Lesson 1 via transes

• Phlebotomy is the process of collecting blood through a vein by using incision or puncture method for analysis or as part of therapeutic or diagnostic measures under the physician's request
• Phlebotomy was derived from two Greek words: Phlebos - vein and Temnein - to cut
• Venesection, also known as phlebotomy, comes from the Latin words Vena - vein and Secto - cutting
• Phlebotomy has evolved over time:

  • Stone age: crude tools used to cut vessels and drain blood from the body
  • 1400 B.C.: ancient Egyptians practiced phlebotomy as a form of "bloodletting"
  • 460-377 BC: Hippocrates believed a person's health depends on the balance of the four humors (Earth, Air, Fire, Water)
  • Middle ages: bloodletting performed by barber-surgeons
  • 17th and 18th centuries: phlebotomy treated as a major therapy
  • Cupping: application of special heated suction cups on the patient's skin
  • Leeching: uses leeches for bloodletting, also used for microsurgical replantation
• Main goals of phlebotomy:

  • For diagnosis and treatment using blood samples
  • For transfusion and removal of blood from the donor
  • For removal of blood for polycythemia or therapeutic purposes
• Two main methods of phlebotomy:

  • Venipuncture: collection of blood through the vein using a needle
  • Capillary puncture: blood collected by puncturing the skin using a lancet
• • Train new technicians and students in duties and responsibilities
• Role of the phlebotomist:

  • Collect blood samples for laboratory testing or transfusion
  • Properly label collected blood samples with necessary data for identification
  • Responsible for delivering or transporting collected samples within appropriate time limits
  • Process collected blood samples such as centrifuging and aliquoting for testing
  • Assist in collecting other specimens like urine and non-blood samples
  • Perform front-office duties, coding, and paperwork
  • Promote good relations with patients and hospital personnel
  • Provide proper instruction to patients for specimen collection
• Traits that form the professional image of the phlebotomist:

  • Good manual dexterity
  • Special communication skills
  • Good organizational skills
  • Thorough knowledge of laboratory specimen requirements
  • Training in phlebotomy skills
• Credentials for a phlebotomist:

  • Certification or license
  • Continuing education
  • Trainings and seminars
• Patient-client interaction:

  • Reassuring and pleasant
  • Good communication with patients
  • Maintain positive customer relations
  • Understand patient's diversity
• Professionalism of a phlebotomist:

  • Professional appearance with conservative clothing and proper personal hygiene
  • Self-confidence in decisions and judgments
  • Integrity derived from honesty and consistency of character
  • Compassion in offering reassurance in a caring way
  • Self-motivation to provide excellence in patient care
  • Dependability in work ethic and taking personal responsibility
  • Ethical behavior following moral principles and standards
• Basic concepts of communication in the healthcare setting:

  • Verbal communication expressing ideas through words
  • Non-verbal communication including facial expressions, kinesics, proxemics, appearance, and touch
  • Active listening
• Levels of healthcare:

  • Inpatient (non-ambulatory): confined inside the hospital, needs immediate treatment
  • Outpatient (ambulatory): walk-in patients for checkups only
  • Three levels of healthcare: primary (health units in rural areas), secondary (non-departmentalized hospitals), tertiary (highly specialized equipment and expertise)
• Other healthcare services:

  • Ambulatory care: medical care for follow-up checkups after discharge
  • Homebound care: care in a patient's home or long-term facility
  • Public health services: local services under the jurisdiction of the government, e.g., free vaccines
• Different clinical analysis areas of the laboratory and types of procedures performed:

  • Hospital with permanent inpatient beds and 24-hour nursing service
  • Clinical Pathology focuses on specimen, clinical chemistry, immunohematology, medical microbiology, immunology, serology, hematology, coagulation, and clinical microscopy
  • Anatomic Pathology focuses on histopathology, immunohistopathology, cytology, autopsy, and forensic pathology
• Sections in the laboratory:

  • Clinical Chemistry: busiest section for testing blood and body fluids, analyzing serum and plasma for chemical constituents
  • Tests performed in Clinical Chemistry include Fasting Blood Sugar, Total Cholesterol, Kidney Function Tests, Liver Function Tests, Electrolytes, B-type natriuretic Peptide, Drug Analysis, Total Protein, Troponin I
  • Microbiology: subdivided into bacteriology, mycobacteriology, mycology, and virology, focused on identifying bacteria and fungi in specimens
• Tests performed in Microbiology:

  • Culture and Sensitivity:
  • Detect microbial infection and determine antibiotic treatment
  • Bacteria will be incubated and different antibiotic treatments will be tested to see effectiveness
  • Blood culture:
  • Detects bacteria and fungi in blood
  • Fungal Culture:
  • Detects the presence of and determines the type of fungi
  • Gram stain:
  • Detects the presence of and aids in the identification of bacteria
  • Gram negative: pink to red
  • Gram positive: purple
• • Mean corpuscular hemoglobin concentration:
  • Determines the weight of hemoglobin in RBC and compares it with the size of the cell
  • Mean corpuscular volume:
  • Determines the size of RBC
  • Platelet count:
  • Determines the number of platelets in circulating blood
  • Decreases if the patient has bleeding
  • Red blood cell count:
  • Determines the number of RBC in circulating blood
  • Red blood cell distribution width:
  • Calculation to determine the differences in the size of RBC
  • White blood cell count:
  • Determines the number of WBC in circulating blood
  • Body fluid analysis:
• • Determines the number and type of cells in bone marrow
  • Erythrocyte Sedimentation Rate:
  • Determines the rate of RBC sedimentation
  • Indicates inflammation
• Hematology and Coagulation Studies:

  • Complete Blood Count:
  • Most common test in Hematology section
  • Screens for conditions like infections and malignancy
  • Differential:
  • Determines the percentage of different types of WBC and evaluates RBC and platelet morphology
  • High Neutrophil indicates bacterial infection
  • Eosinophil indicates parasitic infection/allergy
  • Hematocrit:
  • Determines the volume of RBC packed by centrifugation
  • Hemoglobin:
  • Determines the oxygen-carrying capacity of RBC
  • Mean corpuscular hemoglobin:
  • Determines the amount of hemoglobin in RBC
• Urinalysis:

  • Color:
  • Detects blood, bilirubin, and other pigments
  • Normal color of urine is yellow
  • Appearance:
  • Detects cellular and crystalline elements
  • Specific Gravity:
  • Measures the concentration of urine
  • pH:
  • Determines the acidity of urine
  • Protein:
  • Elevated levels indicate kidney disorders
  • Glucose:
  • Elevated levels indicate diabetes mellitus
  • Blood:
  • Detects red blood cells or hemoglobin
  • Bilirubin:
  • Elevated levels indicate liver disorders
  • Urobilinogen:
  • Elevated levels indicate liver or hemolytic disorder
  • Nitrite:
• • Detects bacterial infection
  • Leukocyte esterase:
  • Detects WBC
  • Indicates urinary tract infection if there are many neutrophils
• Immunohematology/Blood Banking:

  • Blood typing and compatibility testing are main activities
  • Blood bank samples collected in plain red, lavender, or pink stopper plasma
  • Tests conducted include Group and Type, Antibody screen, Direct Coombs, Panel, Type and Crossmatch, and Type and Screen
• Immunology/Serology:

  • Performs tests to evaluate the body's immune response
  • Analyses serum antibodies in infectious agents
  • Tests include Anti-HIV, HCG, CRP, CMV antibody, Hepatitis A, B, C tests, Immunoglobulin levels, VDRL, and RPR
• Laboratories:

  • STAT Laboratory:
  • Stands for short turnaround time, provides immediate results
  • Located near emergency rooms for quick results
  • Reference Laboratory:
  • Large and independent lab providing specialized and confirmatory tests
  • Highly automated with fast turnaround time