L1 Understanding Phlebotomy

• phlebotomy is the process of collecting blood through the vein by using incision or puncture methods.
• phlebotomy is derived from Greek words:

  phlebos - vein

  temnein - to cut

  otomy - incision
• phlebotomy is the act or practice of bloodletting as therapeutic measure
• the practice of phlebotomy can be traced back to the Stone Age.
• ancient Egyptians practiced phlebotomy as a form of bloodletting as early as 1400 BC.
• hippocrates believed on the four humors:

  1. earth - blood and brain
  2. air - phlegm and lungs
  3. fire - black bile and spleen
  4. water - yellow bile and gall bladder
• during middle ages, barber-surgeons performed bloodletting as part of the treatment for some illnesses. it was only 17th and 18th centuries when it was treated as a major therapy.
• cupping and leeching were performed using lancets and fleams.
• venesection - elimination of "bad blood". reduced fever or to produce faint in delivery of babies.
• two historical methods: venesection and cupping
• leeching is also known as hirudotherapy
• haemophagic - blood suckers
• leeches

  • to remove excess blood
  • to relieve pain and pressure as blood pools in an area
  • they get full rapidly
• blood is not just used to cure but to find the cure
• phlebotomy came from being therapeutic to diagnostic purposes.
• main goals of the phlebotomy practice:

  1. for diagnosis and treatment
  2. for transfusion, to remove blood from donor
  3. for removal of blood for polycythemia
• two main methods used in phlebotomy:

  1. venipuncture - blood collection using needle in vein
  2. capillary puncture - puncturing the skin
• primary role of phlebotomists is blood collection
• role of phlebotomists:

  • venipuncture
  • capillary collection
  • patient care
  • receptionist duties
  • sample processing
  • computer work
  • represent laboratory
  • typical work duty/day: in patient and out patient
• lipemic sample (milky colored) - after eating/patients with high cholesterol
• hemolyzed sample (Reddish) - traumatic collection that caused lysis of red blood cells
• traits of phlebotomist:

  • professionalism
  • prevent hurried manner
• dress code:

  • No visible tattoos
  • No T-shirts/sweatshirts
  • No open-toed shoes
  • No blue jeans/ casual attire : scrub suits
  • No fingernails longer than ¼ of an inch
  • No body piercing (max of 2)
• histologic technician - degree in histology with 1 year experience in histopathology
• cytotechnologist - degree with 12 months accredited cytotechnology program
• pathologist - physician and specialized in pathology aka "physician's physician": consultants of physicians
• inpatient - non ambulatory - requires patient to stay in the hospital

  outpatient - patients served by secondary care specialists
• primary level - refers to health units in the rural areas and sub-units which are operated by DOH.
• secondary level - refers to non departmentalized hospitals that attend to patients.
• tertiary level - refers to medical centers and large hospitals where services are sophisticated coupled with highly technical facilities.
• ambulatory care - medical care given to outpatients or patients requiring care or follow up check ups after their discharge.
• homebound services - refers to procedures, tests, and services provided to a patient which are done in a patient's home.
• public health services - belong to the unit at the local level but are still under the jurisdiction of the health department.
• three phases of sample testing (CLSI's accuracy in patient and sample identification)

  1. pre-examination
  2. examination
  3. post examination
• main goal: to get results on the patient's condition to the physician.
• pre-examination:

  • Collection of sample for testing to occur
  • Collection
  • Correct primary sample ID
  • Correct use of equipment
  • Centrifugation
  • Aliquoting
  • Sample integrity maintenance
  • ID and information
  • Request
• examination

  • performance of test to achieve the test result
  • sample testing
  • maintaining testing equipment and reagents
• post examination

  • Results communicated to physician
  • Storage of samples
  • Follow up for repeat testing or address physician concerns
  • Accuracy and reliability
  • Reporting
• hematology - blood and blood forming tissues
• coagulation - ability of blood to from and dissolve clots