simple presentation on slit skin smear samling

1. DERMATOLOGICAL PROCEDURE
 Slit skin smears
Presented By
Dr. Faiqa Qadeer
FCPS Trainee Dermatology
SIMS/SHL

2. Slit Skin Smears
• Its a cytodiagnostic technique used
in diagnosis of various cutaneous
dermatosis.
• It is used to diagnose
leprosy,cutaneous Leishmaniasis and
cutaneous mastocytosis.
• Smears should be taken from the
suspect lesions and from sites of
predilection for M.Leprae in LL, i.e.
forehead, earlobes, chin, extensor
surfaces of arms and buttocks .

3. • How to make a slit skin smear?
 The lesion is cleaned with ether or
alcohol
 a fold is gripped firmly between thumb
and forefinger to render it blood free.
 An incision 5 mm long and 3 mm deep
is made with a scalpel, the blade is
turned at right angles to cut, and
without relaxing finger pressure, the
wound is scrapped several times in one
direction.
 Fluid and pulp from the dermis,
collected on one side of the blade, are
gently smeared on to a glass slide. A
bloody smear is useless.

4. • Fixation and Staining of the Smear :
1. The slide with smear on it is covered with carbol
fuchsin and is heated sufficiently to cause steam
rise from all parts of the slide, but boiling is
avoided. The slide is then left for 15 minutes.
2. The stain is tipped away and the slide is held
gentle stream of water.
3. Pour acid alcohol mixture (1% HCl and 70%
alcohol) on to the slide and leave for 3 seconds if
smear is thin and for 5 seconds if smear is thick,
then wash it. Inspect for the degree of pinkness, if
faintly pink proceed to next step, if deeply pink
treat again with acid alcohol for 2 seconds and
wash with running water.
4. Cover the slide with counter stain, such as 1%
methylene blue for about 10 seconds.
5. Wash with running water and allow to dry.

5. • In stained smears :
 Living bacteria appear as uniformly stained rods(solid
staining).
 Dead bacilli appear as irregularly stained rods
(fragmented bacilli) or as granules (granular bacilli).
• AFB load is determined in the smear:
 Bacterial index.
 Morphological index.

6. Bacterial Index
• The density of bacilli in the smears is known as bacterial
index.
• BI includes both the living and dead bacilli.
• If several smears are taken, mean index is calculated.

7. Bacterial Index (Contd…)
• In lepromatous patients under treatment, there is no fall in BI during the
first 12 months, as both dead and living bacilli are being counted, but after
this a steady fall takes place in next 5-10 years.

8. Morphological Index
• A more sensitive index of bacteriological improvement,
especially in early stages of treatment.
• Takes into account only living or solid staining bacilli.
• MI is the percentage of solid stained bacilli, calculated
after examining 200 red staining elements lying singly.

9. Morphological Index (Contd…)
• Rapid fall in MI within 4-6 months of starting anti-
leprosy therapy.
• Important in determining:
 If a patient’s leprosy is active or not.
 Gives valuable information as to response to treatment.
 Give early intimation of bacterial resistance to chemotherapy or
of defaulting on treatment.

11. Task
 The Pt. with nodulo-plaque type of lesion is sitting on a
chair.Perform slit-skin smear for diagnosis.do not write any
description.
 Provided instruments:
• Scalpel blades
• Spirit swab
• Glass slide
• Cover slip
• Gloves
• Burner
• Table,chairs and paper.

12. Component Key features Component
Score
Introduction
and Consent.
Greet ang gives self introduction.
Obtains informed consent.
0.5
0.5
Emanination Examines:
Lesion with hand lens. 01
Procedure Select active lesion.
Cleans lesion with spirit swab.
Grips edge firmly between thumb and
forefinger to render it blood free.
Select blade #15.
Make incision of 5mm long and 2-3mm
deep with blade turned right angle
without relaxing finger pressure.
Scrape wound in 1 direction.
Collect fluid and pulp.
Places smear gently on glass slide.
Fixes it on glass slide for staining.
7.5
Complete the
Task
Pays thanks to patient. 0.5

13. THANK
YOU