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A rare form of a parasite under the microscope. (the Clinical Chemist: What Is Your Guess?


A 10-year-old boy presented in the emergency department with fever, chills, and recent episodic vomiting. He had immigrated from Nigeria 3 days before the admission. Laboratory results included notable leukopenia, thrombocytopenia, and anemia. His C-reactive protein concentration was 13.1 mg/dL (reference interval, <0.5mg/dL). The following image was seen on a thin smear (Fig. 1).



1. What was the organism in the image that played a pivotal role in the transmission of his disease?

2. What enzyme deficiency can induce hemolysis in patients when they are administered a common drug to treat this medical condition?

3. What is the proposed relationship between this child's anemia and the C- reactive protein concentration?


1. This patient had Plasmodium falciparum infection. The images show the gametocytes, the sexual form of the parasite by which it is transmitted from humans to mosquitoes, its primary host.

2. Primaquine is the recommended treatment for malaria; however, primaquine can induce hemolysis in glucose-6-phosphate dehydrogenase-deficient individuals (1).

3. C-reactive protein has been shown to bind differently to diseased erythrocytes, activating complement-mediated hemolysis and facilitating clearance of the infected cells (2).

Author Contributions: All authors confirmed they have contributed to the intellectual content of this paper and have met the following 3 re quirements: (a) significant contributions to the conception and design, acquisition of data, or analysis and interpretation of data; (b) drafting or revising the article for intellectual content; and (c) final approval of the published article.

Authors' Disclosures or Potential Conflicts of Interest: No authors declared any potential conflicts of interest.

Role of Sponsor: The funding organizations played no role in the design of study, choice of enrolled patients, review and interpretation of data, or preparation or approval of manuscript.


(1.) Piyaphanee W, Krudsood S, Tangpukdee N, Thanachartwet W, Silachamroon U, Phophak N, et al. Emergence and clearance of gametocytes in uncomplicated Plasmodium falciparum malaria. Am J Trop Med Hyg 2006;74:432-5.

(2.) Ansar W, Bandyopadhyay SM, Chowdhury S, Habib SH, Mandal C. Role of C-reactive protein in complement-mediated hemolysis in Malaria. Glycoconj J 2006;23:233-40.

Yan Zhang, [1] * Kyle Riding, [2] and Mark D. Kellogg [1]

[1] Department of Laboratory Medicine, Children's Hospital Boston, Boston, MA; [2] College of Arts and Sciences, University of Massachusetts Dartmouth, Dartmouth, MA.

* Address correspondence to this author at: Department of Laboratory Medicine, Children's Hospital Boston, 300 Longwood Ave., Boston, MA 02115.

Fax 617-730-0383; e-mail

Received December 17, 2010; accepted December 21, 2010.

DOI: 10.1373/clinchem.2010.160804
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Author:Zhang, Yan; Riding, Kyle; Kellogg, Mark D.
Publication:Clinical Chemistry
Date:Mar 1, 2011
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