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No. 46 (PH 12)
Suspect of malaria in Sysmex XT series; case report of two cases
Iwan Joseph, Mansyur Arif, Hardjoeno
Department of Clinical Pathology, Faculty of Medicine Hasanuddin University, Makassar,
Indonesia
Malaria is an infectious disease caused by Plasmodium which is usually presenting fever. Microscopic
examination is gold standard test to diagnose malaria, but sometimes there might be error in laboratory
examination. Automated blood cell analyzer, for example, Sysmex XT2000i and XT1800i are
automatically tools for complete blood count including leukocytes differentiation and can be used to
suspect diagnosis of malaria early. Our case was a male patient of 44 years old who was admitted in
Wahidin Sudirohusodo Hospital of Makassar with chief complaint of fever. On the first day of
admission, stained blood film was negative for Plasmodium, but the Sysmex DIFF scattergram was
abnormal. Based on these findings, complete blood count and stained blood film were performed again
and we found trophozoites, schizonts and gametocytes of Plasmodium falciparum and Plasmodium
malariae. The second case a female patient of 37 years old had an abnormal DIFF scattergrams and we
found Plasmodium vivax in both thick and thin blood films. The results indicated that abnormal DIFF
scattergram of Sysmex analyzer could be used as an early clue or suspicion of Plasmodium infection,
especially if patient presented with chief complaint of fever. Abnormal areas of eosinophils and cell
ghosts as well as neutrophils in the DIFF scattergram may indicated the existence of Plasmodium
malaria.
Key words: Malaria, Sysmex XT, DIFF scattergram abnormal
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