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The existence of malaria pigment has been known for well over a century. It was probably first recognized in 1847 by Johann Heinrich Meckel with the connection with malaria being recognized 2 years later by Rudolf Virchow [1]. Dr. George Carmichael Low, writing to Dr. (later Sir) Patrick Manson, during his expedition to St. Lucia in1901 commented “I went the other day to the dispensary and got five malignant malarias. One child had no symptoms but wasting. Blood contained—Crescents, ring forms, pigmented leucocytes, and marked irregularity in size and shape of the corpuscles” [2]. Low later suggested that observing the presence of pigmented leucocytes was useful in the differential diagnosis between malignant malaria and yellow fever when malaria parasites were infrequent [3].

The blood film shown is from a 54-year-old Afro-Caribbean man who acquired Plasmodium faliparum malaria while residing in Uganda. The image demonstrates numerous ring forms of P. falciparum plus neutrophils showing toxic granulation and left shift. In addition, two of the neutrophils contain malaria pigment, Malaria pigment is hemozoin or β-hematin, an insoluble crystalline derivative of heme. The parasite digests host hemoglobin and converts the heme to hemozoin, thus protecting itself from the toxic effects of heme. A century after Low suggested the diagnostic value of malaria pigment, hemozoin was found to retain diagnostic utility since its ability to depolarize light was found to “flag” blood samples that were likely to contain malaria parasites [4].

References

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  2. References
  • 1
    Sullivan DJ. Hemozoin: A biocrystal synthesized during the degradation of hemoglobin. In: MatsumuraS, SteinbüchelA, editors. Miscellaneous Biopolymers. Biodegradation of Synthetic Polymers. Weinheim: Wiley-VCH; 2004. pp 130156.
  • 2
    Cook GC. Caribbean Diseases: Doctor George Low's Expedition in 1901–02. Oxford: Radcliffe Publishing; 2009. pp 5859.
  • 3
    Low GC. The differential diagnosis of yellow fever and malignant malaria. Brit Med J 1902; 2: 860861.
  • 4
    Scott CS,Zyl D,Ho E, et al. Automated detection of malaria-associated intraleucocytic haemozoin by Cell-Dyn CD4000 depolarization analysis. Clin Lab Haematol 2003; 25: 7786.