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新发传染病电子杂志 ›› 2025, Vol. 10 ›› Issue (2): 70-74.doi: 10.19871/j.cnki.xfcrbzz.2025.02.012

• 病例报道 • 上一篇    下一篇

疟原虫感染导致血常规结果异常的案例分析

周素涛1, 曹欣然2, 许雪晴2, 张斌1   

  1. 1.河北北方学院附属第一医院检验科, 河北 张家口 075000;
    2.河北北方学院研究生学院, 河北 张家口 075000
  • 收稿日期:2024-09-05 发布日期:2025-06-16
  • 通讯作者: 张斌,15028309589@163.com

2 cases report of abnormal routine blood test results due to Plasmodium infection

Zhou Sutao1, Cao Xinran2, Xu Xueqing2, Zhang Bin1   

  1. 1. Department of Clinical Laboratory, The First Affiliated Hospital of Hebei North University, Hebei Zhangjiakou 075000, China;
    2. Graduate School, Hebei North University, Hebei Zhangjiakou 075000, China
  • Received:2024-09-05 Published:2025-06-16

摘要: 疟原虫在红细胞内发育阶段可形成特殊的包涵体,使红细胞形态发生改变,结合疟原虫自身的形态特点,可通过显微镜检查进行鉴别。血涂片的镜检为实验室诊断疟疾最常用的方法,但在缺少患者病史、诊断或相应检查医嘱等信息时,实验室医师缺少对疟原虫感染的敏感性。本研究报道了2例疟原虫感染者,其血常规检测结果异常,其中1例患者表现为白细胞散点图中嗜酸性粒细胞位置异常,另1例患者表现为网织红细胞计数假性增高,网织红细胞散点图呈现“满天星”状。通过外周血涂片镜检,结合患者病史、镜检计数、仪器检测原理等进行分析,确定红细胞内疟原虫不同的发育阶段可导致仪器检测到的侧向散光和侧向荧光强度不同,而误判为不同的细胞。本案例报道可为实验室和临床医师通过血常规散点图预警或识别疟原虫感染提供参考。

关键词: 疟原虫, 嗜酸性粒细胞, 网织红细胞, 散点图, 血常规

Abstract: Due to the reproductive characteristics of Plasmodium parasites, special inclusion bodies are formed in the red blood cells infected with Plasmodium parasites, which can be identified by microscopic examination. Microscopic examination of blood smears has become the most commonly used method for laboratory diagnosis of malaria. However, in the absence of information such as the patient's medical history, diagnosis or corresponding examination orders, laboratory doctors lack sensitivity to Plasmodium parasite infections. This study reports two cases of Plasmodium parasite-infected patients whose red blood cells infected with Plasmodium parasites in peripheral blood led to abnormal blood routine test results. One of the patients showed a pseudo-increase in eosinophils, and the position of eosinophils in the white blood cell scatter plot was abnormal. The other patient showed a pseudo-increase in reticulocyte count, and the reticulocyte scatter plot presented a "starry sky" shape. It was confirmed by microscopic examination of peripheral blood smears and analyzed in combination with the patient's medical history, microscopic counting, and the principle of instrument detection. It was determined that different developmental stages of Plasmodium parasites in red blood cells could lead to different lateral scattered light and lateral fluorescence intensities detected by the instrument and be misjudged as different cells. This analysis can provide a reference for laboratories and clinicians to warn or identify Plasmodium parasite infections through blood routine scatter plots.

Key words: Plasmodium, Eosinophil, Reticulocytes, Scatter diagram, Routine blood test

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