I think yes this is Schuffners dots because of the thick smear.

You can check this link of CDC:http://www.cdc.gov/dpdx/resources/pdf/benchAids/malaria/Pvivax_benchaidV2.pdf.  

hope it will be useful.

Dear Sara Abuelmaali,

Thanks so much, I ll be checking on the link.

Regards

Krisin

You are welcome anytime , hope it will be useful.

good luck

Hello

  Dear Krisin;   As you know there are 3 accepted hypotheses about the origin of the stippling dots include Schoffner's dot. If we suppose that this dots have independent real presence  for instance some dots from parasite, they could be seen in thick smear theoretically, but if they be the empty hole of used hemoglobin by parasite which take the Geimsa stain and appear like some fine dots or if the stippling be the mark of gradual death of RBC, they can not be seen due to a dependent and NOT REAL presence.

 At  a result, I think it would be difficult and improbable  to determine the stippling dotes in thick  blood smear due to distraction of RBCs.  

To the best of my knowledge In case of P. vivax these are called Maurer's dots and not the Schuffner's dots

Professor of Parasitology: You cannot see Schuffners dots in a thick smear, because the dots appear in the parasitized red blood cell. Thick smears are haemolysed, one sees only the parasite and the leucocytes, not erythrocytes. Also Maurer's clefts are seen in P. falciparum, not P. vivax.  

As far as I know you cannot see Schuffners dots in thick smears because they are "scars" of the erythrocyte after the parasite, P, vivax and ovale multiply inside the erythrocyte, and in thick smears the erythrocytes are haemolysed, so you do not have the structure where they are present.

About Maurer's clefts I know that they are present in P.falciparum infection and they are hardly observable in Giemsa stained smears.

Dear all,

You have very strong views on this, thanks, I really appreciate it.

I think the origine of the stippling as raised by dear Abbas is important to look at, but if you refer to Malaria text book by Wenrndorfer the answer is sort of vague, no clear-cut as described in the following: “Cytoplasmic clefts surrounded by single unit membranes appears as a fine stippling pattern following staining with Giemsa and are known as Schuffners dots. Electron-microscope studies show these to be small invaginations, called caveolae, the lumen of which is filled with fuzzy material. The caveolae are continuous with the red cell membranes and are surrounded by small vesicles.”

My question: Which cytoplasma is the cleft belong to? Erythrocyte or parasite?

Parasitophorous vacuole membrane, that originated from the erythrocyte membrane, may be thought as the origine of the cytoplasmic cleft, but later studies found that there is also parasite’s component in the parasitophorous vacuole membrane.

However, M Aikawa et.al revealed that the multiple brick-red dots or the Schüffner's dots have been associated by electron microscopy with caveola-vesicle complexes along the erythrocyte plasmalemma. A monoclonal antibody identifies an antigen in Plasmodium vivax-infected erythrocytes that is associated with the caveola-vesicle complexes of the parasitized host cell. This monoclonal antibody reacts with air-dried P. vivax-infected erythrocytes to produce a pattern by the indirect immunofluorescence test (IFT) that is suggestive of Schüffner's dots, and confirmed the location of this antigen within vesicles of caveola-vesicle complexes.

Can we suggest that Schuffner’s dots incorporate the component of both parasite and erythrocyte?

As Professor Cliff and Carmen say, implicitely, that during the process of staining the dots is washed off as the erytrocyte lysed. But, why both in the thick and thick smear P. vivax still show homogenous redness. Where does this color come from? It is not possible the color of reticulocyte because this cell is in bluer in color compared with erythrocyte.

As to the small invagination which is called caveola, may they be the one causing dark dots in the thin smear? But, what about the color of the vesicles? These object are much more in number and smaller or delicate than the caveole. Can we say the red color (red zone) we see either in thick smear and thin smear is part of schuffner’s dots?

If we can only see the Schuffner’s dots (as dark dots) at thin smear, I doubt a view that says Schuffner’s dots is a useful tool in identification of P. vivax. You know cytoplasmic amuboidity and cell enlargement of P. vivax are prominent characters in identifying this species easily. If my hypothesis accepted i.e. the red zone seen any plasmodia at both thick and thin smear is part of Schuffner’s dot, this will be of help so much to identify all human and simian malaria in accordance with each type of malaria. I hope the legacy of doctor W.A.P. Schuffner is more than just dark dots which only can be seen in thin smear. I need more evidences to support the hypothesis.

Regards

Krisin

Hello dear Krisin

You will not be able to see the Schuffners dots in a thick blood smear, because the Schuffners dots appear in the Red blood cells infected with parasites, and in thick smears erythrocytes are destroyed(Lysis).

best regards

Dear Habibollah

Yes agreed on the lysis. But, if Shuffner's dots have components originated from the parasite it would not be possible destroyed. Only material in RBC membrane (the most outer layer of the RBC corpuscule) that come off during the staining process. So, where does the reddish color  we usually see in P. vivax either at thick and thin smear, come from?    

I'm pretty sure you can see Shuffner's dots even on a thick smear, specially on the edge of the thick film where it is thin. They appear on what is kind of  "ghost membrane" of lysed RBC. When I'll come on those again I'll take pictures and upload them here.

Dear Jean,

Good idea. Yes,please upload not just the one at the edge of the thick smear (ghost cell) but also at the one at somewhere else of the thick smear. I am looking forward to discussing it with you. Thanks so much.

yes,we can.But the method of viewing matters.

I feel that Shuffner's dots can best be viewed in the thin smear only

Yes, you can. Look at the CDC guideline ( attached ) . 

Hi all friends

In my opinion it depends on the probability of finding normal and complete RBCs in the thick smear, because the Schuffner's dots location is the cytoplasm of RBC meanwhile in a good thick smear we expect lysed RBCs. SO the probability of seeing Schuffner's dots in thick smear is too low to occur.