UNDERSTANDING PHLEBOTOMY

LEARNING OUTCOMES
• At the end of this lesson, the students must be able to:
1. Describe the evolution of phlebotomy and the role of
the phlebotomists in today’s healthcare setting;
2. Discuss the traits that form the professional image of
the phlebotomists;
3. Explain the basic concepts of communication as they
relate to the healthcare setting;
4. Distinguish the different types of healthcare settings;
and
5. Enumerate the clinical analysis areas of the laboratory
and the various types of laboratory procedures
performed in the respective areas.
PHLEBOTOMY or venesection act of opening a vein by
using incision or puncture methods to draw blood for
analysis or as part of therapeutic or diagnostic measures
under the physician's request.
▪ phlebos which means vein, and
▪ temnein which means to cut.
Evolution of Phlebotomy
▪ Stone Age - used crude tools to cut vessels and drain
blood from the body.
▪ Ancient Egyptians - a form of "Bloodletting" (1400 B.C.)
▪ Hippocrates (460 - 377 BC - balance of the four humors,
removing the excess by bloodletting.
▪ Middle ages – used to treat illness and performed by
barber-surgeons
▪ 17th and 18th century – treated as major therapy
Cupping
▪ alternative medicine
▪ application of special heated suction cups on the
patient's skin
▪ incision using a fleam or lancet
Leeching
▪ known as Hirudotherapy
▪ uses leeches for bloodletting
▪ used for microsurgical replantation
Main goals of phlebotomy practice:
(1) for diagnosis and treatment using blood samples
(2) for transfusion, to remove blood at the donor center
(3) for removal of blood for polycythemia or therapeutic
purposes
Credentials
✓ Certification
✓ Licensure
✓ Continuing education
ROLE OF PHLEBOTOMISTS
• Collect blood samples for laboratory testing or for
transfusion.
• Deliver or transport collected samples within
appropriate prescribed time limits.
• Process collected blood samples such as centrifuging
and aliquoting samples ready for laboratory testing.
• They are asked to assist in collecting other specimens
such as urine and other non-blood samples from
patients.
• Main players in blood letting activities such as drawing
of blood units from donors for transfusion to a patient
requiring whole blood or blood components
GOOD MANUAL DEXTERITY, SPECIAL COMMUNICATION SKILLS, GOOD
ORGANIZATIONAL SKILLS, THOROUGH KNOWLEDGE OF LABORATORY
SPECIMEN REQUIREMENTS, AND THE TRAINING IN PHLEBOTOMY SKILLS
COUPLED WITH STANDARD PRACTICE.

TRAITS THAT FORM THE PROFESSIONAL

IMAGE OF THE PHLEBOTOMISTS
Credentials
✓ Certification
✓ Licensure
✓ Continuing education
Patient – Client Interaction
(1) Reassuring and pleasant
(2) Able to communicate well
(3) Maintain positive customer relations
(4) Understand the diversity of the patients and be able
to adjust accordingly
Qualities of Professionalism
(1) Professional appearance
(2) Self-confidence
(3) Integrity
(4) Compassion
(5) Self-motivation
(6) Dependability
(7) Ethical Behavior
Communication in the healthcare setting
o Verbal Communication
o Nonverbal Communication
o Active listening

Elements in healthcare communication

✓ Empathy ✓ Confirmation
✓ Control ✓ Trust
✓ Respect
Figure 1.3 Verbal Communication Loop in Health care setting
THE HEALTHCARE SETTING
CATEGORIES OF HEALTHCARE
FACILITIES
1. INPATIENT (NON-AMBULATORY)- requires
patients to stay in the hospital for at least one
night to be serviced by tertiary care
practitioners.
2. OUTPATIENT- patients are served by
secondary care specialists on the same day.
LEVELS OF HEALTHCARE
• PRIMARY LEVEL- refers to health units in the rural
areas and sub-units which are operated by the
Department of Health.
• SECONDARY LEVEL- refers to non-
departmentalized hospitals that attend to
patients during symptomatic stage of an ailment.
• TERTIARY LEVEL- refers to medical centers and
large hospitals where services are sophisticated
coupled with highly technical facilities that can
address serious diseases.
OTHER HEALTHCARE SERVICES
• AMBULATORY CARE- medical care given to outpatients or
patients requiring care or follow-up check-ups after their
discharge from the hospital, which can be freestanding
medical care setting and hospital-owned clinics, or in
outpatient departments and urgent care facilities.
• HOMEBOUND SERVICES- refers to procedures, tests, and
services provided to a patient which are done in a patient’s
home or in a long-term facility.
• PUBLIC HEALTH SERVICES- belong to the unit at the local
level but are still under the jurisdiction of the health
department of the government. Services are offered with
little or no charge at all.
Clinical analysis areas and the types of procedures
Hospital
• with permanent inpatient beds
• 24-hour nursing service
• Managed by organized medical team
• houses the clinical laboratory services (clinical lab) where tests
requested by physicians are performed
2 major divisions
1) Anatomical and Surgical Pathology area
2) Clinical analysis area
Clinical analysis areas
1. Hematology
2. Coagulation
3. Chemistry
4. Serology
5. Urinalysis
6. Microbiology
7. Blood bank/immunohematology
HEMATOLOGY – blood and blood forming tissues
NAME OF TEST AND PROCEDURES
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
8. Mean Corpuscular hemoglobin (MCH) gives the weight of the hemoglobin in the
cell.
9. Mean Corpuscular volume (MCV) shows the size of the cell.
10. Mean Corpuscular hemoglobin concentration (MCHC) gives information on the
concentration of the hemoglobin per unit volume of RBCs.
11. Red blood distribution width (RDW) measures the size differences of the RBCs
COAGULATION – ability of blood to form and dissolve clots

NAME OF TEST AND PROCEDURES

1. Activated partial thromboplastin time (APPT) reflects the adequacy of

herapin therapy.
2. D-dimer checks the thrombin and plasmin activity
3. Fibrin split products (FSP) measures if the level is high because it results to
FDP fragments.
4. Fibrogen tests are performed to check any fibrogen deficiency.
5. Prothrombin Time (PT) or International Normalized Ratio (INR) evaluates
liver diseases or deficiency in Vitamin K
CHEMISTRY – performs most lab test for plasma, white blood, urine, etc.

NAME OF TEST AND PROCEDURES

1. Alanine amino tranferase (ALT) is used to monitor liver disease.
2. Alpha-fetoprotein (AFP) checks levels especially for prenatal screening
3. Alkaline phosphatase (ALP) determines level to check obstructions and
bone disease.
4. Ammonia measures the level which could indicate cirrhosis and hepatitis.
5. Amylase checks the enzyme level which could indicate liver disease,
cholesystitis, etc.
6. Aspartate amino-transferase (AST) measures the level which is indicative of
liver dysfunction.
7. Bilirubin shows the level in the bloodstream that shows red blood
destruction
8. Blood Gases (ABG) evaluates acid-base balance by measuring the pH,
partial pressure of the carbon dioxide and oxygen.
9. Blood Urea Nitrogen (BUN) checks elevated levels which leads to impaired
renal function.
10. B-type natriuretic peptide (BNP) is a cardiac marker for congestive heart
failure.
CHEMISTRY Continuation…

NAME OF TEST AND PROCEDURES

11. C-reactive protein High sensitivity (hs-CRP) detects low level of CRP
12. Carcinoembryonic antigen (CEA) is used for early detection of malignancy
in colorectal cancer.
13. Calcium is used for monitoring effects of the renal failure.
14. Cholesterol (total) indicates risk of cardiovascular diseases.
15. Cortisol shows adrenal hypofunction and hyperfunction.
16. Creatine Kinase (CK) used to check muscle damage.
17. Creatinine checks for cases that indicate renal impairment or muscular
dystrophy.
18. Drug Analysis monitors therapeutic range to avoid toxic levels for drugs.
19. Electrolytes (sodium, potassium, chloride, CO2) shows the sodium values
that determines disorder of the kidney and adrenals.
20. Glucose is used to check diabetic problems, liver disease or malnutrition.
CHEMISTRY Continuation…

NAME OF TEST AND PROCEDURES

21. Gamma-glutamyl transferase (GGT) is used for diagnosis of liver specifically

hepatobiliary problems.
22. Hemoglobin A1C determines the Glycohemoglobin level that shows the
diabetic control over the past months.
23. Lactate dehydrogenase checks lung, kidney and liver dysfunction.
24. Lipase shows the level that could lead to pancreatitis, pancreatic carcinoma
25. Prostate specific antigen is a test that screens patients for presence of
prostate cancer.
26. Total Protein used to check liver and kidney disorders.
27. Triglycerides serves as index to evaluation of atherosclerosis and lipid
metabolism disorder.
28. Troponin-I used for early diagnosis of small myocardial infarcts.
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.
SEROLOGY/IMMUNOLOGY – serum and autoimmune reactions

NAME OF TEST AND PROCEDURES

1. Bacterial Studies
▪ Antinuclear antibody (ANA) shows autoimmune disorders such as systematic lupus
erythematosus
▪ Antistreptolysin O (ASO) titer indicates streptococcal infection
▪ Cold agglutinins checks cases of atypical pneumonia
▪ Febrile agglutinins shows presence of antibodies to specific organisms
▪ FTA-ABS confirms syphilis
▪ Rapid plasma reagin (RPR) when positive it is indicative of syphilis but it needs
confirmation
▪ Rheumatoid factor (RF) indicates rheumatoid arthritis
2. Viral Studies
▪ Anti-HIV screens Human immunodeficiency virus
▪ Cytomegalovirus antibody (CMV) is a confirmation test
▪ Epstein-Barr Virus checks for presence of heterophil antibody which indicates
infectious mononucleisis
▪ Hepatitis B surface antigen checks for presence of hepatitis entigen in the surface
of the red cells.
3. General Studies
▪ C-reactive protein (CRP) indicates inflammation when levels are increased
▪ Human chorionic gonadotropin (HCG) tests are present when patient is pregnant
URINALYSIS – tests urine specimens

NAME OF TEST AND PROCEDURES

1. Physical Evaluation
▪ Color indicates presence of blood melanin, bilirubin or urobilin in the urine
specimen
▪ Clarity shows presence of fat, chyle bacteria which affects the turbidity
▪ Specific Gravity suggests renal tubular involvement or ADH deficiency
2. Chemical Evaluation
▪ Blood - Hematuria could be due to hemorrhage, infection or trauma
▪ Bilirubin - helps differentiate between obstructive and hemolytic jaundice
▪ Glucose - Glucosuria maybe a result of diabetis melitus, renal impairments
▪ Ketones - uncontrolled diabetes mellitus or starvation
▪ Leukocyte - indicates urinary tract infection if there is a lot of neutrophils
▪ pH - indicates in acid-base balance
▪ Protein - Proteinura is an indicateor of renal dysfunction or disorder
▪ Nitrite - positive results could mean 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 fluids or tissues

NAME OF TEST AND PROCEDURES

1. Acid-fast bacili (AFB) is used to monitor treatment for TB

2. Blood culture checks presence of bacteria which indicates bacteremia or
septicemia
3. CLO test shows presence of Helicobacter pylori
4. Culture & Sensitivity (C&S) indicates infection if there is growth in the
pathogenic microorganism
5. Fungus culture and identification - used to determine the type fungi if
present
6. Gram stain - done to allow antimicrobial therapy while waiting for culture
results
7. Occult blood - checks for blood in the stool which could result from
gastrointestinal bleeding
8. Ova and parasites - solves "etiology unknown" intestinal disorders
BLOOD BANK/IMMUNOHEMATOLOGY – blood transfusion

NAME OF TEST AND PROCEDURES

1. Antibody (Ab) screen - agglutination means presence of abnormal

antibodies in the blood
2. Direct antihuman globulin test (DAT) determines transfusion incompatibility
3. Type and RH - shows the blood group (ABO) and type (Rh)
4. Type and crossmatch shows the blood group and screens for antibodies in
the recipient's blood
5. Compatibility testing - detects antibodies and antigen in both recipient's and
donor's blood
Stat labs
• Established in the emergency room of some tertiary
care facilities, so procedures and test can be done
immediately when needed.
Reference laboratory
• Large independent laboratory that receives specimen
from many facilities in the area.
• Provide routine and specialized analysis of the
specimen
• Offer fast turnaround time and reduced cost
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Clinical Laboratory Areas