introduction to phlebotomy

• Phlebotomy


  Also known as venesection, 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
• Phlebos


  Means vein
• Temnein


  Means to cut
• Phlebotomy


  Tutusukan mo para kumuwa ng dugo
• Venipuncture


  You inject something, either a drug
• Evolution of Phlebotomy


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

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

  3. Hippocrates (460 - 377 B.C.) - 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
• 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
• Role of Phlebotomist


  • For diagnosis and treatment using blood samples
  • For transfusion, to remove blood at the donor center
  • 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 puncturing the skin (not just the finger, can also be the earlobes)
• Role of phlebotomists


  • Properly label the collected blood samples
  • Deliver or transport the collected samples within the appropriate prescribed time limits
  • In other institutions, they also process by centrifuging and aliquoting samples ready for laboratory testing
  • Assist in collecting other specimen such as urine
  • Blood-letting activities
• Aliquoting


  Separation of plasma and serum
• Traits that form the professional image of the phlebotomists

  • Good manual dexterity
  • Special communication skills
  • Good organizational skills
  • Thorough knowledge of laboratory specimen requirement
  • Trained in phlebotomy skills coupled with standard practice
• Credentials


  • Certification
  • License
  • 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
• Communication in the Healthcare Setting

  • Verbal
  • Nonverbal
  • Active Listening
• Elements in the Healthcare Communication

  • Empathy
  • Control
  • Respect
  • Confirmation
  • Trust
• Inpatient (nonambulatory)


  Patients require to stay in the hospital for at least 1 night or 2 to be serviced by the healthcare providers or tertiary care practitioner
• Outpatient walk in


  Patients are served by secondary care specialists on the same day
• Levels of healthcare


  • Primary
  • Secondary
  • Tertiary
• Primary level


  Refers to the health units in the rural areas and subunits which are operated by DOH (less than 200 rooms)
• Secondary level


  Non-departmentalized hospitals that attend to patients during the symptomatic stages of ailment (more than 200 rooms)
• Tertiary level

  Medical centers and large hospitals where services are sophisticated coupled with highly technical facilities that can address serious diseases
• Ambulatory care

  Medical care given to outpatients or patients requiring care of follow up check-ups after their discharge from the hospital
• Homebound services

  Procedures, tests and services provided to patients which are done in a patient's home
• Public health services

  Unit at the local level but are still under the jurisdiction of the health department of the government, service offered with little or no charge at all
• Clinical Analysis Areas

  • Hematology
  • Coagulation
  • Chemistry
  • Serology
  • Urinalysis
  • Microbiology
  • Blood bank/Immunohematology
• Hematology


  Tests blood and blood forming tissues
• Hematology tests

  • Hematocrit (Hct)
  • Hemoglobin (Hgb)
  • Red Blood Cell (RBC) count
  • White Blood Cell (WBC) count
  • Platelet (Plt ct) count
  • Differential White Count (Diff)
  • Indices
  • Mean Corpuscular hemoglobin (MCH)
  • Mean Corpuscular volume (MCV)
  • Mean Corpuscular hemoglobin concentration (MCHC)
  • Red blood distribution width (RDW)
• Coagulation


  Tests the ability of blood to form and dissolve clots
• Coagulation tests


  • Activated partial thromboplastin time (APPT)
  • D-dimer
  • Fibrin split products (FSP)
  • Fibrinogen
  • Prothrombin Time (PT) with International Normalized Ratio (INR)
• Chemistry

  Performs most lab tests for plasma, serum, urine
• Chemistry tests

  • Alanine amino transferase (ALT)
  • Alpha-fetoprotein (AFP)
  • Alkaline phosphatase (ALP)
  • Ammonia
  • Amylase
  • Aspartate Amino-Transferase (AST)
  • Bilirubin
  • Blood Gases (ABG)
  • Blood Urea Nitrogen (BUN)
  • B-type Natriuretic Peptide (BNP)
  • Creatine Kinase (CK)
  • Creatinine
  • Drug Analysis
  • Electrolytes (sodium, potassium, chloride, CO2)
  • Glucose
  • Gamma-glutamyl transferase (GGT)
  • Hemoglobin A1C
  • Lactate dehydrogenase
  • Lipase
  • Prostate specific antigen
  • Total Protein
  • Triglycerides
  • Troponin-I
  • Uric Acid
  • Vitamin B12 and folate
• Immunology/Serology tests

  • Bacterial Studies: Antinuclear antibody (ANA), Antistreptolysin O (ASO) titer, Cold agglutinins, Febrile agglutinins, FTA-ABS, Rapid plasma reagin (RPR), Rheumatoid factor (RF)
  • Viral Studies: Anti-HIV, Cytomegalovirus antibody (CMV), Epstein-Barr Virus (EBV), Hepatitis B surface antigen (HBsAg)
  • General Studies: C-reactive protein (CRP), Human chorionic gonadotropin (HCG)
• Urinalysis

  • Physical Evaluation: Color, Clarity, Specific Gravity
  • Chemical Evaluation: Blood, Bilirubin, Glucose, Ketones, Leukocyte, pH, Protein, Nitrite, Urobilinogen
  • Microscopic Evaluation
• Microbiology tests

  • Acid-fast bacilli (AFB)
  • Blood culture
  • CLO test
  • Culture & Sensitivity (C&S)
  • Fungus culture and identification
  • Gram stain
  • Occult blood
  • Ova and parasites
• Blood Bank/Immunohematology tests

  • Antibody (Ab) screen
  • Direct antihuman globulin test (DAT)
  • Type and RH
  • Type and crossmatch
  • Compatibility testing