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WS/T 569-2017 English PDF

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WS/T 569-2017: Microscopic examination of blood films for malaria parasites
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Basic data

Standard ID WS/T 569-2017 (WS/T569-2017)
Description (Translated English) Microscopic examination of blood films for malaria parasites
Sector / Industry Health Industry Standard (Recommended)
Classification of Chinese Standard C62
Word Count Estimation 15,110
Date of Issue 2017-08-01
Date of Implementation 2018-02-01
Regulation (derived from) State-Health-Communication (2017) 11
Issuing agency(ies) National Health and Family Planning Commission of the People's Republic of China

WS/T 569-2017: Microscopic examination of blood films for malaria parasites

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Microscopic examination of blood films for malaria parasites ICS 11.020 C62 WS People's Republic of China Health Industry Standard Plasmodium detection blood smear microscopy 2017-08-01 released 2018-02-01 Implementation Issued by the National Health and Family Planning Commission of the People's Republic of China

Foreword

This standard was drafted in accordance with the rules given in GB/T 1.1-2009. Drafting organizations of this standard. Hainan Provincial Center for Disease Control and Prevention, Jiangsu Provincial Institute of Parasitic Disease Control, and Chinese Center for Disease Control and Prevention Parasitic Disease Prevention and Control Institute, Yunnan Provincial Parasitic Disease Prevention and Control Institute, Hainan Provincial Agricultural Reclamation General Administration Hospital. The main drafters of this standard. Wang Shanqing, Gao Qi, Tang Linhua, Yang Henglin, Zheng Bin, Hu Ximin, Wang Guangze, Li Yuchun, Liu Ying, Ou Yang Fanxian. Plasmodium detection blood smear microscopy

1 Scope

This standard specifies the technical specifications for the detection of Plasmodium by blood smear microscopy. This standard is applicable to the microscopic examination of malaria parasites by disease prevention and control institutions and medical institutions at all levels.

2 Terms and definitions

The following terms and definitions apply to this document. 2.1 Plasmodium spp Plasmodium is a single-celled, parasitic eukaryotic animal that is the pathogen of malaria (malaria). The host of malaria parasites Plasmodium falciparum (Plasmodium falciparum), Plasmodium vivax (Plasmodium vivax), Plasmodium vivax (Plasmodium vivax) malariae) and Plasmodium ovale, etc. 2.2 Blood films A smear made by spreading blood on a glass slide. Blood smears for microscopic examination of plasmodium include thick blood film smears and thin blood film smears Two kinds.

3 Apparatus and equipment

3.1 Biological microscope (100× oil immersion objective lens, 5× or 10× eyepiece). 3.2 Counter. 3.3 Glass slide (clean glass slide without scratches and oil stains). 3.4 Push the film. 3.5 Staining rack for blood slices. 3.6 Blood slice drying rack. 3.7 Slide box. 3.8 Dyeing plate and dyeing tank.

4 Reagents and materials

4.1 Ji's staining stock solution. 4.2 pH7.2 phosphate buffered saline (PBS). 4.3 Methanol (analytical grade). 4.4 Cedar oil or special immersion oil (refractive index ≥ 1.5). 4.5 Xylene (analytical grade). 4.6 75% alcohol. 4.7 One-time blood sampling needle. 4.8 Disposable gloves.

5 Detection steps

5.1 Preparation of blood smear 5.1.1 Blood collection site and blood collection method Sterilize the blood collection site with 75% ethanol. After it dries, puncture the earlobe or fingertip with a disposable blood collection needle to get the blood. The baby can get the blood from the hallux or heel Puncture the blood. Take a sterile push film, hold the middle of the side edge of the push film with your thumb and index finger, scrape 4μL~5μL of blood with the lower left corner of the push film A thick blood film is made, and then 1 μL to 1.5 μL of blood is scraped from the middle of the end to make a thin blood film. 5.1.2 Thick blood film production Take a glass slide, apply a drop of blood from the lower left corner of the push slide to the center of the slide to the left, draw a circle from the inside to the outside to form a diameter of 0.8cm~1.0cm The thickness of the thick round blood film is that 5-10 white blood cells can be seen in the field of an oil microscope. 5.1.3 Thin blood film production Use a dry cotton ball to wipe off the blood stains on the lower left corner of the slide, and then flatten the lower edge of the slide against the midline of the slide. When the blood is between the slide and the slide, When the time is extended to about 2cm wide on both sides, keep the two glass slides at 25°~35°, and quickly push forward from right to left to form a thin tongue-like blood film. Each slide 1 thick blood film and 1 thin blood film (see Appendix A). 5.1.4 Number After the blood film is prepared, place it horizontally, and after it is fully dried, use a pencil to number on the ground glass on one side of the slide or on the thin blood film. 5.2 Fixation and hemolysis 5.2.1 Thin blood film fixation Place one end of the thin blood film facing down at 45°, dip a cotton swab into the methanol solution, and wipe it evenly on the surface of the thin blood film to avoid touching the thick blood film. 5.2.2 Thick blood film hemolysis Add a few drops of distilled water to the dry thick blood film to completely cover the blood film and hemolyze for a few minutes. When the blood film turns light gray, pour out the blood to dissolve it. Staining does not require hemolysis within 1d after the thick blood film is made, and hemolysis is required for more than 1d. 5.3 Gee's stain 5.3.1 Preparation of Ji's stain solution (see Appendix B) Ji's stain includes Ji's stain stock solution and Ji's stain working solution. The stock solution of Ji's dye solution is fully ground from 5g Ji's powder and 250mL glycerin Add 250mL methanol to prepare. The stock solution of Ji's dye solution can be stored for a long time under dark conditions. Commonly used Ji’s staining solution includes 2%, 3% and There are three kinds of 10% concentration, which are respectively prepared in proportions from the stock solution of Ji's stain solution and pH 7.2 phosphate buffered saline (PBS). Ji's dye solution working solution can only Prepare fresh when used. 5.3.2 Staining of a single blood smear (see Appendix C) A single blood smear is commonly used for microscopic malaria detection in clinical malaria patients. Conventional dyeing method using 3% Ji's dye solution Blood smears have good staining quality and can be stored for a long time. The staining time is about 30 minutes. The fast dyeing method with 10% Ji's dye solution takes longer dyeing time Short, 8 min to 10 min, but blood smears are not suitable for long-term storage. 5.3.3 Staining of batches of blood smears (see Appendix C) Gee's staining of batches of blood smears is often used for microscopic plasmodium detection in population epidemiological investigations, and 2% Gee's stain is often used for batching Stain the blood smear. 5.4 Microscopic examination 5.4.1 Microscopic examination Add 1 drop of cedar oil or special immersion oil on the stained blood film, and inspect with a 100× oil immersion objective lens, 5× or 10× eyepiece optical microscope. The blood membrane with good staining quality, red blood cells are light red, eosinophil granules are bright red, neutrophil nuclei are purple-blue, lymph The cytoplasm of the cells and the plasmodium is blue or light blue, and the nucleus of the plasmodium is red. In addition to the ring, malaria pigment can be found in all other stages. Plasmodium The detection is based on thick blood film, and the identification of insect species is based on thin blood film. The sequence of viewing the film is that the thin blood film starts from the tip of the tongue, and the thick blood film starts from the top or Start at the bottom (see Appendix D). 5.4.2 Results judgment 5.4.2.1 Negative test for Plasmodium The thick blood film can be judged as negative only if a minimum of 100 fields of view or the entire thick blood film is not found for plasmodium under the oil microscope. 5.4.2.2 Plasmodium tested positive The Plasmodium found in the blood film is judged to be positive, and the Plasmodium falciparum, Plasmodium vivax, and three are determined according to the morphology of the Plasmodium (see Appendix E). Plasmodium vivax, Plasmodium ovale or mixed infection. 5.4.3 Counting of Plasmodium 5.4.3.1 Plasmodium counting method with thick blood film Microscopic examination of the thick blood film, count the number of malaria parasites and white blood cells in each field of view, count more than.200 white blood cells, when the density of malaria parasites is very low Count 1000.Calculate the density of malaria parasites using the following formula. Plasmodium number ÷ white blood cell number × white blood cell number per microliter of blood = Plasmodium number/micro Ascension. If the white blood cell count cannot be performed, it is calculated as 8000 white blood cells/microliter of blood. 5.4.3.2 Plasmodium counting method with thin blood film Microscopic examination of the thin blood film, count the number of plasmodium and red blood cells in each field of view, count more than 1,000 red blood cells. Calculate the malaria parasite using the following formula density. The number of Plasmodium ÷ the number of red blood cells × the number of red blood cells per microliter of blood = the number of Plasmodium/microliter of blood. If the red blood cell count cannot be performed, then Take 5 million blood per microliter for men and 4.5 million blood per microliter for women. Plasmodium counting method with thin blood film is suitable for high density of plasmodium Count of malaria parasites when (the number of malaria parasites per microliter of blood >16000). 5.5 Preservation of blood smear Use absorbent paper to absorb the cedar oil or special immersion oil on the blood film surface of the tested blood smear, add 2 to 3 drops of xylene on the blood film, and then absorb Water paper is soaked dry (special immersion oil does not need to be washed with xylene, it can be directly soaked dry with absorbent paper). Put the blood smear in the slide box, avoid light, dry and Keep in a cool shade for review. AA

Appendix A

(Informative appendix) Schematic diagram of making thick blood film and thin blood film blood smear The schematic diagram of making thick blood film and thin blood film blood smear is shown in Figure A.1. Figure A.1 Schematic diagram of making thick blood film and thin blood film blood smear BB

Appendix B

(Informative appendix) Preparation of Ji's dye solution B.1 Preparation of Ji's staining stock solution Ji's powder 5.0g, methanol 250mL, glycerol 250mL. Put the Ji's powder in a mortar, add a small amount of glycerin and grind it thoroughly, then add it and grind it until the glycerin is added, pour 500mL with a stopper Dark glass bottle. Add a small amount of methanol in the mortar, wash off the remaining part, pour it into the bottle, add methanol again, and pour it into the bottle after washing until Wash the glycerin in the mortar with methanol. Stopper the bottle tightly, put it at room temperature, shake the solution vigorously for 5 minutes every day, and use it after 3 days. Note. Stopper the bottle tightly to avoid oxidation caused by evaporation and high humidity; store in a dark glass bottle, avoid direct sunlight, store The longer the time, the better the dyeing effect. According to daily needs, use a dry straw to suck a small amount of dyeing stock solution into a closed bottle (about 25mL). Never add water to the stock solution. B.2 Preparation of pH 7.2 phosphate buffered saline (PBS) First prepare two stock solutions. Solution I is 9.5g anhydrous disodium hydrogen phosphate and distilled water to 1000mL, solution II is 9.07g dihydrogen phosphate Add distilled water to potassium to 1000 mL. When preparing, put the phosphate in a volumetric flask, add part of distilled water and shake to dissolve it, then add distilled water Dilute to 1000 mL, shake well, and stopper tightly for later use. Before use, take 73 mL of solution I and 27 mL of solution II and pour them into a 1000 mL volumetric flask, Add part of the distilled water, mix and shake well, then add distilled water to dilute to 1000mL mark, stopper the bottle stopper and shake again, it will be formulated to pH 7.2 The buffer solution. B.3 Preparation of Ji's staining working solution B.3.1 Preparation of 3% Ji's staining working solution Add 3 mL of Ji's staining stock solution to 97 mL pH 7.2 phosphate buffer and mix well. B.3.2 Preparation of 10% Ji's staining working solution Add 1 mL of Ji's staining stock solution to 9mLpH 7.2 phosphate buffer and mix well. B.3.3 Preparation of 2% Ji's staining working solution Add 2 mL of Ji's staining stock solution to 98mLpH 7.2 phosphate buffer and mix well. B.3.4 Matters needing attention Do not shake the bottle containing the original dyeing solution when sucking the original dyeing solution. Ji’s dyeing working fluid should be used and prepared now, and do not use the unused Ji’s Pour the dyeing working solution back into the original solution bottle. CC

Appendix C

(Informative appendix) Dyeing method C.1 Single blood smear staining method C.1.1 3% Ji's staining solution C.1.1.1 Place the thin blood film fixed with methanol on the blood smear horizontally in the staining dish. C.1.1.2 Use a pipette to draw about 3 mL of the newly prepared 3% Ji's stain solution, and drop it on the thick and thin blood film until the stain solution evenly covers the blood film but does not overflow until. C.1.1.3 Let stand for about 30 minutes for dyeing. C.1.1.4 Move the staining plate to the flushing pool, and rinse with slow running water along the upper edge of the blood smear for about 1 min. C.1.2 Rapid staining method with 10% Ji's solution C.1.2.1 Place the thin blood film fixed with methanol on the blood smear horizontally on the staining plate. C.1.2.2 Use a pipette to draw about 3 mL of the newly prepared 10% Ji's stain solution, and drop it on the thick and thin blood film until the stain solution evenly covers the blood film but does not overflow until. C.1.2.3 Let stand for dyeing for about 8 min to 10 min. C.1.2.4 Move the staining plate to the flushing pool, and rinse with slow running water along the upper edge of the blood smear for about 1 min. C.1.2.5 Insert the stained blood smear with the blood film facing down into the blood slice drying rack and let it dry. C.2 Batch blood smear staining method C.2.1 Insert the blood film of each blood smear into the staining tank in one direction, or insert the blood film of the blood smear outward in pairs into the staining tank. C.2.2 Pour the newly prepared 2% Ji's stain solution to immerse the thick and thin blood film. C.2.3 Let stand for dyeing for about 30 minutes. C.2.4 Pour tap water or PBS buffer into the dyeing vat to overflow, remove the scum on the surface of the dyeing solution, and pour out the remaining dyeing solution in the dyeing vat. Add new water and rinse slowly 2 to 3 times. C.2.5 Take out the blood smear, insert the blood film into the drying rack, and let it dry. C.3 Matters needing attention Do not pour out the dye solution directly after staining. Rinse the blood smear together with the dye solution in water, or add water along the edge of the glass slide and the staining tank. Make the surface of the dye solution overflow and rinse gently to prevent the dye particles from contaminating the blood film. When dyeing in batches, do not pour the dye solution directly onto the thick blood film So as not to wash away the thick blood film. In addition to the concentration of the dye solution, the dyeing time is also related to the temperature during dyeing. When dyeing in batches, a leaflet should be carried out first. Try staining blood smears to determine the best staining time. DD

Appendix D

(Informative appendix) Schematic diagram of the sequence of viewing routes See Figure D.1 for the sequence diagram of the viewing route. Figure D.1 Schematic diagram of the sequence of the viewing route EE

Appendix E

(Informative appendix) Four forms of plasmodium with thin and thick blood film (Ji's staining) E.1 The thin and thick blood film morphology of Plasmodium falciparum is shown in Figure E.1. Figure E.1 Morphology of the thin and thick blood film of Plasmodium falciparum E.2 The thin and thick blood film morphology of Plasmodium vivax is shown in Figure E.2. Figure E.2 Thin and thick blood film morphology of Plasmodium vivax E.3 The thin and thick blood film morphology of Plasmodium vivax is shown in Figure E.3. Figure E.3 Morphology of the thin and thick blood film of Plasmodium vivax E.4 The thin and thick blood film morphology of Plasmodium ovale is shown in Figure E.4. Figure E.4 Thin and thick blood film morphology of Plasmodium egg

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