Collect


Blood, Lavender

*Tissue, Sterile Container (for Tissue, please use Direct Parasite Exam order)

Preferred Draw Volume

3 mL (Fill to vacuum capacity of tube)

Unacceptable Conditions

Clotted blood samples
Blood samples collected in citrate or heparin or other additives
Blood samples not maintained at Room Temperature
Blood smears (films) that are wet
Blood smears that are damaged during/after drying

Collection Comments

Blood tubes are transported immediately to hospital lab. Make 4 thick and 8 thin blood smears within 1 hour of collection.

Send completely dry slides AND blood tube to IU Health Pathology Laboratory immediately (STAT). Document the date and time when the slides were prepared. 

For all Ordering providers, please instruct local lab to send both blood tube AND slides to IUHPL STAT, as well as date and time documentation pertinent to each collection. Include information regarding travel and exposure history (if available).

CAUTION: If more than 1 hour has elapsed following collection, the ability to distinguish different parasites from one another may be impacted. Consequently, a disclaimer may be added to the result.

Specimen Preparation

Resources for smear preparation:

IUH LABS: Follow IUH Policytech Procedure: Procedure Blood Parasite Detection and Identification (Reference #25103).

OUTREACH CLIENTS: Follow CDC instructions for specimen/smear processing (The Scratch Method is recommended for Thick smear preparation.)

Storage/Transport Temperature

Blood tubes and Slides: Room Temperature

Stability (from collection to initiation)

Time Sensitive: Slides must be made within 1 hour of blood draw.

Ordering Recommendations

The Blood and Tissue Parasite Exam order results in performance of a three component Diagnostic Algorithm for detection of parasites that cause malaria and babesiosis. When detected, Plasmodium species identification and Plasmodium/Babesia enumeration (parasitemia count) will be attempted. Parasites that cause trypanosomiasis, leishmaniasis and certain forms of filariasis may also be an incidental finding of this diagnostic algorithm, but only when parasites are present at appropriate levels for detection. Note: this procedure is not optimized for the detection of non-malaria, non-babesia parasites and, presently, a better approach for detecting Trypanosoma trypomastigotes, Leishmania amastigotes and microfilariae of Wuchereria bancrofti, Brugia species and Loa loa is via a send-out test which entails a concentration step (ARUP #3018849). 

Note: This Malaria Testing Discovery Form details the information that is appropriate to communicate to IUHPL Clinical Microbiology (317-491-6999) at the time of order submission. 

If submitting tissue, please use Direct Parasite Exam order and follow pertinent Test Menu instructions.

Performed

Initiated STAT upon receipt in IUHPL

Methodology

Diagnostic Algorithm Components:
(1) preliminary (must be confirmed) Wright Stain of thin blood smear with microscopic review (Screen), performed in IUHPL Hematology, (2) preliminary (must be confirmed) BinaxNOW Malaria Rapid Antigen Test, performed in IUHPL Clinical Microbiology, and (3) definitive pH-balanced Giemsa Stain of thick blood smear (optimal for Plasmodium/Babesia detection) and thin blood smear (optimal for Plasmodium species identification and Plasmodium/Babesia enumeration) with microscopic review, performed in IUHPL Clinical Microbiology. 

Reported

Within hours of receipt in IUHPL

Performing Lab

Hematology & Microbiology

Other Performing Labs

Arnett, Ball

Synonyms

  • 3132
  • Babesia Exam
  • Blood Parasite Exam
  • Malaria Exam
  • Tissue Parasite Exam
  • Parasite Examination, Blood and Tissue
  • Chagas Disease

Reference Interval

No parasites seen

Interpretive Data

(1) For the Microscopic Review of Wright-stained Blood Smears: result is preliminary and has less analytical sensitivity than the Giemsa-stained Blood Smear review which follows.

(2) For the Malaria Antigen Test: Malaria infection may be present but below the detection limit of the test. Thus, when the Malaria Antigen Test is negative, infection cannot be ruled out and confirmation via microscopic review of Giemsa-stained Blood Smears must follow within hours. 

Malaria Antigen Test Reported ResultsCommon Interpretation
(+) P. falciparumPlasmodium falciparum protein antigen only detected.
(+) P. non-falciparumMalaria protein antigen detected, representing Plasmodium vivax or Plasmodium malariae or Plasmodium ovale or a mix of these species.
(+) P. falciparum mixPlasmodium falciparum protein antigen detected. In some cases, this may represent a mix of Plasmodium falciparum antigen with Plasmodium vivax, Plasmodium malariae, or Plasmodium ovale protein antigen. Differentiation between a Plasmodium falciparum only infection and a mixed infection containing Plasmodium falciparum and another Plasmodium species is not possible with this test.


(3) For the Microscopic Review of Giemsa-stained Blood Smears: result is definitive, and any parasite seen will be reported to the genus and species level (if possible). Lifecycle stage(s) seen will also be noted. Also, the parasitemia for Plasmodium and Babesia species will be determined. Note that mixed infections are possible. If Plasmodium species identification from microscopic reading of blood smears is uncertain, genus level only may be provided with a statement that specimen should be sent out for PCR-based identification if clinically warranted (ARUP #2004963).

Any parasites seen upon Microscopic Review and/or detected via Malaria Antigen Test are considered a CRITICAL Result.

(4) The negative predictive value of a single blood draw is not optimal for detection of parasites in most situations. If clinically warranted, consider sending additional samples over several days and, also, consider contacting the IUHPL Division of Clinical Microbiology to discuss your differential with the Director of the Parasitology Section or the On Call Clinical Microbiology Director/Fellow.

CPT Codes

87207, 87899

LOINC Codes

 NAMELOINC
ResultWright's Stain Parasite50625-3
 Preliminary Malaria Test70569-9
 Antigen Interpretation48767-8
 Interp Parasite51714-4

Test Code (Outreach Synonym)

3132

Catalog Code

952859
Collection

Collect


Blood, Lavender

*Tissue, Sterile Container (for Tissue, please use Direct Parasite Exam order)

Preferred Draw Volume

3 mL (Fill to vacuum capacity of tube)

Unacceptable Conditions

Clotted blood samples
Blood samples collected in citrate or heparin or other additives
Blood samples not maintained at Room Temperature
Blood smears (films) that are wet
Blood smears that are damaged during/after drying

Collection Comments

Blood tubes are transported immediately to hospital lab. Make 4 thick and 8 thin blood smears within 1 hour of collection.

Send completely dry slides AND blood tube to IU Health Pathology Laboratory immediately (STAT). Document the date and time when the slides were prepared. 

For all Ordering providers, please instruct local lab to send both blood tube AND slides to IUHPL STAT, as well as date and time documentation pertinent to each collection. Include information regarding travel and exposure history (if available).

CAUTION: If more than 1 hour has elapsed following collection, the ability to distinguish different parasites from one another may be impacted. Consequently, a disclaimer may be added to the result.

Specimen Preparation

Resources for smear preparation:

IUH LABS: Follow IUH Policytech Procedure: Procedure Blood Parasite Detection and Identification (Reference #25103).

OUTREACH CLIENTS: Follow CDC instructions for specimen/smear processing (The Scratch Method is recommended for Thick smear preparation.)

Storage/Transport Temperature

Blood tubes and Slides: Room Temperature

Stability (from collection to initiation)

Time Sensitive: Slides must be made within 1 hour of blood draw.
Ordering

Ordering Recommendations

The Blood and Tissue Parasite Exam order results in performance of a three component Diagnostic Algorithm for detection of parasites that cause malaria and babesiosis. When detected, Plasmodium species identification and Plasmodium/Babesia enumeration (parasitemia count) will be attempted. Parasites that cause trypanosomiasis, leishmaniasis and certain forms of filariasis may also be an incidental finding of this diagnostic algorithm, but only when parasites are present at appropriate levels for detection. Note: this procedure is not optimized for the detection of non-malaria, non-babesia parasites and, presently, a better approach for detecting Trypanosoma trypomastigotes, Leishmania amastigotes and microfilariae of Wuchereria bancrofti, Brugia species and Loa loa is via a send-out test which entails a concentration step (ARUP #3018849). 

Note: This Malaria Testing Discovery Form details the information that is appropriate to communicate to IUHPL Clinical Microbiology (317-491-6999) at the time of order submission. 

If submitting tissue, please use Direct Parasite Exam order and follow pertinent Test Menu instructions.

Performed

Initiated STAT upon receipt in IUHPL

Methodology

Diagnostic Algorithm Components:
(1) preliminary (must be confirmed) Wright Stain of thin blood smear with microscopic review (Screen), performed in IUHPL Hematology, (2) preliminary (must be confirmed) BinaxNOW Malaria Rapid Antigen Test, performed in IUHPL Clinical Microbiology, and (3) definitive pH-balanced Giemsa Stain of thick blood smear (optimal for Plasmodium/Babesia detection) and thin blood smear (optimal for Plasmodium species identification and Plasmodium/Babesia enumeration) with microscopic review, performed in IUHPL Clinical Microbiology. 

Reported

Within hours of receipt in IUHPL

Performing Lab

Hematology & Microbiology

Other Performing Labs

Arnett, Ball

Synonyms

  • 3132
  • Babesia Exam
  • Blood Parasite Exam
  • Malaria Exam
  • Tissue Parasite Exam
  • Parasite Examination, Blood and Tissue
  • Chagas Disease
Result Interpretation

Reference Interval

No parasites seen

Interpretive Data

(1) For the Microscopic Review of Wright-stained Blood Smears: result is preliminary and has less analytical sensitivity than the Giemsa-stained Blood Smear review which follows.

(2) For the Malaria Antigen Test: Malaria infection may be present but below the detection limit of the test. Thus, when the Malaria Antigen Test is negative, infection cannot be ruled out and confirmation via microscopic review of Giemsa-stained Blood Smears must follow within hours. 

Malaria Antigen Test Reported ResultsCommon Interpretation
(+) P. falciparumPlasmodium falciparum protein antigen only detected.
(+) P. non-falciparumMalaria protein antigen detected, representing Plasmodium vivax or Plasmodium malariae or Plasmodium ovale or a mix of these species.
(+) P. falciparum mixPlasmodium falciparum protein antigen detected. In some cases, this may represent a mix of Plasmodium falciparum antigen with Plasmodium vivax, Plasmodium malariae, or Plasmodium ovale protein antigen. Differentiation between a Plasmodium falciparum only infection and a mixed infection containing Plasmodium falciparum and another Plasmodium species is not possible with this test.


(3) For the Microscopic Review of Giemsa-stained Blood Smears: result is definitive, and any parasite seen will be reported to the genus and species level (if possible). Lifecycle stage(s) seen will also be noted. Also, the parasitemia for Plasmodium and Babesia species will be determined. Note that mixed infections are possible. If Plasmodium species identification from microscopic reading of blood smears is uncertain, genus level only may be provided with a statement that specimen should be sent out for PCR-based identification if clinically warranted (ARUP #2004963).

Any parasites seen upon Microscopic Review and/or detected via Malaria Antigen Test are considered a CRITICAL Result.

(4) The negative predictive value of a single blood draw is not optimal for detection of parasites in most situations. If clinically warranted, consider sending additional samples over several days and, also, consider contacting the IUHPL Division of Clinical Microbiology to discuss your differential with the Director of the Parasitology Section or the On Call Clinical Microbiology Director/Fellow.
Additional Information

CPT Codes

87207, 87899

LOINC Codes

 NAMELOINC
ResultWright's Stain Parasite50625-3
 Preliminary Malaria Test70569-9
 Antigen Interpretation48767-8
 Interp Parasite51714-4

Test Code (Outreach Synonym)

3132

Catalog Code

952859

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