Lesson 1: UNDERSTANDING PHLEBOTOMY

• Phlebotomy


  The process of collecting blood through the vein by incision or puncture methods to draw blood for analysis or as part of therapeutic or diagnostic measures under physician's request
• phlebos

  vein
• temnein


  to cut
• Venesection


  Also called phlebotomy
• Practice of phlebotomy can be traced back to

  Stone Age
• Ancient Egyptians practiced phlebotomy as a form of "bloodletting"

  1400 BC
• Hippocrates


  • A Greek physician who believed that a person's health was dependent on the balance of Four Humors: Earth - blood and brain, Air - phlegm and lungs, Fire - black bile and spleen, Water - yellow bile and gallbladder
  • Removal of excess humor through bloodletting must be performed to keep balance
• Barber-surgeons performed bloodletting as part of the treatment for some illnesses

  Middle Ages
• Phlebotomy was treated as a major therapy

  17th and 18th Century
• Cupping


  • An alternative medicine that helps ease pain, inflammation, or other health-related concerns
  • Involves application of special heated suction cups on patient's skin and the incision that is made using a fleam (lancet), previously wiped with a rag
• Leeching


  • Hirudotherapy, a method that uses leeches for bloodletting and is currently used for microsurgical replantation
  • Process involves a drop of milk or blood on patient's skin and introducing Hirudo medicinalis (medicinal leech) to the site, allowing it to engorge and fall off
  • Believed that leeches inject local vasolidator, anesthetic, and hirudin, which is an anticoagulant
• Phlebotomy evolved from simple bloodletting in ancient times, into a fundamental diagnostic tool in the healthcare industry today
• Main goals of the Phlebotomy practice

  • Diagnosis and treatment using blood samples
  • Transfusion, to remove blood from donor
  • For removal of blood for polycythemia or therapeutic purposes
• 2 Main methods used in Phlebotomy

  • Venipuncture
  • Capillary puncture
• Venipuncture


  • Method of blood collection using a needle inserted in a vein
• Capillary puncture


  • Done by puncturing the skin
• Main role of phlebotomist

  • Collect blood samples for laboratory testing or for transfusion
  • Properly label collected blood samples with the necessary data to identify the patient
  • Responsible for delivering or transporting collected samples within appropriate prescribed time limits
  • Process collected blood samples such as: centrifugation and aliquoting samples ready for laboratory testing
  • Assist in collecting other specimens (urine and other non-blood samples) from patients
  • Draw blood units from donors for transfusion to a patient requiring whole blood or blood components
• Traits that Form the Professional Image of a Good Phlebotomist

  • Good manual dexterity
  • Special communication skills
  • Good organizational skills
  • Thorough knowledge of laboratory specimen requirements
  • Training in phlebotomy skills coupled with standard practice
• Credentials Phlebotomists need to maintain

  • Certification or License
  • Continuing education
  • Official recognition and are certified to have completed the training by an accredited body as required by healthcare institution
  • Passed a certifying or licensure examination
  • Documents granted by an official regulating body for having completed education, experience, and examination requirements
• Qualities of Professionalism for a Phlebotomist

  • Maintain professional appearance and proper personal hygiene
  • Have self-confidence in expressing decisions and judgements to patients and co-workers
  • Show compassion, sensitivity to the needs of others, and the ability to stay calm and maintain a helpful demeanor towards those in need
  • Be self motivated, have positive attitude and the initiative to follow through tasks and continuously look for areas of improvement
  • Be dependable, observe proper work ethic, and take personal responsibility for their actions
  • Display good ethical behavior, conforming with standards so as to avoid exposing patients to harm
• Verbal Communication


  • Involves expressing ideas through words
  • Sender (speaker) and receiver (listener) are able to accurately exchange ideas by using FEEDBACK wherein they are able to clarify and confirm ideas hampered by vagueness, confusion, and biases
  • Use words that can be easily understood by patients
• Dimensions of Non-Verbal Communication

  • Kinesics (body motion and language)
  • Proxemics (individual's concept and use of space)
  • Appearance (attire)
  • Touch (thoughtful expression)
• Active Listening


  • A major part of communication
  • Leads to better understanding of situations and instructions
  • Phlebotomists should build rapport by listening to patients
  • Ensure that they have interpreted messages correctly by giving feedback
  • Bear in mind the elements in healthcare communication, so they could handle patients more carefully (includes EMPATHY, CONTROL, RESPECT, CONFIRMATION, and TRUST)
• Healthcare Facility Categories

  • Inpatient (Non-ambulatory, requires patients to stay in the hospital for at least one night to be serviced by tertiary care practitioners)
  • Outpatient (Patients served by secondary care specialist on the same day)
• Levels of Healthcare

  • Primary Level (Health units in the rural areas and sub-units operated by the DOH)
  • Secondary Level (Non-departmentalized hospitals that attend to patients during the symptomatic stages of an ailment)
  • Tertiary Level (Medical centers and large hospitals with sophisticated services and highly technical facilities)
• Other Healthcare Services

  • Ambulatory Care (Medical care given to outpatients or patients requiring care or follow-up check-ups after discharge from the hospital)
  • Homebound Services (Procedures, tests, and services provided to a patient in their 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, offered with little to no charge)
• Hospital


  • 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
  • Houses the clinical laboratory services (clinical lab): where tests requested by physicians are performed
• Major Divisions of the Clinical Laboratory

  • Anatomical and Surgical Pathology Area (Handles test related to histology, cytology, and cytogenetics)
  • Clinical Analysis Area (Divided into seven areas)
• Clinical Analysis Areas and Examples of Tests/Procedures

  • Hematology (Blood and blood-forming tissues: Hematocrit, Hemoglobin, Red Blood Cell Count, White Blood Cell Count, Platelet Count, Differential White Blood Cell Count, Indices like MCH and MCV)
  • Chemistry (Electrolytes, enzymes, hormones, drugs, and other substances in the blood)
  • Urinalysis (Physical, chemical, and microscopic examination of urine)
  • Microbiology (Identification of microorganisms that cause infections)
  • Serology/Immunology (Detection of antibodies and antigens in the blood)
  • Blood Bank (Typing, cross-matching, and antibody screening of blood)
  • Coagulation (Measurement of the body's ability to form blood clots)
• Clinical laboratory services (clinical lab)


  Where tests requested by physicians are performed
• Two major divisions of the clinical laboratory

  • Anatomical and surgical pathology area
  • Clinical analysis area
• Anatomical and surgical pathology area


  • Handles tests related to histology (microscopic structure of tissues), cytology (structure of cells), and cytogenetics (chromosomal deficiencies)
• Clinical analysis area


  • Hematology
  • Coagulation
  • Chemistry
  • Serology/Immunology
  • Urinalysis
  • Microbiology
  • Blood bank/Immunohematology
• Hematocrit (Hct)


  Hemoglobin level and RBC count
• Hemoglobin (Hgb)


  Values that rule out anemia
• Red blood cell (RBC) count


  Erythropoietic activity
• White blood cell (WBC) count


  Leukocyte response
• Platelet count


  Chemotherapy and radiation conditions
• Differential white blood cell count


  Changes in the appearance or quantity of specific cell types
• Indices


  • Mean corpuscular hemoglobin (MCH)
  • Mean corpuscular volume (MCV)
  • Mean corpuscular hemoglobin concentration (MCHC)
  • Red blood cell distribution width (RDW)