Malaria Thick Smear Preparation

A. Background information
Thick smears consist of a thick layer of dehemoglobinized (lysed) red blood cells
(RBCs). The blood elements (including parasites, if any) are more concentrated
(app. 3!) than in an e"ual area of a thin smear. Thus, thick smears allo# a more
efficient detection of parasites (increased sensiti$ity). %o#e$er, they do not permit an
optimal re$ie# of parasite morphology. &or e'ample, they are often not ade"uate for
species identification of malaria parasites. (f the thick smear is positi$e for malaria
parasites, the thin smear should be used for species identification.
B. Preparation of malaria thick smear from a finger stick
). (dentify the sur$ey participant.
*. +lace all collection materials on top of disposable pad. +lace the correct label on
the rough frosted end of the slide. ,t a minimum, the label should indicate the
sample (- and collection date. .nce the patient is seated comfortably, open the
lancet, alcohol s#abs, gauze, bandage, and other items. %a$e all items ready
for blood collection.
3. +ut on your po#der/free glo$es. Turn patient0s hand up#ard. 1assage patient0s
hand and lo#er part of the finger to increase blood flo#.
2. 3crub the patient0s middle finger or ring finger #ith an alcohol s#ab. -ry #ith
gauze.
4. %old the finger in an up#ard position and lance the palm side surface of the
finger bet#een the nail and the finger pad #ith the proper size lancet
(adult5child). +ress firmly on the finger #hen making the puncture. -oing so #ill
help you to obtain the amount of blood you need. (mmediately discard the lancet
into the sharps container.
6. 7sing a dry gauze pad, #ipe a#ay the first drop of blood. 8e't, touch the clean,
labeled microscope slide near one end to the second formed blood drop. 1ake
sure that blood drop is placed on same side of the slide that the label is on.
,l#ays grasp the slide by its edges.
9. 3pread the drop of blood #ith the corner of another slide or an applicator stick to
make an area about ) / ).4 cm in diameter. Correct thickness is attained #hen
ne#sprint is barely legible through the smear.
:. ,pply a sterile adhesi$e bandage o$er the puncture site.
;. <ay the slides flat and allo# the smears to dry thoroughly. +rotect the slides from
dust and insects. (nsufficiently dried smears and5or smears that are too thick can
detach from the slides during staining. This risk is increased in smears made #ith
anticoagulated blood.
,t room temperature, drying can take se$eral hours= 3 minutes is the minimum.
%andle the smear $ery delicately during staining. +rotect thick smears from hot
en$ironments to pre$ent heat/fi'ing the smear.
C. Preparation of malaria thick smear from venous blood
(f you are using $enous blood, blood smears should be prepared as soon as possible
after collection. , delay can result in changes in parasite morphology and staining
characteristics.