PMLS 2

• Phlebotomy


  The act of opening a vein by using incision or puncture methods to draw blood for analysis or as part of therapeutic or diagnostic measures under the physician's request
• Temnein


  To cut
• Evolution of Phlebotomy


  1. Stone Age - used crude tools to cut vessels and drain blood from the body

  2. Ancient Egyptians - a form of "Bloodletting" (1400 B.C.)

  3. Hippocrates (460 - 377 BC) - balance of the four humors, removing the excess by bloodletting

  4. Middle Ages – used to treat illness and performed by barber-surgeons

  5. 17th and 18th century – treated as major therapy
• Methods Used for Bloodletting during Ancient Times

  • Cupping
  • Leeching
• Cupping


  Alternative medicine, application of special heated suction cups on the patient's skin, incision using a fleam or lancet
• Leeching


  Known as Hirudotherapy, uses leeches for bloodletting, used for microsurgical replantation
• Phlebotomy has evolved from simple bloodletting in the ancient times into a fundamental diagnostic tool in the healthcare industry today
• Main Goals of Phlebotomy Practice

  • For diagnosis and treatment using blood samples
  • For transfusion, to remove blood from the
  • For removal of blood for polycythemia or therapeutic purposes
• Venipuncture


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


  Done by skin puncture
• Phlebotomists


  • Credentials: Certification, Licensure, Continuing education
  • Patient-Client Interaction: Reassuring and pleasant, Able to communicate well, Maintain positive customer relations, Understand the diversity of the patients and be able to adjust accordingly
  • Qualities of Professionalism: Professional appearance, Self-confidence, Integrity, Compassion, Self-motivation, Dependability, Ethical Behavior
• Verbal Communication


  One of the basic concepts of communication in the healthcare setting
• Nonverbal Communication


  One of the basic concepts of communication in the healthcare setting
• Active listening


  One of the basic concepts of communication in the healthcare setting
• Elements in healthcare communication

  • Empathy
  • Confirmation
  • Control
  • Trust
  • Respect
• The Verbal Communication Loop in the Healthcare Setting
• Inpatient (non-ambulatory)


  Patients are required to stay in the hospital for at least one night to be serviced by tertiary care practitioners
• Outpatient


  Patients are served by secondary care specialists on the same day
• Healthcare Services


  • Primary level – refers to the health units in the rural areas and sub-units which are operated by the DOH
  • 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
• Other Health Services


  • Ambulatory care – is medical care given to outpatients or patients requiring care or follow-up check-ups after their discharge from the hospital
  • Freestanding medical care setting
  • Hospital-owned clinics
  • OPD departments
  • Homebound services – refers 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 are offered with little or no charge at all.
• Hospital


  Is an institution that has permanent inpatient beds, 24-hour nursing service along with therapeutic and diagnostic services, managed by organized medical team, houses the clinical laboratory services (clinical lab) where tests requested by physicians are performed
• Clinical Analysis Areas


  • Hematology – blood and blood-forming tissues
  • Coagulation – ability of blood to form and dissolve clots
  • Chemistry – amounts of certain chemicals in a blood sample
  • Serology/Immunology – serum and autoimmune reactions in the blood
  • Urinalysis – tests urine specimen
  • Microbiology – microorganisms in body fluids or tissues
  • Blood bank/Immunohematology – blood for transfusion
• Hematology Tests and Procedures

  • Hematocrit (Hct)
  • Hemoglobin (Hgb)
  • Red Blood Cell (RBC) Count
  • White Blood Cell (WBC) Count
  • Platelet (Plt. Ct.) Count
  • Differential White Blood Cell Count (Diff ct.)
  • RBC Indices
  • Mean Corpuscular Hemoglobin (MCH)
  • Mean Corpuscular Volume (MCV)
  • Mean Corpuscular Hemoglobin Concentration (MCHC)
  • Red Blood Cell Distribution Width (RDW)
• Coagulation Tests and Procedures


  • Activated Partial Thromboplastin Time (APPT)
  • D-dimer
  • Fibrin Split Products (FSP)
  • Fibrinogen Test
  • Prothrombin Time (PT) / International Normalized Ratio (INR)
• Chemistry Tests and Procedures


  • Alanine aminotranferase (ALT)
  • Alpha-fetoprotein (AFP)
  • Alkaline phosphatase (ALP)
  • Ammonia
  • Amylase
  • Aspartate aminotransferase (AST)
  • Bilirubin
  • Arterial Blood Gases (ABG)
  • Blood Urea Nitrogen (BUN)
  • B-type natriuretic peptide (BNP)
  • C-reactive Protein High sensitivity (hs-CRP)
  • Carcinoembryonic antigen (CEA)
  • Calcium
  • Cholesterol (total)
  • Cortisol
  • Creatine Kinase (CK)
  • Creatinine
  • Drug Analysis
  • Electrolytes (sodium, potassium, chloride, CO2)
  • Glucose
  • Gamma-glutamyl transferase (GGT)
  • Hemoglobin A1C (HBA1C)
  • Lactate dehydrogenase
  • Lipase
  • Prostate Specific Antigen (PSA)
  • Total Protein
  • Triglycerides
  • Troponin-I
  • Uric Acid
  • Vitamin B12 and Folate
• Serology/Immunology Tests and Procedures

  • Bacterial Studies
  • Antinuclear antibody (ANA)
  • Antistreptolysin O (ASO)
  • Cold Agglutinins
  • Febrile Agglutination Test
  • FTA-ABS
  • Rapid Plasma Reagin (RPR)
  • Rheumatoid factor (RF)
  • Viral Studies
  • Anti-HIV
  • Cytomegalovirus antibody (CMV)
  • Epstein-Barr Virus
  • Hepatitis B surface antigen (HBsAg)
  • General Studies
  • C-reactive protein (CRP)
  • Human Chorionic Gonadotropin (HCG)
• Urinalysis Tests and Procedures

  • Physical Evaluation: Color, Clarity, Specific Gravity
  • Chemical Evaluation: Blood, Bilirubin, Glucose, Ketones, Leukocyte, pH, Protein, Nitrite, Urolibinogen
  • Microscopic Evaluation: WBCs, RBCs, Epithelial Cells, Casts, Crystals, Mucus Threads, Spermatozoa
• Microbiology Tests and Procedures

  • Acid-fast bacilli (AFB)
  • Blood Culture
  • Campylobacter-like organism (CLO) Test
  • Culture & Sensitivity (C&S)
  • Fungus Culture and Identification
  • Gram Stain
  • Occult Blood
  • Ova and Parasites
• Blood Bank/Immunohematology Tests and Procedures

  • Antibody (Ab) Screen
  • Direct Antihuman Globulin Test (DAT)
  • ABO and Rh Type
  • Type and Crossmatch
  • Compatibility testing
• Stat Labs


  Established near the emergency room
• Reference Laboratory


  Large, independent laboratory that receives specimen from many facilities in the area, provides specialized analysis of the specimen (blood, urine, and tissues) for confirmatory testing, offers fast turnaround time and reduced cost
• Phlebotomy


  The act of opening a vein by using incision or puncture methods to draw blood for analysis or as part of therapeutic or diagnostic measures under the physician's request
• Temnein


  To cut
• Evolution of Phlebotomy


  1. Stone Age - used crude tools to cut vessels and drain blood from the body

  2. Ancient Egyptians - a form of "Bloodletting" (1400 B.C.)

  3. Hippocrates (460 - 377 BC) - balance of the four humors, removing the excess by bloodletting

  4. Middle Ages – used to treat illness and performed by barber-surgeons

  5. 17th and 18th century – treated as major therapy
• Methods Used for Bloodletting during Ancient Times

  • Cupping
  • Leeching
• Cupping


  Alternative medicine, application of special heated suction cups on the patient's skin, incision using a fleam or lancet
• Leeching


  Known as Hirudotherapy, uses leeches for bloodletting, used for microsurgical replantation
• Phlebotomy has evolved from simple bloodletting in the ancient times into a fundamental diagnostic tool in the healthcare industry today
• Main Goals of Phlebotomy Practice

  • For diagnosis and treatment using blood samples
  • For transfusion, to remove blood from the
  • For removal of blood for polycythemia or therapeutic purposes
• Venipuncture


  Method of blood collection using a needle inserted in a vein