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Test ID: LMALP Malaria PCR with Parasitemia Reflex, Varies

Useful For

Detection of Plasmodium DNA and identification of the infecting species, with reflex percent parasitemia calculated using thin blood films for positive cases


An adjunct to conventional microscopy of Giemsa-stained films


Detection and confirmatory identification of Plasmodium species: Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale, Plasmodium malariae, and Plasmodium knowlesi


This test should not be used to screen asymptomatic patients.

Testing Algorithm

If positive, the percent parasitemia will be performed at an additional charge.


For information see Malaria Laboratory Testing Algorithm.

Method Name

Real-Time Polymerase Chain Reaction (PCR)/DNA Probe Hybridization

Reporting Name

Malaria PCR with Parasitemia Reflex

Specimen Type


Ordering Guidance

1. When monitoring percent parasitemia for patient response to therapy, order MAL / Rapid Malaria/Babesia Smear, Varies (conventional blood film exam) instead of this test.

2. This test is not performed on a STAT basis and, therefore, should not be used as a primary screening test for malaria.

3. This test is used primarily to confirm a presumptive malaria diagnosis and to determine infecting Plasmodium species, particularly when the parasite morphology on traditional blood films is suboptimal.

4. Clients in the Rochester, MN area who are seeking a primary test for malaria and who can deliver the specimen within 4 hours of collection should order MAL / Rapid Malaria/Babesia Smear, Varies.

5. Laboratories that are unable to deliver a specimen within 4 hours of collection should perform an initial screen for malaria and other blood parasites in their laboratory prior to sending a specimen to Mayo Clinic Laboratories.

Shipping Instructions

Label all slides and place dry slides in a labeled slide box. Rubber band labeled slide box and labeled EDTA tube together and send to lab refrigerate.

Specimen Required

Both blood and slides are required.


Specimen Type: Blood

Container/Tube: Lavender top (EDTA)

Specimen Volume: 3 mL

Collection Instructions:

1. Invert several times to mix blood.

2. Send whole blood specimen in original tube. Do not aliquot.


Specimen Type: Blood films

Container/Tube: Clean, grease-free slides in plastic slide container

Specimen Volume: 2 Thin blood films and 2 thick blood films

Collection Instructions:

1. Blood films should be made from fresh blood using fingerstick or drops of blood from needle following venipuncture. However, EDTA anticoagulated blood is also acceptable.

2. Prepare thin blood films as follows:

 a. Prepare a thin film with a "feathered edge" that is no more than a single cell thick.

 b. Allow the film to thoroughly air dry and then fix by briefly immersing in either absolute or 95% methyl alcohol.

 c. Allow to air dry after fixation.

3. Prepare thick blood films as follows:

 a. Place a large drop of blood (approximately the size of a dime and preferably from a fingerstick) on a slide.

 b. Using a corner of a second slide, spread the drop in a circular motion while applying firm pressure to literally scratch the blood onto the carrier slide. This technique allows the blood to dry quickly and adhere well to the slide. Use approximately 20 circular sweeps with the second slide. The drop of blood should be about the size of a quarter when finished.

 c. Do not fix. Air dry thoroughly (approximately 45 minutes) before placing in transport container.

Specimen Minimum Volume

Blood: 1 mL
Slides: See Specimen Required

Specimen Stability Information

Specimen Type Temperature Time Special Container
Varies Refrigerated (preferred) 7 days
  Ambient  7 days

Clinical Information

Malaria is a mosquito-transmitted disease caused by apicomplexan parasites in the genus Plasmodium. It is an important cause of morbidity and mortality worldwide, with the World Health Organization estimating 219 million cases and 435,000 malaria-related deaths in 2017. Malaria disproportionately affects individuals living in Africa (90% of cases), with individuals living in southeast Asia and the eastern Mediterranean regions next most affected. Malaria is also encountered outside of endemic regions, such as the United States, usually in returning travelers.


Malaria is caused primarily by 4 species of the protozoa Plasmodium: Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae, and Plasmodium ovale. A fifth Plasmodium species, Plasmodium knowlesi, is a simian parasite that may be an important source of human infection in some regions of Southeast Asia. Differentiating P falciparum and P knowlesi from other species is important since both can cause life-threatening infections. In addition, P falciparum is typically resistant to many commonly used antimalarial agents, such as chloroquine.


Microscopy of Giemsa-stained thick and thin blood films is the standard laboratory method for diagnosis and species identification of malaria parasites. Under optimal conditions, the sensitivity of the thick film microscopy is estimated to be 10 to 30 parasites per microliter of blood. However, microscopic diagnosis requires considerable expertise and may be insensitive or nonspecific when inadequate training and facilities are available. Furthermore, prolonged exposure to EDTA, transportation conditions, and prior use of antimalarial drugs may alter parasite morphology and negatively impact the ability to perform speciation by microscopy. Finally, Babesia parasites have a similar appearance to P falciparum ring forms (early trophozoites) on peripheral blood films, resulting in potential diagnostic confusion.


Polymerase chain reaction (PCR) is an alternative method for malaria diagnosis that allows for sensitive and specific detection of Plasmodium species DNA from peripheral blood. PCR may be more sensitive than conventional microscopy in very low parasitemias and is more specific for species identification. It may be particularly useful when subjective microscopy does not permit certain identification of the species present. Malaria PCR can be used in conjunction with a traditional blood film or Babesia PCR when the clinical or morphologic differential includes both babesiosis and malaria. Examination of the thin film also allows for calculation of percent parasitemia, which can be used to predict prognosis and monitor response to treatment.

Reference Values



A positive result indicates the presence of Plasmodium nucleic acid, and the melting curve analysis indicates the infecting species.

Clinical Reference

1. Centers for Disease Prevention and Control (CDC). Malaria. CDC. Updated August 19, 2022. Accessed November 17, 2022. Available at

2. Swan H, Sloan L, Muyombwe A, et al: Evaluation of a real-time polymerase chain reaction assay for the diagnosis of malaria in patients from Thailand. Am J Trop Med Hyg. 2005 Nov;73(5):850-854

3. World Health Organization (WHO). Malaria. WHO. Updated July 26, 2022. Accessed November 17, 2022. Available at

Day(s) Performed

Monday through Sunday

Report Available

Same day/1 to 3 days

Test Classification

This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information


87207 (if applicable)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
LMALP Malaria PCR with Parasitemia Reflex 47260-5


Result ID Test Result Name Result LOINC Value
37116 Malaria PCR w/ Parasitemia 47260-5

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
MALCT Plasmodium Percent Parasitemia Rflx No No
Mayo Clinic Laboratories | Microbiology and Infectious Disease Catalog Additional Information: