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Plasmodium Falciparum Blood Smear Guide

1. P. falciparum causes malaria infections where the red blood cells maintain their normal size. Typically only rings and gametocytes are seen on blood smears unless the blood was able to sit before preparation. 2. Rings have delicate cytoplasm with one or two small chromatin dots. Multiple infection of red blood cells is more common than in other Plasmodium species. Gametocytes are crescent or sausage shaped with either a single chromatin mass or diffuse chromatin. 3. Trophozoites are rarely seen but can appear slightly amoeboid. Mature trophozoites tend to have denser cytoplasm and sometimes yellow pigment. Schizonts containing 8 to 24

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325 views4 pages

Plasmodium Falciparum Blood Smear Guide

1. P. falciparum causes malaria infections where the red blood cells maintain their normal size. Typically only rings and gametocytes are seen on blood smears unless the blood was able to sit before preparation. 2. Rings have delicate cytoplasm with one or two small chromatin dots. Multiple infection of red blood cells is more common than in other Plasmodium species. Gametocytes are crescent or sausage shaped with either a single chromatin mass or diffuse chromatin. 3. Trophozoites are rarely seen but can appear slightly amoeboid. Mature trophozoites tend to have denser cytoplasm and sometimes yellow pigment. Schizonts containing 8 to 24

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kim hanbinhanbyul
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© © All Rights Reserved
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Plasmodium falciparum

Basic guidelines
A. Capillary blood should be obtained by fingerstick, or venous blood should be obtained by
venipuncture.
B. Blood smears, at least two thick and two thin, should be prepared as soon as possible after
col-lection. Delay in preparation of the smears can result in changes in parasite
morphology and staining characteristics.
C. Schüffner’s dots can be demonstrated in Giemsa stain, which is preferred to Wright or Wright-
Giemsa stains.

In P. falciparum infections, red blood cells (rbcs) are normal in size. Typically only rings and
gametocytes are seen unless the blood sat before the smears were prepared.
1. Rings
P. falciparum rings have delicate cytoplasm and one or two small chromatin dots. Rbcs that are infected
are not enlarged; multiple infection of rbcs is more common in P. falciparum than in other species. Occa-
sional appliqué forms (rings appearing on the periphery of the rbc) can be present.

Rings in a thick blood smear. Images from a thick blood smear showing more rings.

Rings in a thick blood smear. Images from a thick blood smear showing more rings. Note the classic “headphones”
appearance of many of the rings.
Plasmodium falciparum

Thin, delicate rings in a thin blood smear. Thin, delicate rings in a thin blood smear. Rings in a blood smear. Note the multiply-
Note the double chromatin dot in the in- infected rbcs
fected rbc at top, and the appliqué form in
the infected rbc at bottom.

Rings in thin blood smears. Note the multiply-infected rbcs, some appliqué forms and some classic “head phone” form of
several of the in-fected red blood cells.

Rings and some developing trophozoites seen in thin smears, Note also the presence of Maurer’s clefts, which are often seen in older
ring forms. Maurer’s clefts stain best with an alkaline pH of 7.2—7.6.
Plasmodium falciparum
2. Gametocytes
P. falciparum gametocytes are crescent or sausage shaped. The chromatin is in a single
mass (macrogamete) or diffuse (microgamete).

Gametocytes in a thick blood smear. Gametocytes in a thick smear. Note also the presence of several rings.

Gametocyte in a thin smear with rings and Two gametocytes in a thin smear. Gametocyte in a thin smear showing the
Maurer’s clefts. membrane of the rbc.

Gametocytes; the one on the right is un- Gametocytes in thin blood smears. Note the presence of “Laveran’s bib” (black arrow),
dergoing exflagellation which is not always visible.
Plasmodium falciparum
3. Trophozoites
P. falciparum trophozoites are rarely seen in peripheral blood smears. Older, ring stage parasites are re-
ferred to as trophozoites. The cytoplasm of mature trophozoites tends to be more dense than in younger
rings. As P. falciparum trophozoites grow and mature, they tend to retain their ring-like shape and some-
times trace amounts of yellow pigment can be seen within the cytoplasm. Growing trophozoites in P. fal-
ciparum can appear slightly amoeboid in shape.

Trophozoites in a thick blood smear. Mature, compact trophozoites in a thin Compact trophozoites in a thin blood
blood smear. smear.

4. Schizonts
P. falciparum schizonts are seldom seen in peripheral blood. Mature schizonts have 8 to 24
small merozoites; dark pigment, clumped in one mass.

Mature schizont in a thin blood smear. Ruptured schizont in a thin blood Another schizont in a thin blood
smear. smear.

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