Introduction to Phlebotomy

• Phlebotomy is derived from the Greek words "Phleb" (Vein) and "Tomia" (To cut)
• The concept of phlebotomy is relatively young, dating back to 1900
• Egyptians practiced bloodletting around 1400 BC, believing that sickness resided in the blood
• Bloodletting, known today as blood transfusion, was attempted in 1628 by William Harvey, with procedures from human to animal
• Hippocrates introduced the concept of the Four humors (Yellow Bile, Black Bile, Phlegm, Blood) and bloodletting as a cure for various ailments
• In 1900, Karl Landsteiner discovered the ABO blood groups and performed the first blood procedure
• Credentials needed to be a medical technologist include a license and continuing professional training
• Types of healthcare facilities:

  • Stand-alone clinics: test specimens but do not fixate signatures; may be understaffed
  • Physician office laboratories: consist of primary care physicians or specialists
  • Health Management Organizations (HMO): managed care group practice centers providing various services
  • Reference laboratories: large, independent labs performing routine and specialized tests
  • Blood donor centers: collect, label, and prepare blood components for transfusions
• Health Management Organizations (HMO) characteristics:

  • Provide various services like physicians' offices, clinical labs, radiology, etc.
  • Charge members a prepaid fee for services
  • Employ phlebotomists as part of the clinical laboratory staff
  • Partner with hospitals to provide services for free
• Reference laboratories:

  • Contract with healthcare providers to perform routine and specialized tests
  • Employ phlebotomists to collect samples
  • Have gold standard methods for specialists
  • Examples include National Kidney Transplant Institute, Research Institute for Tropical Medicine, etc.
• Blood donor centers:

  • Phlebotomists collect, label, and prepare blood components for transfusions
  • Interact with the public, conduct interviews, and test samples to screen potential donors
  • Screen blood donors for weight, height, blood pressure, and blood typing
• Patient Rights (DOH):

  • Right to appropriate medical care and humane treatment
  • Right to informed consent for procedures
  • Right to privacy and confidentiality of medical information
  • Right to information about their health condition and results
  • Right to choose healthcare providers and facilities
  • Right to self-determination in medical decisions
  • Right to religious beliefs affecting medical treatment
  • Right to medical records, leave, correspondence, visitors, and grievances
• Tort Law:

  • Tort: wrongful act causing harm to a person or property
  • Intentional torts: assault, battery, defamation (libel, slander), invasion of privacy
  • Unintentional torts: medical malpractice, negligence (duty, breach of duty, causation, damages)
• Phlebotomy:

  • Involves collecting blood samples for laboratory analysis
• National Kidney Transplant Institute focuses on hematological procedures and blood banking
• Research Institute for Tropical Medicine specializes in microbiology and emerging diseases
• Lung Center of the Philippines – Clinical Chemistry
• East Avenue Medical Center specializes in Toxicology and Drug testing
• STD-AIDS Cooperative Central Laboratory (SACCL) is where all STIs are tested with maximum confidentiality
• At SACCL, people are provided anonymity through wearing jackets, sunglasses, masks, and caps
• Responsibilities of a laboratory director (pathologist) include working with the laboratory administrator to establish policies, interpret test results, perform bone marrow biopsies and autopsies, and diagnose diseases from tissue specimens or cell preparations
• The laboratory manager (administrator) or chief-medical technologist is responsible for the overall technical and administrative management of the laboratory
• The laboratory manager is usually a medical laboratory scientist (MLS) with a master’s degree and 5 or more years of laboratory experience, holding the highest position a licensed medical technologist can attain
• A technical supervisor or section head is an MLS with experience and expertise related to a particular laboratory section or sections, often holding specialty certifications for each section
• Responsibilities of a technical supervisor include reviewing all laboratory test results, consulting with the pathologist on abnormal test results, scheduling personnel, maintaining automated instruments, preparing budgets, maintaining reagents and supplies, orienting, evaluating, and teaching personnel, and providing protocols for new test procedures
• A medical technologist is licensed and has completed a bachelor’s degree in medical technology, along with 1 year of training in an accredited medical technology/clinical laboratory science program
• A medical technologist performs laboratory procedures that require independent judgment and responsibility with minimal technical supervision, maintaining equipment and records, performing quality assurance, and preventive maintenance activities related to test performance settings
• A laboratory technician, at the bottom of the hospital chain, is a graduate of a relevant program who performs routine laboratory procedures according to established protocols under the supervision of a technologist, supervisor, or laboratory director
• Phlebotomists collect blood from patients for laboratory analysis, having usually completed a structured phlebotomy training program
• Phlebotomists are trained to identify patients properly, obtain the correct amount of blood by venipuncture or microtechnique, and are at the bottom of the hospital chain as graduates of a relevant program
• Anatomical area responsible for the analysis of surgical specimens, frozen sections, biopsies, cytological specimens, and autopsies
• Specialized sections within the anatomical area:

  • Cytology Section
  • Histopathology/Histology Section
  • Cytogenetics
  • Hematology
  • Coagulation
  • Clinical Chemistry
  • Blood Bank (Immunohematology)
  • Serology
  • Microbiology
  • Clinical Microscopy
  • Phlebotomy
  • Sample Processing
• Cytology Section:

  • Physicians or pathologists are hands-on in this area
  • Cytologists process and examine tissue and body fluids for abnormal cells
  • Common test: Papanicolaou (Pap) smear
• Histopathology/Histology Section:

  • Physicians or pathologists are hands-on
  • Histology technicians and technologists process and stain tissue from various sources
  • Pathologist examines the tissue
  • Medtechs prepare tissue slides
  • Common procedures: Autopsy (cadaver) and Biopsy (alive)
• Cytogenetics:

  • Performs chromosome studies to detect genetic disorders
• Hematology:

  • Focuses on cellular elements like RBCs, WBCs, and platelets in body fluids and bone marrow
  • CBC machine used for testing
  • CBC examines illnesses
• Coagulation:

  • Evaluates the overall process of hemostasis
  • Tests platelet function and hemostasis
  • Types of hemostasis tests: 1° for platelet function and count, 2° for testing coagulation factors
• Clinical Chemistry:

  • Most automated section
  • Performs various tests including electrophoresis, therapeutic drug monitoring, enzyme immunoassays
  • Tests substances like proteins, carbohydrates, enzymes, hormones, toxicology, and lipids
• Blood Bank (Immunohematology):

  • Collects, stores, and prepares blood for transfusion
  • Tests blood for blood group, Rh type, compatibility, and abnormal antibodies
• Serology:

  • Evaluates the body's immune response
  • Tests for antibodies and cellular activation
  • Used for rapid diagnosis