
  • Plasmodium Vivax: mainly found in Asia and South America, this parasite causes milder symptoms, but it can stay in the liver for years which can result in symptoms reoccurring if it isn’t treated properly.
  • Plasmodium Ovale: uncommon and usually found in West Africa.
  • Plasmodium Malariae: this is quite rare and usually only found in Africa.
  • Plasmodium Knowlesi: this is very rare and found in parts of southeast Asia.


Each has variations which help identification (see table below):



P. Falciparum

P. Vivax

P. Malariae

P. Ovale

Size (RBC)Not enlargedEnlargedNot enlargedEnlarged
Shape (RBC)Round, sometimes crenatedRound or ovalRoundRound or oval, often fimbriated
Colour (RBC)Normal, but may become darker or may have a purple rimNormal to paleNormalNormal
Stippling (RBC)Maurer’s spots, appear as large red spots, loops and cleftsSchuffner’s dots, appear as small red dots, numerousZiemann’s dots, few tiny dots, rarely detectedSchuffner’s dots (James’s dots). Numerous small red dots
Pigment (RBC)Black or dark brownSeen as a haze of fine golden brown granules scattered through the cytoplasmBlack or brown coarse granules, scatteredIntermediate between P. Vivax and P. Malariae
Trophozoite (parasite)Small, delicate, sometimes two chromatin dots, multiple rings commonly foundRelatively large, one chromatin dot, sometimes two, often two rings in one cellCompact, one chromatin dot, singleCompact, one chromatin dot, single
Schizont (parasite)Medium sizeLargeSmallMedium
Gametocyte (parasite)Crescent shapedSphericalSimilar to P. Vivax, but smaller and less frequentLike P. Vivax but smaller
P. Falciparum - trophozoites and crescent shaped gametocyte

P. Falciparum - trophozoites and crescent shaped gametocyte

P. Vivax - Gametocyte (L) and trophozoite (R)

P. Vivax - Gametocyte (L) and trophozoite (R)

Testing for the diagnosis of malaria is confirmed by a microscopic (blood films) and no-microscopic (FBC, rapid test) tests. See next newsletter. 

QSP Newsletter Quiz Issue 34 Cell Picture

Cell Quiz

This cell is from a 26 year old female, presenting with tiredness, jaundice, and axillary adenopathy. What test should be performed?

A) Glandular fever screening test
B) Rheumatoid factor
C) Ferritin

The answer will be displayed in the next QSP Newsletter and on our social media (LinkedIn / Facebook / Twitter).


Last Month’s Quiz Answer

What feature is shown in the cell below:

A) Pelger-Huet Anomaly
B) Neutrophil Hypersegmentation
C) Neutro Toxic Granulation

The Answer:

The cell caused some debate as to whether it was a true hypersegmented Neutrophil as seen in megaloblastic anemia or a dysplastic feature. This shows the difficulty sometimes in identifying single cells without clinical context.


Essential Haematology, A.V .Hoffbrand & J.E.Pettit https://www.ncbi.nlm.nih.gov/books/NBK555962/

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