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Microscopy smear examination 2014
- 1. MICROSCOPY SMEAR EXAMINATION RECORDING & REPORTING
- 2. CCoonntteenntt OOvveerrvviieeww •Requiredmaterials •Reading the smear •Appearance of AFB •Malaysia grading scale •WHO/IUATLD grading scale •Cleaning of objectives •Storage of smears
- 4. SSyysstteemmaattiicc EExxaammiinnaattiioonn ooffSSmmeeaarrss 2 cm 3 cm
- 5. OOvveerrvviieeww ooff MMiiccrroossccooppyy • Place smear facing upwards onto stage • Focus using 10x objective • Apply immersion oil and focus 100x objective • Examine at least 300 fields • Quantitate AFB • Record and report results • Store all smears
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- 7. AAFFBB iinn SSiinngglleeAArrrraannggeemmeenntt
- 8. AAFFBB -- iinnVVaarriioouuss AArrrraannggeemmeennttss
- 9. AAFFBB -- iinnVVaarriioouuss AArrrraannggeemmeennttss
- 10. EExxcceessssiivvee HHeeaatt FFiixxiinnggooff SSmmeeaarr
- 11. GGllaassss SSlliiddee SSccrraattcchhaanndd AAFFBB
- 12. WWhhaatt iiss tthheeiimmppoorrttaannccee ooff SSmmeeaarr ggrraaddiinngg ?? -To know the disease status -Quality Control
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- 14. OBSERVATION OOFF SSTTAAIINNEEDDSSMMEEAARR (oolldd MMaallaayyssiiaann ssttaannddaarrdd)) 3 cm = 100 visual field •Examine the smear under x100 objective with the 10 eye piece lens •Read at least 300 visual fields to give a report a negative
- 15. RReeccoorrddiinngg aanndd rreeppoorrttiinngg -- mmaaxxiimmuumm 5500 bbaacciillllii iiss ccoouunntteedd Old Malaysian Standard If 50 or more bacilli found in the first line > 50 /L 11 to 49 bacilli seen at the end of first line Write the actual no. of AFB seen 35/L, or 11/L If 50 bacilli seen in any part of the slides 50/ >L Number of bacilli seen after 3 lines examined Write the actual no. of AFB seen 3/3L or 49 /3L No AFB seen 0/3L
- 16. OOBBSSEERRVVAATTIIOONN OOFF SSTTAAIINNEEDDSSMMEEAARR --IInntteerrnnaattiioonnaall SSttaannddaarrdd-- 3 cm = 150 visual field •Examine the smear under x100 objective with the 10 eye piece lens •Read at least 300 visual fields to give a report a negative
- 17. Number of AFBNumber of fields* examined What to report No AFB in 300 fields 300 fields No Acid Fast Bacilli seen 1–9 AFB in 100 fields 100 fields Record exact figure (1 to 9 AFB per 100 fields) 10– 99 AFB in 100 fields 100 fields 1 + 1– 10 AFB in each field 50 fields 2 + More than 10 AFB in each field 20 fields 3 + * Oil immersion fields
- 18. RReeccoorrddiinngg aanndd RReeppoorrttiinngg Interpretation of Smears
- 19. SSmmeeaarr CCoonnttaaiinnss NNoo AAFFBB iinn 330000 FFiieellddss wwiillll bbee ggrraaddeedd aass No AFB Seen
- 20. 00 -- NNooAAFFBB sseeeenn iinn 330000 vviissuuaall ffiieellddss 1VF 2VF 3VF 4VF................................ 148VF 149VF 150VF
- 21. 11--99 AAFFBB sseeeenn iinn110000 VVFF wwiillll bbee ggrraaddeedd aass Scanty
- 22. Scanty - 1-9AFB seen in 100 VF (Write the actual number of AFB seen, e.g. 1/100VF, 3/100VF…9/100VF)
- 23. Scanty - 1-9AFB seen in 100 VF (Write the actual number of AFB seen, e.g. 1/100VF, 3/100VF…9/100VF) 7/100VF
- 24. AA ssmmeeaarr wwiitthh1100 ttoo 9999 bbaacciillllii iinn 110000 ffiieellddss wwiillll bbee ggrraaddeedd aass 1+
- 25. 11++ -- 1100--9999AAFFBB sseeeenn iinn 110000 VVFF 1+
- 26. 11++ -- 1100--9999AAFFBB sseeeenn iinn 110000 VVFF 1+
- 27. AA ssmmeeaarr wwiitthh11 ttoo 99 bbaacciillllii iinn aatt lleeaasstt 5500 ffiieellddss wwiillll bbee ggrraaddeedd aass 2+
- 28. 22++ -- 11--1100AAFFBB//OOIIFF iinn aatt lleeaasstt 5500 VVFF 1VF=3 2VF=1 3VF=2................ 49VF=3 50VF=4 2+
- 29. AA ssmmeeaarr wwiitthh mmoorree tthhaann 1100 AAFFBB//OOIIFF iinn aatt lleeaasstt 2200 ffiieellddss wwiillll bbee ggrraaddeedd aass 3+
- 30. 33++ -- MMoorreetthhaann 1100 AAFFBB//OOIIFF iinn aatt lleeaasstt 2200 VVFF 3+
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- 33. HHooww ttoo ssttoorreetthhee sslliiddeess??
- 34. RReemmoovvee OOiill ffrroommSSmmeeaarrss
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- 36. WWhhaatt wwiillll hhaappppeennwwhheenn tthhee ssmmeeaarr rreessuullttss aarree rreeppoorrtteedd iinnccoorrrreeccttllyy ??
- 38. These variations canbe minimized by;
- 39. MMAAIINN CCAAUUSSEESS OOFFFFAALLSSEE RREEAADDIINNGGSS IINN SSMMEEAARR PPRREEPPAARRAATTIIOONN Check point Causes False Positive F(+) False Negative F(-) Size Too big Too small ** Evenness Uneven Sloughed-off ** Thickness Too thick Too thin ** Cleanliness Dirt Artifact ** * Sputum quality Saliva * Staining Overheating Insufficient heating Under decolourization * * ***
- 40. FFaallssee NNeeggaattiivveess aanndd CCoonnsseeqquueenncceess
- 41. FFaallssee PPoossiittiivveess aanndd CCoonnsseeqquueenncceess
- 42. EXERCISE GGrraaddee tthheeFFoolllloowwiinngg SSmmeeaarrss::
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Editor's Notes
- #5 An acceptable size of a smear should be approximately 1-2 cm×2-3 cm. One (1) horizontal line in a 1 x 2 cm smear or in a 2 x 3 cm smear would cover about 100 to 150 visual fields.