PRINCIPLES OF MEDICAL LABORATORY IN SCIENCE 2
MT1B - DURAN, MA. ANDREA NICOLE B.
UNDERSTANDING PHLEBOTOMY
PHLEBOTOMY
It is the process of collecting blood through the
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.
The word is derived from two Greek words:
phlebos, which means vein, and temnein,
which means to cut.
It is also called venesection.
EVOLUTION OF PHLEBOTOMY
1. Stone Age
Back then, humans used crude tools to cut
vessels and drain blood from the body.
The ancient Egyptians also practiced
phlebotomy as a form of “bloodletting” as early
as 1400 BC
Hippocrates (460-377 BC), a Greek physician,
believed that a person’s health was dependent
on the balance of the four humors:
1) Earth – blood and brain
2) Air – phlegm and lungs
3) Fire – black bile and spleen
4) Water – yellow bile and gall bladder
2. Middle Ages
Barber-surgeons performed bloodletting as part
of the treatment for some illnesses.
It was only 17th and 18th centuries when
phlebotomy was treated as a major therapy.
Cupping and leeching were performed by
phlebotomists using lancets and fleams
Most commonly used in the 17th century is fleam
Cupping is an alternative medicine that helps
ease pains or inflammation. Application of
special heated suctions on patient’s skin.
Incision using a fleam or lancet which is
previously wipe with a rag.
Leeching is also known as “Hirudotherapy”
(Hirudo Medicinalis which means it has local
vasodilator anesthetic Hirudin-anticoagulation),
is a method that uses leeches for bloodletting
and is currently used for microsurgical
replantation.
Main Goals of the Phlebotomy Practice:
1. For diagnosis and treatment using blood
samples.
2. For transfusion, to remove blood from the donor.
3. For removal of blood for polycythemia or
therapeutic purposes.
Two Main Methods Used In Phlebotomy:
1. Venipuncture – method of blood collection using
a needle inserted in a vein
2. Capillary puncture – done by puncturing the skin
WEEK 1: JAN 12, 2023
ROLE OF THE PHLEBOTOMISTS
1. To collect blood samples for laboratory testing or
for transfusion.
2. They properly label collected blood samples with
the necessary data to identify the patient.
3. They are also responsible in delivering or
transporting collected samples within
appropriate prescribed time limits.
CREDENTIALS
They should have the following: certification or
license and continuing education.
They have the official recognition and are
certified to have completed the training by an
accredited body as required by the healthcare
institution.
They should have passed a certifying or
licensure examination and must be able to
present documents granted by an official
regulating body.
They should also have continuing education and
should attend trainings and seminars to keep
them updated on the changes in the practice of
their profession.
PATIENT-CLIENT INTERACTION
1. Reassuring and pleasant when dealing with
patients.
2. Able to communicate well despite cultural and
social differences.
3. Maintain positive customer relations
especially since they are only contact of the
patient from the clinical laboratory.
4. Must understand the diversity of the patients
and be able to adjust accordingly.
QUALITIES OF PROFESSIONALISM
1. Professional appearance should be
maintained. Phlebotomists should wear
conservative clothing and observe proper
personal hygiene always.
2. Phlebotomists must have self-confidence
especially because they would be directly
expressing their decisions and judgments to
patients and fellow co-workers.
3. They must be persons of integrity, exhibiting
honesty and consistency in their actions, values
and beliefs.
4. They must show compassion, sensitivity to the
needs of others, and the ability to stay calm and
maintain a helpful demeanor.
5. Phlebotomists are self-motivated, having the
positive attitude.
6. They are dependable, observe proper work
ethic.
7. They display good ethical behavior, conforming
to standards to avoid exposing patients to harm.
 PRINCIPLES OF MEDICAL LABORATORY IN SCIENCE 2
MT1B - DURAN, MA. ANDREA NICOLE B.
COMMUNICATION IN THE HEALTHCARE
SETTING
1. Verbal Communication
Involves expressing ideas through words.
To be able to have effective communication in
a healthcare setting.
2. Non-verbal Communication
Phlebotomists should be keen in observing
the patient’s facial expression and other non-
verbal communication cues that could tell
something about how the patient feels.
3. Active Listening
Listening is a major part of communication. It
leads to better understanding of situations
and instructions.
HEALTHCARE SETTING
Healthcare facilities are categorized as
inpatient (non-ambulatory), that requires
patients to stay in the hospital for at least one
night to be serviced by tertiary care
practitioners, and outpatient, in which
patients are served by secondary care
specialists on the same day.
Primary level refers to health units in the rural
areas and sub-units which are operated by
the DOH
Secondary level refers to non-
departmentalized hospital 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.
Ambulatory care is medical care given to
outpatients or patients requiring care or
follow-up check-ups after their discharge from
the hospital, which can be in the freestanding
medical care setting and hospital-owned
clinics.
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
Elements in Healthcare Communication
Empathy
Control
Respect
Confirmation
Trust
WEEK 1: JAN 12, 2023
CLINICAL ANALYSIS AREAS
A hospital is 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.
2 Major Divisions:
1. Anatomical and Surgical Pathology Area
Handles tests
Histology (Microscopic structure of tissues)
Cytology (structure of cells)
Cytogenetics (chromosomal deficiencies
and genetic disease)
2. Clinical Analysis Area
The clinical analysis area is divided into
seven areas: Hematology, Coagulation,
Chemistry, Serology/Immunology,
Urinalysis, Microbiology, Blood
bank/immunohematology
Hematology
 Blood and blood-forming tissues
 Hematocrit (Hct) checks the hemoglobin
level and the red cell count
 Hemoglobin (Hgb) tests the value to rule out
anemia
 Red Blood Cell (RbC) count is used to
measure the erythropoietic activity
 White Blood Cell (WbC) count checks the
leukocyte response
o Neutrophil
o Basophil
o Eosinophil
o Monocyte
o Lymphocyte
 Platelet (Plt ct) count usually used to
monitor chemotherapy and radiation
conditions
 Differential White Count (Diff) monitor
changes in the appearance or quantity of
specific cell types
 Mean Corpuscular hemoglobin (MCH)
gives the weight of the hemoglobin in the cell
 Mean Corpuscular volume (MCV) shows
the size of the cell
 Mean Corpuscular hemoglobin
concentration (MCHC) gives information on
the concentration of the hemoglobin per unit
volume of RBCs
 Red blood distribution width (RDW)
measures the size differences of the RBCs
Coagulation
 Ability of blood to form and dissolve clots
 PRINCIPLES OF MEDICAL LABORATORY IN SCIENCE 2
MT1B - DURAN, MA. ANDREA NICOLE B.
 Activated partial thromboplastin time
(APPT) reflects the adequacy of heparin
therapy
 D-dimer checks the 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
Chemistry
 Amounts of certain chemicals in a blood
sample (plasma, white blood, urine, etc.)
 Alanine amino transferase (ALT) is used to
monitor liver disease
 Alpha-fetoprotein (AFP) checks levels.
Especially for prenatal screening
 Alkaline phosphate (ALP) determines level
to check obstructions and other disease
 Ammonia measures the level which could
indicate cirrhosis and hepatitis
 Amylase checks the enzyme level which
could indicate liver disease, cholecystitis,
etc.
 Aspartate amino-transferase (AST)
measures the level which is indicative of liver
dysfunction
 Bilirubin shows the level in the bloodstream
that shows red blood destruction
 Blood Gases (ABG) evaluates acid-base
balance by measuring the pH, partial
pressure of the carbon dioxide and oxygen
 Blood Urea Nitrogen (BUN) checks
elevated levels which leads to impaired renal
function
 B-type natriuretic peptide (BNP) is a
cardiac make for congestive failure
 High Sensitivity C-reactive protein (hs-
CRP) detects low level of CRP
 Carcinoembryonic antigen (CEU) is used
for early detection of malignancy in colorectal
cancer
 Calcium is used for monitoring effects of the
renal failure
 Cholesterol (total) indicates risk of
cardiovascular diseases
 Cortisol shows adrenal hypofunction and
hyper function
 Creatine Kinase (CK) used to check muscle
damage
 Creatinine checks for cases that indicate
renal impairment or muscular dystrophy
WEEK 1: JAN 12, 2023
 Drug analysis monitors therapeutic range to
avoid toxic levels for drugs
 Electrolytes (sodium, potassium, chloride,
CO2) shows values that determine disorder
of the kidney and adrenals.
 Gamma-glutamyl transferase (GGT) is
used for diagnosis of liver specifically
hepatobiliary problems
 Hemoglobin A,C determines glycosylated
hemoglobin level
 Lactate dehydrogenase checks lung,
kidney, and liver dysfunction
 Lipase shows the level that could lead to
either pancreatitis or pancreatic carcinoma
 Prostate Specific Antigen (PSA) test that
screens patients for the presence of prostate
cancer
 Total Protein used to check liver and kidney
disorders
 Triglycerides serve as index in the
evaluation of atherosclerosis and lipid
metabolism disorder
 Troponin I used for early diagnosis of small
myocardial infarcts
 Uric Acid Test used to check levels that
indicate gout and renal problems
 Vitamin B12 and Folate Tests used to
check for anemia and diseases of the small
intestine
Serology/Immunology
 Serum and autoimmune reactions in the
blood
 Bacterial Studies
o Antinuclear Antibody (ANA) – shows
autoimmune disorders such as
systematic lupus erythematosus
o Antistreptolysin-O (ASO) Titer –
indicates streptococcal infection
o Cold Agglutinins - checks cases of
atypical pneumonia
o Febrile Agglutination Test – shows
the presence of antibodies to specific
organisms
o FTA-ABS confirms syphilis
o Rapid Plasma Reagin (RPR) – when
positive, it is indicative of syphilis but it
still needs confirmation
o Rheumatoid Factor (RF) – indicates
rheumatoid arthritis
Urinalysis
 Tests urine specimen
 Physical Education
o Color indicates the presence of blood
melanin, bilirubin or urobilin in the urine
specimen
 PRINCIPLES OF MEDICAL LABORATORY IN SCIENCE 2
MT1B - DURAN, MA. ANDREA NICOLE B.
o Clarity/transparency shows the
presence of fat, chyle, or bacteria which
affect the turbidity
o Specific gravity suggest renal tubular
involvement or ADH deficiency
 Chemical Evaluation
o Blood – hematuria could be due to
hemorrhage, infection, or trauma and
hemolytic jaundice
o Glucose – glucosuria may be a result
of diabetes mellitus, renal impairments
o Ketones – uncontrolled diabetes
mellitus or starvation
o Leukocyte – indicates urinary tract
infection if there is a lot of neutrophils
o pH – indicates the acid-base balance
o Protein – proteinuria is an indicator of
renal dysfunction or disorder
o Nitrite – positive results could mean
bacterial infection
o Urobilinogen – increases in amount
when the patient suffers from hepatitis
issues
 Microscopic Evaluation
o Shows the status of the urinary tract,
hematuria, pyuria, etc.
Microbiology
 Microorganisms in body fluids or tissues
 Acid-Fast Bacilli (AFB) used to monitor the
treatment for TB
 Blood Culture for the presence of
Helicobacter pylori
 Culture and Sensitivity (C&S) indicates
infection if there is growth in the pathogenic
microorganism
 Fungus Culture and Identification used to
determine the type of fungi if present
 Gram Stain it is done to allow antimicrobial
therapy while waiting for culture results
 Occult Blood checks for blood in the stool
which could result from gastrointestinal
bleeding
 Ova and Parasites (O&P) Exam solves
“etiology unknown” intestinal disorders
Blood bank/Immunohematology
 Blood for transfusion
 Antibody (Ab) Screen agglutination means
presence of abnormal antibodies in the blood
 Direct Antihuman-globulin Test (DAT)
determines transfusion incompatibility
 ABO and Rh Type shows the ABO and Rh
blood groups
 Type and Crossmatch shows the blood
group and screen for antibodies in the
recipient’s blood
WEEK 1: JAN 12, 2023
 Compatibility Testing detects antibodies
and antigen in both recipient’s and donor’s
blood
STATS LABS
This laboratory facility is usually located near the
emergency room of some tertiary-care facilities
so that procedures and test can be done
immediately when needed.
REFERENCE LABORATORY
It is a large and independent laboratory that
provides specialized and confirmatory laboratory
tests for blood, urine, and tissues and offers as
well faster turnaround or processing time.
NATIONAL REFERENCE LABORATORIES IN
THE PHILIPPINES
1. East Avenue Medical Center – NRL for
environmental and occupational health,
toxicology, micronutrient assay, and industrial
and chemical emergencies.
2. Lung Center of the Philippines – NRL for
General Clinical Chemistry, Anatomic Pathology
for pulmonary disease and pleural diseases
3. National Kidney and Transplant Institute –
NRL for Hematology, Immunohematology,
Urinalysis, Anatomic Pathology for cardiac
diseases
4. Philippine Heart Center – NRL for cardiac
markers and Anatomic Pathology for cardiac
diseases
5. Research Institute for Tropical Medicine –
NRL for dengue, influenza, TB, and other
mycobacteria, malaria, and other parasites,
bacterial, enteric diseases, measles and other
viral exanthems, Mycology, Enteroviruses,
Antimicrobial resistance and Emerging Diseases
6. San Lazaro Hospital – STD AIDS Cooperative
Central Laboratory (SACCL) – NRL for
HIV/AIDS, Hepatitis and other Sexually
Transmitted Infections