1. Anatomy
    2. 1. Mediastinum
    2. The Heart Development
    3. Pericardium
    4. Features of the Heart
    5. Arterial Supply of Heart
    6. Venous Drainage of the Heart
    7. Conducting System of Heart
    8. Nervous System of Heart
    9. Foetal Circulation and Changes at Birth
    10. Microscopic Structure of Heart
    11. Arteries
    12. Arch of Aorta
    13. Descending Thoracic Artery
    14. Abdominal Aorta
    15. Subclavian Artery
    16. Axiallary Artery
    17. Internal Thoracic Artery
    18. Brachial Artery
    19. Radial Artery
    20. Ulnar Artery
    21. Palmar Arches
    22. External Iliac Artery
    23. Internal Iliac Artery
    24. Femoral Artery
    25. Popliteal Artery
    26. Posterior Tibial Artery
    27. Anterior Tibial Artery
    28. Dorsalis Pedia Artery
    29. Common Carotid Artery
    30. External Carotid Artery
    31. Internal Carotid Artery
    32. Veins
    33. Internal Jugular Vein
    34. External Jugular Vein
    35. Superior Venacava
    36. Inferior Venacava
    37. Brachiocephali vein
    38. Subclavian vein
    39. Axillary vein
    40. Cephalic vein
    41. Basilic vein
    42. Azygous vein
    43. Hemiazyous vein
    44. Accessory Hemiazyoug Vein
    45. Internal Hemiazygous Vein
    46. Internal Iliac Vein
    47. Femoral Vein
    48. Popliteal Vein
    49. Long Saphenous Vein
    50. Small or Short Saphenous Vein
    51. Hepato-portal System
    52. Lymphatic System
    53. Spleen
    54. Thymus
    55. Thoracic duct
  2. Pharmacology
    3. 56. Congestive Heart Failure
    57. Therapy of Arrhythmiasis
    58. Angina pectoris
    59. Therapy of Hypertension
    60. Therapy of Shock
    61. Haemostatic Agents
    62. Therapy of Thromboembolic Disorder
    63. Thrombolytic or Fibrinolytics
    64. Antifibrinolytics
    65. Antiplatelet Drugs
    66. Therapy of Iron Deficiency Anemia
    67. Therapy of Megaloblastic Anaemia
    68. Hypolipidemic Drugs and Plasma Expanders
  3. Physiology
    4. 69. Properties of Myocardial Cells
    70. Heart - A Mechanical Pump
    71. Cardiac Cycle
    72. Electrocardiogram (ECG)
    73. Cardiac Output (CO)
    74. Haemodynamics of Circulation
    75. Heart Sounds
    76. Arterial Pulse
    77. Blood pressure
    78. Regional circulation
    79. Cardiovascular chanes during exercise
    80. Edema Dropsy of fluid retention
    81. Shock
    82. Hematology
  4. Pathology
    5. 83. Anaemia
    84. Hypertension
    85. Hypertensive Heart Disease
    86. Ischemic Heart Disease
    87. Angina pectoris
    88. Myocardial infarction
    89. Rheumatic Fever and Rheumatic Heart Disease (RHD)
    90. Acute Pericarditis
    91. Myocarditis
    92. Infective Endocarditis (IE)
    93. Congenital Heart Disease
    94. Cardiomyopathies
    95. Arteriosclerosis
    96. Atherosclerosis
    97. Inflammatory Disease of Blood Vessels
    98. Aneurysms and Dissection
    99. Congestive Heart Failure
    100. Iron Deficiency Anaemia
    101. Megaloblastic anaemia
    102. Pancytopenia
    103. Leucocytosis and Leucopenia
    104. Aplastic anaemia
    105. Haemolytic anaemia
    106. Hereditary Spherocytosis
    107. Haemoglobinipathies
    108. Thalassemia syndrome
    109. Sickle Cell Disease
    110. Leukaemia
    111. Leukemoid reaction
    112. Lymphadenitits
    113. Hodgkin lymphoma
    114. Non-hodgkin lymphoma
    115. Myeloproliferative disorders
    116. Myelofibrosis
    117. Multiple myeloma
    118. Bleeding disorders
    119. Coagulation disorders
    120. any
    121. Blood grouping
  5. Microbiology
    6. 122. Introduction of Blood borne infections
    123. Infective Endocarditis
    124. Brucella
    125. Rickettsiae
    126. Leishmania donovani
    127. Plasmodium
    128. Wuchereria bancrofti
  6. Biochemistry
    7. 129. Metabolism in Blood Cells
    130. Iron metabolism
    131. Haemoglobin
    132. Lipoprotein metabolism
    133. Biochemical aspect of MI
Microbiology
127. Plasmodium
LABORATORY DIAGNOSIS
Microscopic tests
Peripheral blood smear
__content
Specimen collection
Specimen
Peripheral blood
Site of collection
  1. Ear lobe or Finger prick → Older children and Adults
  2. Great toes → Infants
Blood film preparation
  1. Directly from the capillary blood.
  2. Anticoagulated blood → Within an hour of collection of blood.
Time for taking blood
  1. Few hours after the height of the paroxysm of fever.
  2. Before taking antimalarial drugs.
Types of Peripheral Blood Smear
Both the smears are made at the same time from capillary blood either on the same or different slides. At least two thick and two thin smears should be made.
Thick smear
  1. A big drop of blood is spread over 1-2 cm square area on a clean glass slide.
  2. The thickness of the film should be such that it allows newsprint to be read.
Thin smear
  1. A small drop of blood is taken on a corner of a slide.
  2. It is spread by another spreader slide at an angle of 45° and then is lowered to an angle of 30° and is pushed gently to the left, till the blood is exhausted.
    3. ➢ Surface of good thin film:
    1. Even and uniform
    2. Consists of a single layer of RBCs
    3. Forms a 'feathery tail end' near the center of the slide
    4. Margins of the film don't touch the sides of the slide
Stains
Romanowsky's stains
  1. Leishman's stain
  2. Giemsa and Field's stain
  3. Wright's stain or
  4. JSB (Jaswant Singh and Bhattacharya) stain
Fluorescence microscopy (Kawamoto's technique)
  1. It is fluorescent staining method for demonstrating malaria parasites.
  2. Blood smears are prepared on a slide and are stained with Acridine-orange and examined under a fluorescence microscope.
  3. Nuclear DNA is stained green.
Quantitative buffy coat examination
__content
It is an advanced microscopic technique for malaria diagnosis and consists of three basic steps.
Steps
  1. Blood (60μL) is collected in a capillary tube coated internally with acridine orange.
  2. Capillary tube is centrifuged, which causes separation of components of blood according to their densities, forming discrete layers as RBCs, WBCs, lymphocytes and platelets.
  3. Examination of capillary tube at the buffy coat region under UV light source.
Interpretation
  1. Acridine orange has a property of staining the nuclear DNA fluorescent brilliant green.
  2. Normal RBCs don't take up the stain (as they are anucleated).
  3. However, parasitized RBCs appear as brilliant green dots.
  4. WBCs also take up the stain.
Advantages
  1. Faster (Entire tube can be screened within minutes)
  2. More sensitive (at least as good as a thick film)
  3. Quantification is possible.
Non-microscopic tests
Antigen detection test
__content
Rapid Diagnostic Tests
Antigens
Parasite lactate dehydrogenase (pLDH)
  1. Produced by all Plasmodium species.
  2. But currently available test kits can differentiate only two.
    3. ⬦ pan-LDH: common to all species and
    ⬦ Pf-LDH: specific to P. falciparum.
Parasite aldolase
Produced by all Plasmodium species.
Histidine rich protein-2 (HRP-II)
Produced only by P. falciparum.
Principle
Procedure
Interpretation
Advantages
  1. Simple to perform.
  2. Don't require extra equipment.
  3. Don't require trained microscopist.
Sensitivity
  1. More than 90% at > 100 parasites/μL
  2. Markedly reduced at < 100 parasites/μL
Prognosis
pLDH is produced by the viable parasites, hence it is used to monitor the response for treatment.
Pregnancy
HRP-II is a reliable marker to diagnose malaria in pregnancy.
Severity
Intensity of the band is directly proportional to the parasitemia and severity of the disease.
Disadvantages
Antibody detection
Not used because antibodies persists even after the clinical cure.
Culture
Molecular diagnosis
Nested multiplex PCR
  1. Targets 18s rDNA
  2. Detects all five human malaria parasite including P. knowlesi.
PCR
Used to detect drug resistant genes.
Real time PCR
    Useful for
  1. Quantification and
  2. Speciation of parasites
Automated systems
Parasite F digital cytometry
Automated microscopy methods
Other Nonspecific tests
  1. Normocytic hemolytic anaemia
  2. Leukopenia
  3. Metabolic acidosis
  4. Raised EST and
  5. Hypoglycemia

Question Answers

Q.

Describe life cycle of Plasmodium falciparum. Describe value of thick and thin smear of blood for the diagnosis of malaria.

(8= 8)

➤

Q.

Write short notes on: Amastigote form of Leishmania donovani

➤

Q.

Describe pathogenesis, life cycle and laboratory diagnosis of Plasmodium vivax.

(10= 10)

➤

Q.

List four blood parasites. Describe laboratory diagnosis of Plasmodium vivax.

➤