The sample must be taken from the finger
tip, for a sample on an anticoagulant (EDTA) makes it more
difficult to create the thick film.
Before coloring a thick film, it must either be
allowed to dry for 24 hours at ambient temperature, or, at worst,
at least two hours at 37°C. This fact is hardly compatible with an
emergency examination. Certain technical features do facilitate
accelerated drying, but they involve material constraints (use of a
micro-wave oven).
The major drawbacks appear at the moment of
reading: in fact, the morphology of the parasites is
modified and the infected red blood cells, whose morphology is very
useful for the diagnosis of species, are lyzed. Furthermore, nor is
it possible to count the infected RBCs. Only a very rough
evaluation of the parasitemia can be envisaged in terms of a
parasite/leukocyte ratio.
Thus, the thick film technique would seem to be a well tried
enrichment technique, which is only viable and sensitive when read
by highly trained technicians, but which even in the hands of
experts, cannot be used in an emergency context and does not
provide a rapid answer to the three questions posed to the
biologist:
is Plasmodium evidenced by the
examination?
is it a Plasmodium
falciparum ?
if it is a Plasmodium falciparum,
what is the parasitic density?
It will perhaps be necessary to recommend once again a wide use
of this method if the announced disappearance of the QBC Malaria
Test® is effective, before other techniques, with a low detection
threshold, are developed.