PMLS2 L1

• Phlebotomy


  The process of collecting blood through the vein by incision or puncture methods to draw blood for analysis
• Temnein


  To cut
• Venesection


  Also referred to as phlebotomy
• Evolution of phlebotomy


  1. Stone Age

  2. 1492: Pope Innocent VII - First blood transfusion

  3. William Harvey identified that blood flowed through blood vessels in one direction

  4. Crude tools are used to cut vessels and drain blood from the body

  5. Ancient Egyptians: Phlebotomy as a form of "bloodletting" as early as 1400 BC
• Hippocrates (460-377 BC)


  • Greek Physician
  • Father of Medicine
  • Believed that a person's health was dependent on the balance of the 4 humors: Earth—blood and brain, Air—phlegm and lungs, Fire—black bile and spleen, Water—yellow bile and gallbladder
  • Excess humor must be removed through blood letting to keep the balance
• Middle Age


  Barber-surgeons performed bloodletting as part of treatment for some illnesses
• 17th and 18th Century

  1. Phlebotomy was treated as major therapy

  2. Cupping and leeching were performed by phlebotomists using lancets and fleams
• Cupping


  An alternative medicine that helps to ease pain, inflammation, or other health-related concerns. It involves the application of special heated suction cups on the skin and incision made using a fleam (lancet) which is previously wiped with rag. Similar to ventossa.
• Leeching (Hirudotherapy)


  A method using leeches for bloodletting (currently used for microsurgical replantation). It involves placing a drop of milk or blood on the skin and introducing Hirudo medicinalis (medicinal leech) to the site — to engorge and fall off. It is believed that the leeches inject local vasodilator, anesthetic, and hirudin, which is an anticoagulant.
• Phlebotomy


  • Evolved from simple bloodletting (Ancient times) -> a fundamental diagnostic tool in healthcare today
• Main goals of phlebotomy

  • For diagnosis and treatment using blood samples
  • For transfusion, to remove blood from donor
  • For removal of blood for polycythemia vera or therapeutic purposes
• 2 main methods of phlebotomy


  • Venipuncture - method of blood collection using needles inserted in a vein
  • Capillary Puncture - done by puncturing the skin
• Venipuncture methods


  • Syringe System Method - simplest
  • Butterfly/Wing Method - for patients that has thin veins (e.g. pediatric patients)
  • Evacuated Tube System
• Capillary Puncture methods


  • Feather
  • Bullet
• Roles of phlebotomists (clinical laboratory)


  • To collect blood samples for laboratory testing or for transfusion
  • To properly label the collected samples with necessary data to identify the patient
  • Responsible for delivering or transporting collected samples within appropriate prescribed time limits
• Roles of phlebotomists (other institutions)

  • Also processes collected blood samples such as centrifuging and aliquoting samples ready for laboratory testing
  • (Sometimes) Assists in collecting other specimens like urine and other non-blood samples
• Traits that form the professional image of phlebotomists

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


  • Certification or license and continuing education
  • Must have official recognition and must be certified to complete the training in an accredited body required by the healthcare institution
  • Must pass the certifying or licensure examination and must be able to present documents granted by an official regulating body for having completed education, experience, and examination requirements
  • Must have continuing education and must attend training and seminars to be updated with the changes in practice
• Patient-client interaction


  • Must be reassuring and pleasant when dealing with patients
  • Must be able to communicate well despite cultural and social differences
  • Must maintain positive customer relations (since they are the only contact of the patient from the clinical laboratory, and their attitude may affect how the patient views the hospital services generally)
  • Must understand the diversity (pediatric & geriatric) of patients and be able to adjust accordingly
• Qualities of professionalism


  • Professional appearance
  • Self-confidence
  • Integrity
  • Compassion
  • Self-motivated
  • Dependable
  • Good ethical behavior
• Verbal communication


  Involves expressing ideas through words. The sender (speaker) and receiver (listener) must be able to accurately exchange ideas by using feedback wherein they can clarify and confirm ideas hampered by vagueness, confusion, and biases. Must use words that can be easily understood (Layman's terms).
• Non-verbal communication


  Must be keen in observing the patient's facial expressions and other non-verbal cues that could tell something about how the patient feels. e.g. Kinesics (body motions and language), proxemics (individual's concept and use of space), appearance (attire), and touch (thoughtful expression)
• Active listening


  Prompts better understanding of situations and instructions. Builds rapport by listening to patients. Must ensure that the phlebotomist interpreted the message correctly by providing feedback.
• Elements in healthcare communication


  • Empathy
  • Control
  • Respect
  • Confirmation
  • Trust
• Healthcare settings


  • Inpatient (Non-ambulatory) - Healthcare facilities, Requires the patients to stay in the hospital for at least 1 night to be serviced by tertiary care practitioners
  • Outpatient - Healthcare facilities, Patients are served by secondary care specialists on the same day
• Levels of healthcare


  • Primary level - Health units in rural areas and sub-units operated by the Department of Health
  • Secondary level - Non-departmentalized hospitals that attend to patients during symptomatic stages of ailment
  • Tertiary level - Medical centers and large hospitals where services are sophisticated with highly technical facilities that can address serious diseases
• Ambulatory care


  Medical care given to outpatients or patients requiring care or follow-up check-ups after their dischargement from hospital. Can be in free standing medical care settings and hospital-owned clinics, or in the outpatient departments and urgent care facilities.
• Homebound services


  Procedures, tests, services given to a patient in their home or in a long-term facility.
• Public health services


  Medical units at a local level but are still under the jurisdiction of the government health department. Services are offered with little to no charge at all.
• 2 major divisions of the clinical laboratory


  • Anatomical and Surgical Pathology - Tests related to histology (microscopic structures of tissues), cytology (structures of cells), and cytogenetics (chromosomal deficiencies and genetic disease)
  • Clinical Analysis Area - Divided into 7 areas: Hematology, Coagulation, Chemistry, Immunology, Microbiology, Toxicology, Molecular Diagnostics
• Hematology tests


  • Hematocrit (Hct) - hemoglobin level and red blood cell count
  • Hemoglobin (Hgb) - values that rule out anemia
  • Red Blood Cell (RBC) Count - erythropoietic activity
  • Platelet Count - chemotherapy and radiation conditions
  • Differential White Blood Cell Count - changes in the appearance or quantity of specific cell types
  • Indices - show the changes in RBC size, weight, and Hgb content
  • Mean Corpuscular Hemoglobin (MCH) - weight of the hemoglobin in the cell
  • Mean Corpuscular Volume (MCV) - size of the cell
  • Mean Corpuscular Hemoglobin Concentration (MCHC) - concentration of the hemoglobin per unit volume of RBCs
  • Red Blood Cell Distribution Width (RDW) - size differences of the RBCs
• Coagulation tests


  • Activated Partial Thromboplastin Time (APTT) - adequacy of heparin therapy (coagulation factors under intrinsic pathway)
  • D-dimer - thrombin and plasmin activity
  • Fibrin Split Products (FSP) - amount of fibrin degradation products (FDPs) in the blood
  • Fibrinogen Test - fibrinogen levels in the blood
  • Prothrombin Time (PT) or International Normalized Ratio (INR) - liver diseases or deficiency in Vitamin K (factor 10972) (coagulation factors under extrinsic pathway)
• Chemistry tests


  • Alanine Aminotransferase Test (ALT) - liver damage
  • Alpha-fetoprotein (AFP) - alpha-fetoprotein levels in pregnant women during the second trimester of pregnancy
  • Alkaline Phosphatase (AP) Test - amount of alkaline phosphatase enzyme in the bloodstream
  • Ammonia - measures the level that could indicate cirrhosis and hepatitis
  • Lipase - checks the enzyme level that could indicate pancreatitis
• Activated Partial Thromboplastin Time (APTT)


  Adequacy of heparin therapy (coagulation factors under intrinsic pathway)
• 1. dimer


  Thrombin and plasmin activity
• Fibrin Split Products (FSP)


  Amount of fibrin degradation products (FDPs) in the blood
• Fibrinogen Test


  Fibrinogen levels in the blood
• Prothrombin Time (PT) or International Normalized Ratio (INR)


  Liver diseases or deficiency in Vitamin K (factor 10972) (coagulation factors under extrinsic pathway)
• Potassium


  Cardiac arrhythmia, hypokalemia
• Alanine Aminotransferase Test (ALT)


  Liver damage