BSMP

Test Indication

Microscopic examination of both thick and thin film remains the gold standard for confirmation of malaria. The thick film is more sensitive for detecting malaria parasites as the blood is more concentrated which allow for a greater volume of blood to be examined. On the other hand, the thin film helps in parasite species identification.

Sample Type & Volume

i. Thick smear: Size of a 5cents coin, diameter 1-2cm.

ii. Thin Smear: Blood smear of  2cm size.

Both thick & thin smear on one slide

Tools

Glass slide

Sample Collection& Labeling

Capillary blood obtained by fingerstick:

1. Label pre-cleaned slides in the frosted-end of glass slide with the patient’s name, identity number and date and time of collection with grease pencil only.

2. Wear gloves.

3. Clean the slide with alcohol and allow to dry. Do not touch the surface of the slide where the blood smear will be made.

4. Prick the side of the pulp of the 3rd or 4th finger or in infants prick the heel with a sterile lancet.

5. Wipe away the first drop of blood with clean gauze.

6. Apply gently pressure to the finger and collect 2 drops of blood on the clean glass slide – one drop near the frosted end and one drop on 2/3 of the slide.

Preparing Thin Smear

1. Bring a clean spreader slide, held at a 45o angle, toward the drop of blood on the 2/3 slide.

2. Wait until the blood spread the entire width of the spreader slide.

3. While holding the spreader slide at the same angle, pus it forward rapidly and smoothly.

Preparing Thick Smear

1. Using the corner of the spreader slide, spread the drop of blood (near the frosted end slide) in a circle the size of a dime, diameter 1-2cm. Do not make the smear too thick or it will fall off the slide. You should be able to read newsprint through it.

2. Wait until the thin and thick smears are completely dry in horizontal position then send the smear to laboratory.

Notes

1. If any question on smear preparation, you may consult with Microbiology Lab.

2. If the initial film is negative, repeat another 2 samples or more especially at peak of fever if symptoms persist.

3. Once Plasmodium is detected, the BFMP test should be done daily during hospital stay, weekly tests x 4 during follow-up for all species and additional monthly tests x 11 during follow-up for P.vivax.

Reference

Management Guideline of Malaria in Malaysia, Disease Control Division, Ministry of Health, 2020.