[LEC] Understanding Phlebotomy

• Phlebotomy - Process of Collecting blood through Vein by using incision or puncture method to draw blood for analysis or as part THERAPEUTIC or DIAGNOSTIC measures under the physician's request

• Phlebotomy came from Greek words:

  • phlebos - vein
  • temnein - to cut
• Phlebotomy is also called as venesection
• Venesection comes from Latin words:

  • Vena - vein
  • Sectio - cutting
• Back in the stone age, crude tools are used to cut vessels and drain blood from the body.
• In 1400 B.C., ancient Egyptians also practiced phlebotomy as form of "bloodletting"
• Hirudo medicinalis - Medical leeches used for blood letting
• The Greek Physician Hippocrates believed that a person's health depend on the balance of four humors:

  • Earth - blood and brain
  • Air - phlegm and lungs
  • Fire - black bile and spleen
  • Water - Yellow bile and gall bladder
• In the middle ages, blood letting was performed by barber-surgeons as part of the treatment for some illnesses.
• Cupping and leeching was performed by phlebotomists using lancets and fleams
• Cupping is an alternative medicine that helps ease the pain, inflammation, or other health-related concerns. It is the application of special heated suction cups on the patient's skin and the incision that is made using a fleam (lancet) which is previously wiped with a rag.
• The other term for leeching is hirudotheraphy
• Hirudotheraphy or leeching is the process of utilizing leeches for blood letting and is currently used for microsurgical replantation. The process involved placing a drop of milk or blood on the patient's skin and introducing Hirudo medicinalis to the site, allowing it to engage and fall off.
• Hirudo medicinalis are used because it is believed that leeches inject a local vasodilator, anesthetic, and hirudin (anticoagulant).
• Phlebotomy was treated as a major therapy during the 17th and 18th Centuries
• Main Goals of Phlebotomy

  1. For diagnosis and treatment using blood samples
  2. For transfusion, to remove blood from the donor, and
  3. For removal of blood for polycythemia or therapeutic purposes.
• 2 main methods of phlebotomy

  1. Venipuncture
  2. Capillary Puncture
• Venipuncture is the method of collection of blood through the vein using a needle
• Capillary puncture is the process where blood is collected by puncturing the skin using a lancet
• Traits that form the professional image of the phlebotomists:

  • good manual dexterity
  • special communication skills
  • good organizational skills
  • Thorough knowledge of laboratory specimen requirements
  • Training in phlebotomy skills couples with standard practice
• Credentials of phlebotomists

  • Official recognition
  • Continuing education
  • Attend trainings and seminars
• Non verbal communication:

  kinesics

  proxemics

  appearance

  touch
• kinesics - body motion and language
• proxemics - individual's concept and use of space
• appearance - attire
• touch - thoughtful expression
• inpatient (Non-ambulatory) - requires patient to stay in the hospital for at least one night to be served by tertiary care practitioners
• Outpatient - patients are served by secondary care specialists on the same day
• 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 the symptomatic stages 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.
• Ambulatory care is medical care given to outpatients or patients requiring requiring care or follow-up check-ups after their discharge from the hospital, which can be a freestanding medical care setting and hospital-owned clinics, or in the outpatient departments and urgent care facilities.
• Homebound services refer 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 which are offered with little to no charge at all.
• A hospital is an institution that has permanent inpatient beds with 24-hour nursing service along with therapeutic and diagnostic services managed by organized medical staff or personnel.
• 2 major divisions of a hospitals:

  • anatomical and surgical pathology area
  • clinical analysis area
• The anatomical and surgical pathology area handles tests that are related to histology (microscopic structures of tissues), cytology (structures of cells), and cytogenetics (chromosomal deficiencies and genetic disease).
• Areas under clinical analysis area

  • Hematology
  • Coagulation
  • Chemistry
  • Serology/Immunology
  • Urinalysis
  • Microbiology
  • Blood bank/Immunohematology
• Hematology - blood and blood forming tissues
• Coagulation - ability of blood to form and dissolve clots