MLS 038

Lesson title: Introduction to Phlebotomy COMMON TESTS PERFORMED

• Complete Blood Count
THE CLINICAL LABORATORY o Differential - % of different types of WBCs and
evaluates RBCs and platelet morphology
ANATOMICAL CLINICAL o Hematocrit (Hct) – volume of RBCs packed by
CYTOLOGY HEMATOLOGY/COAGULATION centrifugation
HISTOLOGY MICROSCOPY o Hemoglobin (Hgb) – oxygen-carrying capacity of
CYTOGENETICS CHEMISTRY RBCs
BLOOD BANK o MCV – the size of RBCs
SEROLOGY(IMMUNOLOGY) o MCH – amount of hemoglobin in RBCs
MICROBIOLOGY o MCHC – weight of the Hgb in a red blood cell
URINALYSIS o Platelet count – no. of platelets in blood
PHLEBOTOMY o Red cell distribution width (RDW) – diff size of
RBCs
ANATOMICAL o White blood cell count (WBC) – no. of platelets
in blood
- Responsible for the analysis of surgical specimens, • Other Routine Test
frozen sections, biopsies, cytological specimens, o Body fluid analysis – type of cells
and autopsies. o Bone marrow – type of cells in bone marrow
o Erythrocyte sedimentation rate (ESR) –
CLINICAL
o Reticulocyte count – bone marrow production
- This are analyzed in the clinical sections: o Sickle cell – Screening test for sickle cell anemia
o Blood o Special stains – type of anemia
o Bone marrow
o Microbiology samples COAGULATION
o Urine - The overall process of hemostasis is evaluated;
o Other body fluids o Platelets
Laboratory Information Systems (LIS) - are o Blood vessels
responsible for the laboratory computer operations, o Coagulation factors
maintaining records, and documentation for the o Fibrinolysis
compliance with accrediting regulations. o Inhibitors
o Anticoagulant therapy (Heparin and
HEMATOLOGY Coumadin)
- Is the study of formed (Cellular) elements of the Test performed:
blood. o Prothrombin Time (PT)
o Red Blood Cells (Erythrocytes) - Extrinsic Pathway of coagulation cascade
o White Blood Cells (Leukocytes): and monitors Coumadin
- Neutrophils o Activated Partial Thromboplastin Time (APTT)
- Lymphocytes - Intrinsic Pathway of coagulation cascade
- Monocytes and monitors Heparin
- Basophils o Thrombin Time (TT)
- Eosinophils - Clotting time; if adequate fibrinogen is
o Platelets (Thrombocytes) present
- Whole Blood is the most common fluid analyzed o Bleeding Time
obtained by using a collection tube with an - Evaluates function of platelets
anticoagulant to prevent clotting. o Factors Assays
SPECIMEN TYPE - Detect Factor Deficiency
• Plasma – Liquid portion of the blood obtained CHEMISTRY
from a sample that has been anticoagulated; - Most automated area in the laboratory
contains fibrinogen. - Study of components in the blood including:
• Serum – Liquid portion of the blood obtained if the o Enzymes
sample is allowed to clot; does not contain o Hormones
fibrinogen. o Electrocytes

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o Chemical and poisons - SSR containing gel are not acceptable

Test performed on: - Patient identification is critical in this section
o Serum Test Performed:
o Plasma o Group and type – ABO and Rh typing
o Urine o Type and crossmatch – ABO, Rh typing and
o Other body fluids compatibility testing
- Performed primarily on serum collected in gel o Antibody Screening
barriers, but may also be collected in tubes with o Direct Coombs Test
red, green, grey, or royal blue stoppers o Indirect Coombs Test
PRE-ANALYTICAL FACTORS
Factors that affect test results: SEROLOGY/ IMMUNOLOGY
Hemolyzed – specimens that appear red because - Section performs test to evaluate the body’s
release of hemoglobin from RBCs immune response
Icteric – specimens that are abnormally yellow due to - Detects the presence of antibodies to bacteria,
excess bilirubin fungi, parasites, viruses, and antibodies produce
Lipemic – specimens that are too cloudy because of against body substances (autoimmunity)
increased lipids - Samples are collected in:
- Fasting samples are preferred (8-12 hours) o Red stoppers
Test performed:
o Hepatitis B surface antigen
o Hepatitis Panel
o VDRL and RPR for Syphilis
o Anti-HIV
o Western blot (confirms HIV)
o HCG (pregnancy)
o Antibody titer
MICROBIOLOGY
- Identification of pathogenic microorganisms,
effective antibiotic therapy and infection control
ROUTINE TESTS:
in the hospital
o Test for electrolytes like Na, K, Cl, CO2
May be divided into:
o Lipid panel
• Bacteriology
o Total protein
• Mycology
o Enzyme immunoassays
o Fasting Blood sugar • Parasitology
o Blood gas analysis • Virology
o Therapeutic drug monitoring SPECIMEN TYPE:
o Blood Urea Nitrogen (BUN) o Blood
o Creatinine o Sputum
o Wounds
o Feces
BLOOD BANK/ IMMUNOHEMA
o Urine
- Section of the lab where blood may be collected,
o GI tract
stored, and prepared for transfusion
o Throat swab
- Collected from donors, tested for the presence of
o CSF (Cerebrospinal Fluid)
bloodborne pathogens (Hepatitis and HIV), and
Test performed:
stored for transfusions
o Culture and Sensitivity – primary
- Blood may also be separated into components
procedure
including packed cells, platelets, fresh frozen
o Gram stain
plasma, cryoprecipitate
o Blood culture
ANALYTICAL FACTORS
o Acid-fast bacillus (AFB) culture
- Samples are collected in:
o Fungal Culture
o Plain red (serum)
o Occult blood
o Lavender
o Ova and parasites (stool sample)
o Pink (plasma)

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URINALYSIS research and developmental protocols for

- Detection disorders and infections of kidneys and new test procedures.
detect metabolic disorders such as diabetes and 4. Medical Laboratory Scientist
liver disease - A bachelor’s degree in medical technology
- Consists physical, chemical, and microscopic and 1 year training in accredited
examination of urine laboratory
- Urine sample must not sit at room temperature - Performs laboratory testing requiring
for longer than 2 hours independent judgment
Test performed: - Minimal supervision
PHYSICAL EXAMINATION: 5. Medical Laboratory Technician
o Color - 2-year associate degree from an
o Volume accredited college medical laboratory
o Clarity program
MICROSCOPIC: - Performs laboratory testing by protocol
o Cells under supervision
o Casts 6. Laboratory Assistant
o Crystals - Has a training in phlebotomy, sample
o Microbes receiving and processing, quality control
CHEMICAL EXAMINATION: and preventive maintenance of
o pHh instruments, and computer data entry
o Protein and can perform basic “walved”
o Glucose laboratory testing
o Ketones 7. Phlebotomist
o Blood - Highschool diploma and a phlebotomy
o Bilirubin training program
o Urobilinogen - Sample collection and processing
o Specific gravity
o Nitrite PHLEBOTOMY AND THE HEALTHCARE FIELD
o Leukocyte esterase CERTIFICATIONS

CLINICAL LABORATORY PERSONNEL

1. Laboratory Director (Pathologist)
- A physician who has completed a 4-5 year
pathology residency
- Works both clinical and anatomical
pathology
- Liason between the medical staff and lab
staff
2. Laboratory Manager (Administrator)
- Medical laboratory Scientist with a
master’s degree and 5 or more years of HEALTH-CARE DELIVERY SYSTEM
laboratory experience Employment settings:
- Responsible for overall technical and o Hospitals
administrative management o Physician Office Laboratory (POL)
o Health Maintenance Organizations (HMO)
3. Technical Supervisor o Reference Laboratories
- Med lab scientist with experience and o Urgent care centers
expertise related to the particular o Nursing homes
laboratory section o Home health-care agencies
- Review all the lab results; consults the
pathologist for abnormal results;
scheduling of personnel; maintenance of
automated machines and provides

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o Blood donor centers MEDICAL LAW – Specifies legally required conduct of

health-care providers.

TORT LAW
A wrongful act committed by one person against
another that causes harm to the other person or his
/her property is called a tort
Intentional:
o Assault – a harmful touching/ threat without
consent
o Battery – a harmful touching with consent
o Defamation – spoken or written words that
can injure a person’s reputation
Unintentional:
o Negligence - failure to give reasonable care in
a malpractice suit
o Malpractice – Misconduct or lack of skills that
HOSPITAL PATIENT CARE AREAS
results in injury to the patient
REGULATORY, ETHICAL, AND LEGAL ISSUES
• CLIA (Clinical Laboratory Improvement
Amendments of 1988) – Requirements for
persons performing walved, provider-
performed microscopy, moderate complexity,
and high-complexity testing.
• JC (Joint Commission) – Accreditation and
certification of health care organizations
• CLSI (Clinical and Laboratory Standards
institute) – agency that develops written
standards and guidelines for sample collection,
handling and processing, and laboratory testing
and reporting
• CAP (College of American Pathologists) –
Laboratory accreditation and provision of
proficiency testing

JOINT COMMISSION PATIENT SAFETY GOALS

• Improving the Accuracy of Patient Identification
• Improving the Effectiveness of Communication
among Healthcare Givers
• Reduce the Risk of Healthcare-Associated
Infections
• Encourage Patients’ Active Involvement in their
own case as a Patient Safety Strategy
• Handwashing
PATIENT’S BILL OF RIGHTS/ PATIENT CARE PARTNERSHIP
• Be respectful of their patients
• Refer patients to their healthcare provider for
information on their tests and condition
• Recognize that a patient can refuse treatment
• Maintain confidentiality of patient information
ETHICS VERSUS MEDICAL LAW
ETHICS – are recommended standards of right or
wrong