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Lesson 1: Introduction to Phlebotomy

Reminders: Cupping
• Supplemental handouts for Principles in • alternative medicine
Medical Laboratory Science 2 • application of special heated suction cups
• Refer to your discussion and references on the patient's skin
for the full context of the information • incision using a fleam or lancet
here.
• You are not allowed to distribute, share, Leeching
or reveal to anyone, the contents of the • known as Hirudotherapy
handouts. • uses leeches for bloodletting
• Remember to act ethically and uphold • used for microsurgical replantation
the core values of National University -
MOA. Phlebotomist
• obtain samples of blood for testing;
Lesson 1 collect blood from donors for those in
need of blood transfusions, sometimes
Introduction to Phlebotomy
handle other types of specimens, such as
urine, sputum, stool, and hair
Phlebotomy
• Centralized
• Also known as venesection act of opening
• Decentralized
a vein by using incision or puncture
• Hybrid phlebotomy
methods to draw blood for analysis or as
part of therapeutic or diagnostic
Role of Phlebotomist
measures under the physician's request
• For diagnosis and treatment using blood
o phlebos which means vein, and
samples
o temnein which means to cut
• For transfusion, to remove blood at the
donor center
Evolution of Phlebotomy
• For removal of blood for polycythemia or
• Stone Age - used crude tools to cut
therapeutic purposes
vessels and drain blood from the body
• Ancient Egyptians (1400 B.C.) - a
Credentials:
form of "Bloodletting"
1. Certification
• Hippocrates (460 - 377 B.C.) -
2. Licensure
balance of the four humors, removing the
3. Continuing Education
excess by bloodletting
• Middle ages – used to treat illness and
Patient - Client Interaction
performed by barber-surgeons
• Reassuring and pleasant
• 17th and 18th century – treated as
• Able to communicate well
major therapy
• Maintain positive customer relations

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• Understand the diversity of the patients •Laboratory

and be able to adjust accordingly •Environmental services
•Administration
Qualities of Professionalism •Food service
(1) Professional appearance •Medical records
(2) Self-confidence
(3) Integrity Phases of Sample Testing
(4) Compassion 1. Pre-Examination Phase
(5) Self-motivation 2. Examination Phase
(6) Dependability 3. Post-Examination Phase
(7) Ethical Behavior
Pre-Examination Phase
Communication in the Healthcare Setting • Previously known as pre-analytical
1. Verbal phase
2. Nonverbal • Includes all processes from collecting the
3. Active Listening sample to having it ready for testing e.g.:
• Clinician’s request
Elements in the Healthcare • Patient identification and information
Communication • Correct sample collection
• Empathy • Correct primary sample identification
• Control • Correct use of all equipment
• Respect • Sample preparation or centrifugation
• Confirmation • Proper preparation of sample aliquots
• Trust • Maintaining sample integrity

Examination Phase
• Previously known as analytical phase
• Includes all processes done to sample to
achieve result
• Sample testing
• Maintaining testing equipment
• Maintaining reagents

Post-Examination Phase
• Previously known as postanalytical
phase
• Process in which the results of the testing
Areas of the Hospital
are communicated to the health care
•Electrocardiology (EKG)
provider or physician
•Electroencephalography (EEG)
• Reporting of results
•Radiology
• Ensuring accuracy and reliability of
•Pharmacy
delivery of results
•Physical therapy
• Follow-up to repeat testing or address
•Occupational therapy
physician’s concerns
•Nursing
• Storage of sample after the examination
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A hospital is an establishment that has oMean Corpuscular hemoglobin

permanent inpatient beds with 24-hour nursing concentration (MCHC) - gives
service along with therapeutic & diagnostic information on the concentration of
services managed by organized medical staff or the hemoglobin per unit volume of
personnel. It houses the clinical laboratory RBCs.
services (clinical laboratory) where tests • Red blood distribution width (RDW) -
requested by physicians are performed. measures the size differences of the RBCs

Two Major Divisions: • Coagulation

• Anatomical and Surgical Pathology Area • ability of blood to form and dissolve
• Clinical Analysis Area clots

Clinical Analysis Areas • Activated partial thromboplastin time

1. Hematology (APPT) - reflects the adequacy of herapin
2. Coagulation therapy.
3. Chemistry • D-dimer checks the thrombin and plasmin
4. Serology activity
5. Urinalysis • Fibrin split products (FSP) measures if
6. Microbiology the level is high because it results to FDP
7. Blood bank/Immunohematology fragments.
• Fibrogen tests are performed to check any
• Hematology fibrogen deficiency.
- blood & blood forming tissues • Prothrombin Time (PT) with
International Normalized Ratio (INR)
• Hematocrit (Hct) - checks the hemoglobin evaluates liver diseases or deficiency in
level and the red cell count. Vitamin K
• Hemoglobin (Hgb) - tests the value to rule
out anemia. • Chemistry
• Red Blood Cell (RBC) count - used to • performs most lab test for plasma,
measure the erythropoietic activity. serum, urine, etc.
• White Blood Cell (WBC) count - checks
the leukocyte response • Alanine amino tranferase (ALT)
• Platelet (Plt ct) count - used to monitor o used to monitor liver disease.
chemotherapy and radiation conditions. • Alpha-fetoprotein (AFP)
• Differential White Count (Diff) - o checks levels especially for prenatal
monitors changes in the appearance or screening
quantity of specific cell types • Alkaline phosphatase (ALP)
• Indices - shows the changes in RBC size, o determines level to check
weight and Hgb content obstructions and bone disease.
o Mean Corpuscular hemoglobin • Ammonia
(MCH)- gives the weight of the o measures the level which could
hemoglobin in the cell. indicate cirrhosis and hepatitis.
o Mean Corpuscular volume (MCV)
shows the size of the cell.

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• Amylase - checks the enzyme level which • Lactate dehydrogenase

could indicate liver disease, cholesystitis, o checks lung, kidney and liver
etc. dysfunction.
• Lipase
• Aspartate Amino-Transferase (AST) o shows the level that could lead to
o measures the level which is indicative pancreatitis, pancreatic carcinoma
of liver dysfunction. • Prostate specific antigen
• Bilirubin o a test that screens patients for
o shows the level in the bloodstream presence of prostate cancer.
that shows red blood destruction • Total Protein
• Blood Gases (ABG) o used to check liver and kidney
o evaluates acid-base balance by disorders.
measuring the pH, partial pressure of • Triglycerides
the carbon dioxide and oxygen. o serves as index to evaluation of
• Blood Urea Nitrogen (BUN) atherosclerosis and lipid metabolism
o checks elevated levels which leads to disorder.
impaired renal function. • Troponin-I
• B-type Natriuretic Peptide (BNP) o used for early diagnosis of small
o a cardiac marker for congestive heart myocardial infarcts.
failure • Uric Acid tests
• Creatine Kinase (CK) o used to check levels that indicates
o used to check muscle damage. gout and renal problems.
• Creatinine • Vitamin B12 and folate tests
o checks for cases that indicate renal o done to check for anemia and
impairment or muscular dystrophy. diseases of the small intestine.
• Drug Analysis
o monitors therapeutic range to avoid • Immunology/Serology
toxic levels for drugs. • serum and autoimmune reactions
• Electrolytes (sodium, potassium,
chloride, CO2) 1. Bacterial Studies
o shows the sodium values that • Antinuclear antibody (ANA) shows
determines disorder of the kidney and autoimmune disorders such as
adrenals. systematic lupus erythematosus
• Glucose • Antistreptolysin O (ASO) titer
o used to check diabetic problems, liver indicates streptococcal infection
disease or malnutrition • Cold agglutinins checks cases of
• Gamma-glutamyl transferase (GGT) atypical pneumonia
o used for diagnosis of liver specifically • Febrile agglutinins shows presence of
hepatobiliary problems. antibodies to specific organisms
• Hemoglobin A1C • FTA-ABS confirms syphilis
o determines the Glycohemoglobin • Rapid plasma reagin (RPR) when
level that shows the diabetic control positive it is indicative of syphilis but it
over the past months. needs confirmation
• Rheumatoid factor (RF) indicates
rheumatoid arthritis
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2.Viral Studies • Nitrite - positive results could mean

• Anti-HIV screens Human bacterial infection
immunodeficiency virus • Urolibinogen - increases in amount
• Cytomegalovirus antibody (CMV) is when patient suffers from hepatic issues
a confirmation test
• Epstein-Barr Virus (EBV) checks for 3. Microscopic Evaluation
presence of heterophil antibody which • shows the status of the urinary tract,
indicates infectious mononucleosis hematuria, pyuria, etc.
• Hepatitis B surface antigen (HBsAg)
checks for presence of hepatitis entigen • Microbiology
in the surface of the red cells • microorganisms in body fluids or
3.General Studies tissues
• C-reactive protein (CRP) indicates
inflammation when levels are increased • Acid-fast bacili (AFB) is used to monitor
• Human chorionic gonadotropin treatment for TB
(HCG) tests are present when patient is • Blood culture checks presence of bacteria
pregnant which indicates bacteremia or septicemia
• CLO test shows presence of Helicobacter
• Urinalysis pylori
• test urine specimens • Culture & Sensitivity (C&S) indicates
infection if there is growth in the pathogenic
1. Physical Evaluation microorganism
• Color indicates presence of blood • Fungus culture and identification - used
melanin, bilirubin or urobilin in the urine to determine the type fungi if present
specimen • Gram stain - done to allow antimicrobial
• Clarity shows presence of fat, chyle therapy while waiting for culture results
bacteria which affects the turbidity • Occult blood - checks for blood in the stool
• Specific Gravity suggests renal tubular which could result from gastrointestinal
involvement or ADH deficiency bleeding
• Ova and parasites - solves "etiology
2.Chemical Evaluation unknown" intestinal disorders
• Blood - Hematuria could be due to
hemorrhage, infection or trauma • Bloodbank/Immunohematology
• Bilirubin - helps differentiate between • blood for transfusion
obstructive and hemolytic jaundice
• Glucose - Glucosuria maybe a result of • Antibody (Ab) screen - agglutination
diabetis melitus, renal impairments means presence of abnormal antibodies
• Ketones - uncontrolled diabetes mellitus in the blood
or starvation • Direct antihuman globulin test
• Leukocyte - indicates urinary tract (DAT) determines transfusion
infection if there is a lot of neutrophils incompatibility
• pH - indicates in acid-base balance • Type and RH - shows the blood group
• Protein - Proteinura is an indicateor of (ABO) and type (Rh)
renal dysfunction or disorder

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• Type and crossmatch shows the blood

group and screens for antibodies in the
recipient's blood
• Compatibility testing - detects
antibodies and antigen in both recipient's
and donor's blood

Stat Labs
• Established in the emergency room

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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