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To the Editor:—
Dr. Shookhoff's point concerning the necessity of immediate blood films whenever malaria enters even remotely into the differential diagnosis is, of course, well taken, and I echo it heartily. My objection, with which I am sure Dr. Shookhoff would be in equally hearty agreement, is to the common practice of ordering such smears only at the time of a fever spike.Dr. Shookhoff and I concur in essentials; my statement that a film taken at the height of fever "may be devoid of recognizable parasites" and his observation that such a film "may contain only ring forms... [which] are small and may be overlooked" are perhaps two different ways of emphasizing the same problem. The technician, who sees little malaria (as most do), needs an optimum film for specific diagnosis and will not get one if smears are ordered to be taken only when the patient has
Markell EK. Timing the Blood Smear For Malaria Diagnosis. JAMA. 1967;202(3):248. doi:10.1001/jama.1967.03130160122047