Week 1: Phlebotomy Health Care Delivery System  Cupping involved the application of a

heated suction apparatus, called the “cup,”

Historical Perspective: to the skin to draw the blood
 They readily transmitted a host of blood-
460-377B.C borne infections from patient to
 Hippocrates patient.
 stated that disease was the result
of excess substance-such as
blood, phlegm, black bile, and  Leeches were used.
yellow bile-within the body.  This procedure involved enticing
the Hirudo medicinalis, a European
1400 B.C medicinal leech, to the spot needing
 application of a leech to a patient bloodletting with a drop of
evidences bloodletting in Egypt in about milk or blood on the patient’s
1400 B.C. skin
 the components of the
Middle Ages worm’s saliva,
 in the Middle Ages, barber–surgeons  local vasodilator (substance that
flourished. By 1210, the Guild of Barber– increases the diameter of blood
Surgeons had been formed; Long Robe vessels).
and Surgeons of the Short Robe.  local anesthetic.
 hirudin, an anticoagulant (a
 Short Robe surgeons were substance that prevents clotting).
forbidden by law to do any surgery
except bloodletting, wound
surgery, cupping, leeching,  It was potentially a very dangerous method.
shaving, tooth extraction, and  It was usually performed on the superficial
enema administration. temporal artery or one of its branches.
 artery was partially cut through
 Long Robe surgeon, barber– a single incision.
surgeons placed a striped pole,
from which a bleeding bowl was
suspended, outside their doors.  Scarificators contained from 1 to 20 blades,
They are in charge of “cutting the and were similar in appearance to the
hair” up to “amputating limbs” lancet.
 Cupping devices were made of glass, a
gourd, or an animal’s horn.
17th to 18th century
 phlebotomy was considered a major
therapeutic (treatment) process
 The lancet, a tool used for cutting the vein
during venesection
 amount of blood withdrawn was
approximately 10 mL, but excessive
phlebotomy was common.
Types of Blood Letting techniques (Venesection)
Phlebotomy Today • Comply with all procedures
Phlebotomy is performed to: instituted in the procedure manual.
1. Obtain blood for diagnostic purposes and • Promote good relations with
to monitor prescribed treatment patients and hospital personnel.
2. Remove blood for transfusions at a donor • Assist in collecting and
center documenting monthly workload and
3. Remove blood for therapeutic purposes, recording data.
such as treatment for polycythemia, a • Maintain safe working conditions.
disorder involving the overproduction of red • Perform appropriate laboratory
blood cells computer operations.
• Participate in continuing education
Phlebotomy is primarily accomplished by one of two
programs.
procedures:
• Collect and perform point-of-care
1. Venipuncture, which involves collecting
testing (POCT).
blood by penetrating a vein with a needle
and syringe or other collection apparatus • Perform quality-control checks on
2. Capillary puncture, which involves POCT instruments.
collecting blood after puncturing the skin • Perform skin tests.
with a lancet. • Prepare and process specimens.
• Collect urine drug screen
The term phlebotomist is applied to any individual specimens.
who has been trained in the various techniques • Perform electrocardiography.
used to obtain blood for laboratory testing or blood • Perform front-offi ce duties, current
donations. procedural terminology coding, and
paperwork.
A competent clinical phlebotomist must have good
manual dexterity, special communication skills,
good organizational skills, and a thorough
knowledge of laboratory specimen requirements
and departmental policies.

• Prepare patients for collection

procedures associated with
laboratory samples.
• Collect routine skin puncture and
venous specimens for testing as
required.
• Prepare specimens for transport to
ensure stability of sample.
• Maintain patient confi dentiality.
• Perform quality-control checks while
carrying out clerical, clinical, and
technical duties.
• Transport specimens to the
laboratory.
Official Recognition
CERTIFICATION 1. Recognizing Diversity
 a voluntary process by which an agency 2. Professionalism
grants recognition to an individual who has 3. Self-Confidence
met certain prerequisites in a particular 4. Integrity
technical area 5. Compassion
 indicates the completion of defined 6. Self-Motivation
academic and training requirements and 7. Dependability
the attainment of a satisfactory score on an 8. Ethical Behavior
examination. 9. Confidentiality
 I.e. Certification programs
1. Basic Phlebotomy procedure by PNRC
2. Blood Donation Procedure

LICENSURE
 Licensure is the act of granting a license.
 License in healthcare is an official
document or permit granted by a state
agency that gives legal permission for a
person to work in a particular health
profession.
 must meet specific education and
experience requirements and pass an
examination before the license is granted
 I.e. PRC license (MLT, RMT)

CONTINUING EDUCATION
 Continuing education is designed to update
the knowledge or skills of participants and
is generally geared to a learning activity or
course of study for a specific group of
health professionals, such as
phlebotomists
 I.e. ASCPi, PAMET, PASMETH, PCQACL,
PSMLS.

PATIENT–CLIENT INTERACTION

 Positive “customer relations” involves

promoting goodwill and a harmonious
relationship with fellow employees, visitors,
and especially patients.
 A competent phlebotomist with a
professional manner and a neat
appearance helps to put the patient at ease
and establish a positive relationship.
COMMUNICATION SKILLS One-dimensional, nonverbal communication is
 Many different types of people or multidimensional and involves the following
customers interact with phlebotomists. elements.
Often, the customer’s perception of the
healthcare facility is based on the (1) happy,
employees they deal with on a one-to-one (2) sad,
basis (3) surprise,
 bedside manner (the ability to (4) fear,
communicate empathically with the (5) anger,
patient) (6) disgust.

Communication with Patient Kinesics

 study of nonverbal
Verbal Communication communication is also called kinesics; it
 Expression through the spoken word is the includes characteristics of body motion and
most obvious form of communication. language such as facial expression,
 It involves a sender (speaker), a receiver gestures, and eye contact.
(listener), and, when complete, a process  If the verbal and nonverbal
called feedback, creating what is referred messages do not match, it is called
to as the communication feedback loop a KINESIC SLIP. When this
happens, people tend to trust what
they see rather than what they
hear.
 when a patient is anxious,
nonverbal signs may include tight
eyebrows, an intense frown,
narrowed eyes, or a downcast
mouth

Communication barriers - Biases or personalized

Filters that become obstructions to hearing and
understanding what has been said and are frequent
causes of miscommunication.
 Examples of communication barriers
1. Language limitations
2. cultural diversity
3. Emotions
4. Age
5. physical disabilities such as hearing loss

Nonverbal Communication - It has been stated that

80% of language is unspoken.
Proxemics  Primary – refers to the health units
in rural areas and sub-units.
 Proxemics is the study of an individual’s
concept and use of space.
 Secondary – refers to non-
 Every individual is surrounded by an
departmentalized hospitals that
invisible “bubble” of personal territory in
attend to patients during the
which he or she feels most comfortable
symptomatic stages of an ailment.
 It is often necessary, in the
 Tertiary – larger hospitals and
healthcare setting, to enter
medical centers that has
personal or intimate zones
sophisticated services coupled with
 not carefully handled, the patient
highly technical facilities that can
may feel threatened, insecure, or
address serious illnesses.
out of control.
The Different Clinical Analysis Areas of the
Laboratory

 Clinical labs offers test procedures to aid

physicians in diagnosis of diseases. It has
two major divisions:

 Anatomical and surgical

Appearance pathology – related to the tests
such as histology, cytology and
 A phlebotomist’s physical appearance cytogenetics.
should communicate cleanliness and
confidence. Lab coats, when worn, should  Clinical Analysis area – divided in
completely cover the clothing underneath to seven different areas.
and should be clean and pressed. Shoes
should be conservative and polished. Close
attention should be paid to personal
hygiene. Bathing and deodorant use should
be a daily routine.

The Healthcare Setting

 Healthcare facilities are categorized as

inpatient that requires the patient to stay at
the hospital for at least a night and
outpatient in which patients are served
and dismissed the same day.

 Healthcare has 3 levels of service:

Examples of Tests and Procedures in Clinical 8. Mean Corpuscular hemoglobin (MCH)
Analysis Area gives the weight of the hemoglobin in the
cell.
Test Procedures 9. Mean Corpuscular volume (MCV) shows
Clinical Area the size of the cell.
10. Mean Corpuscular hemoglobin
Hematology – blood and Hematocrit concentration (MCHC) gives information on
blood-forming tissues the concentration of the hemoglobin per
Hemoglobin
unit volume of RBCs.
Red Blood Cell Count 11. Red blood distribution width (RDW)
measures the size differences of the RBCs
White Blood Cell
12. Activated partial thromboplastin time
Count
(APPT) reflects the adequacy of herapin
Platelet Count therapy.
13. D-dimer checks the thrombin and plasmin
Differential and WBC activity
count 14. Fibrin split products (FSP) measures if the
RBC Indices (MCV, level is high because it results to FDP
MCH, MCHC, RDW) fragments.
15. Fibrogen tests are performed to check any
Coagulation – part of Activated Partial fibrogen deficiency.
hematology, ability to Thromboplastin Time 16. Prothrombin Time (PT) or International
form and dissolve clots (APTT) Normalized Ratio (INR) evaluates liver
diseases or deficiency in Vitamin K
D-Dimer test
Fibrin split products
Fibrinogen Tests
Prothrombin time

1. Hematocrit (Hct) checks the hemoglobin

level and the red cell count.
2. Hemoglobin (Hgb) tests the value to rule
out anemia.
3. Red Blood Cell (RbC) count is used to
measure the erythropoietic activity.
4. White Blood Cell (WbC) count checks the
leukocyte response
5. Platelet (Plt ct) count usually used to
monitor chemotherapy and radiation
conditions.
6. Differential White Count (Diff) monitors
changes in the appearance or quantity of
specific cell types
7. Indices shows the changes in RBC size,
weight and Hgb content
 Test Procedures 3. Alkaline phosphatase (ALP) determines
Clinical level to check obstructions and bone
Area disease.
4. Ammonia measures the level which could
Clincal Alanine Alphafetoprotein indicate cirrhosis and hepatitis.
Chemistr aminotransferase (AFP) 5. Amylase checks the enzyme level which
y– (ALT) could indicate liver disease, cholesystitis,
amounts etc.
Alkaline Ammonia
of certain 6. Aspartate amino-transferase (AST)
phosphatase
chemicals measures the level which is indicative of
(ALP)
in the liver dysfunction.
blood Amylase Aspartate 7. Bilirubin shows the level in the bloodstream
sample aminotransferas that shows red blood destruction
e (AST) 8. Blood Gases (ABG) evaluates acid-base
balance by measuring the pH, partial
Bilirubin tests Arterial Blood
pressure of the carbon dioxide and oxygen.
Gas (ABG)
9. Blood Urea Nitrogen (BUN) checks
Blood Urea B-Natriuretic elevated levels which leads to impaired
nitrogen (BUN) peptide (BNP) renal function.
10. B-type natriuretic peptide (BNP) is a
C-Reactive Carcinoembryoni cardiac marker for congestive heart failure.
protein (CRP) c Antigen (CEA) 11. C-reactive protein High sensitivity (hs-CRP)
Blood Calcium Cholesterol detects low level of CRP
12. Carcinoembryonic antigen (CEA) is used
Cortisol Creatine Kinase for early detection of malignancy in
colorectal cancer.
Creatinine Drug Analysis
13. Calcium is used for monitoring effects of
Electrolytes Glucose the renal failure.
14. Cholesterol (total) indicates risk of
Gamma Hemoglobin A1C
cardiovascular diseases.
glutamyltransferas
15. Cortisol shows adrenal hypofunction and
e (GGT)
hyperfunction.
Lactate Lipase 16. Creatine Kinase (CK) used to check
Dehydrogenase muscle damage.
(LD) 17. Creatinine checks for cases that indicate
renal impairment or muscular dystrophy.
Prostate Specific Total Protein 18. Drug Analysis monitors therapeutic range
Antigen (PSA) to avoid toxic levels for drugs.
Triglycerides Troponin 19. Electrolytes (sodium, potassium, chloride,
CO2) shows the sodium values that
Uric Acid Vitamin level determines disorder of the kidney and
tests adrenals.
20. Glucose is used to check diabetic
1. Alanine amino tranferase (ALT) is used to problems, liver disease or malnutrition
monitor liver disease. 21. Gamma-glutamyl transferase (GGT) is
2. Alpha-fetoprotein (AFP) checks levels used for diagnosis of liver specifically
especially for prenatal screening hepatobiliary problems.
 22. Hemoglobin A1C determines the
Glycohemoglobin level that shows the 1. Bacterial Studies
diabetic control over the past months.  Antinuclear antibody (ANA) shows
23. Lactate dehydrogenase checks lung, autoimmune disorders such as systematic
kidney and liver dysfunction. lupus erythematosus
24. Lipase shows the level that could lead to  Antistreptolysin O (ASO) titer indicates
pancreatitis, pancreatic carcinoma streptococcal infection
25. Prostate specific antigen is a test that  Cold agglutinins checks cases of atypical
screens patients for presence of prostate pneumonia
cancer.  Febrile agglutinins shows presence of
26. Total Protein used to check liver and kidney antibodies to specific organisms
disorders.  FTA-ABS confirms syphilis
27. Triglycerides serves as index to evaluation  Rapid plasma reagin (RPR) when positive
of atherosclerosis and lipid metabolism it is indicative of syphilis but it needs
disorder. confirmation
28. Troponin-I used for early diagnosis of small  Rheumatoid factor (RF) indicates
myocardial infarcts. rheumatoid arthritis
29. Uric Acid tests are used to check levels that
indicates gout and renal problems.
30. Vitamin B12 and folate tests are done to
check for anemia and diseases of the small
intestine.

Clinical Area Test Procedures

Serology/Immunology - serum and autoimmune reactions to Bacterial Studies
blood
 Antinuclear antibody
 Antistreptolysin O
 Cold Agglutinins
 Febrile Agglutination tests
 FTA-ABS
 Rapid Plasma Reagin
 Rheumatoid factor
Viral Studies
 Anti-HIV
 Cytomegalovirus Antibody
 Epstein-Barr Virus
 Hepatitis B surface antigen
(HBsAg)
General Studies
 CRP
 Human Chorionic Gonadotropin
2. Viral Studies
  Anti-HIV screens Human immunodeficiency  Specific Gravity suggests renal tubular
virus involvement or ADH deficiency
 Cytomegalovirus antibody (CMV) is a
confirmation test 2. Chemical Evaluation
 Epstein-Barr Virus checks for presence of  Blood - Hematuria could be due to
heterophil antibody which indicates hemorrhage, infection or trauma
infectious mononucleisis  Bilirubin - helps differentiate between
 Hepatitis B surface antigen checks for obstructive and hemolytic jaundice
presence of hepatitis entigen in the surface  Glucose - Glucosuria maybe a result of
of the red cells. diabetis melitus, renal impairments
 Ketones - uncontrolled diabetes mellitus or
3. General Studies starvation
 C-reactive protein (CRP) indicates
inflammation when levels are increased
 Human chorionic gonadotropin (HCG) tests
are present when patient is pregnant
Clinical Area Test Procedures

Clinical Physical Evaluation Other Body Fluid Analysis

Microscopy – test  Color  Stool
urine and other  Clarity  Cerebrospinal Fluid (CSF)
body fluid  Specific Gravity  Synovial fluid
specimen  Amniotic fluid
Chemical Evaluation
 Gastric fluid
 Blood
 Peritoneal fluid
 Bilirubin
 Pleural fluid
 Glucose
 Pericardial fluid
 Ketones
 Semen
 Leukocyte
 Sweat
 pH
 Vaginal secretions
 Protein
 Sputum
 Nitrite
 Urobilinogen

Microscopic Evaluation

URINALYSIS – tests urine specimens  Leukocyte - indicates urinary tract infection

if there is a lot of neutrophils
1. Physical Evaluation  pH - indicates in acid-base balance
 Color indicates presence of blood melanin,
 Protein - Proteinura is an indicateor of renal
bilirubin or urobilin in the urine specimen dysfunction or disorder
 Clarity shows presence of fat, chyle
 Nitrite - positive results could mean
bacteria which affects the turbidity bacterial infection
 Urolibinogen - increases in amount when
patient suffers from hepatitic issues

3. Microscopic Evaluation
 shows the status of the urinary tract,
hematuria, pyuria, etc.
MICROBIOLOGY – micro organisms in body body fluids and tissues Blood Culture
fluids or tissues
Culture and
1. Acid-fast bacili (AFB) is used to monitor Sensitivity
treatment for TB
2. Blood culture checks presence of bacteria Fungus Culture and
which indicates bacteremia or septicemia Identification
3. Culture & Sensitivity (C&S) indicates
infection if there is growth in the pathogenic Gram staining
microorganism
4. Fungus culture and identification - used to Ova and Parasites
determine the type fungi if present
5. Gram stain - done to allow antimicrobial Blood Bank/ Antibody Screen
therapy while waiting for culture results
6. Ova and parasites - solves "etiology Immunohematology –
Direct Antihuman
unknown" intestinal disorders transfusion and blood
Globulin test
components.
Blood bank/immunohematology - blood for
ABO and Rh Typing
transfusion

1. Antibody (Ab) screen - agglutination means Type and

presence of abnormal antibodies in the Crossmatching
blood
2. Direct antihuman globulin test (DAT) Compatibility testing
determines transfusion incompatibility
3. Type and RH - shows the blood group
(ABO) and type (Rh) The STAT Lab and Reference Lab
 Stat labs
4. Type and crossmatch shows the blood
o Established in the emergency
group and screens for antibodies in the
recipient's blood room
 Reference laboratory
5. Compatibility testing - detects antibodies
o Large independent laboratory that
and antigen in both recipient's and donor's
blood receives specimen from many
facilities in the area.
o Provide routine and specialized
analysis of the specimen
o Offer fast turnaround time and
reduced cost

Clinical Area Test Procedures

Microbiology – microorganism in Acid Fast Bacilli