PRINCIPLES OF MEDICAL LABORATORY

SCIENCE PRACTICE 2 TYPES OF BLOOD LETTING TECHNIQUES

CHAPTER 1 – PHLEBOTOMY HEALTH CARE Cupping

DELIVERY SYSTEM o Cupping
involved the
Healthcare System History application of a
heated suction
apparatus, called
the “cup,” to the skin
to draw the blood
o They
readily transmitted a
host of blood-borne
infections from
patient to patient.

Leeching
o Leeches
were used.
o This
procedure involved
enticing the Hirudo
medicinalis a
European medicinal
leech, to the spot
needing bloodletting with a drop of milk or blood on
the patient’s skin
o the components of the worm’s saliva,
o local vasodilator (substance that
increases the diameter of blood vessels).
o local anesthetic.
o hirudin, an anticoagulant (a substance
that prevents clotting).
• 460-377 B.C – Hippocrates
• stated that disease was the result of
excess substance-such as blood, phlegm, black Arteriotomy
bile, and yellow bile-within the body. o It was potentially a very dangerous
• 1400 B.C method.
• application of a leech to a patient o It was usually performed on the
evidences bloodletting in Egypt in about 1400 B.C. superficial o
• Middle Ages temporal artery or one of its branches.
• in the Middle Ages, barber–surgeons o artery was partially cut through a single
flourished. By 1210, incision.
• the Guild of Barber–Surgeons had been
formed; Long Robe and Surgeons of the Short
Robe.
• Short Robe surgeons were forbidden by
law to do any surgery except bloodletting, wound
surgery, cupping, leeching, shaving, tooth
extraction, and enema administration.
• Long Robe surgeon, barber–surgeons
placed a striped pole, from which a bleeding bowl
was suspended, outside their doors.
• 17th to 18th century
• phlebotomy was considered a major
therapeutic (treatment) process
• The lancet, a tool used for cutting the vein
during venesection
• amount of blood withdrawn was
approximately 10 mL, but excessive phlebotomy
was common.
 19. Perform front-office duties, current
PHLEBOTOMY TODAY procedural terminology coding and paperwork.

1. Obtain blood for diagnostic purposes and RECOGNITION OF PHLEBOTOMIST

to monitor prescribed treatment
2. Remove blood for transfusions at a donor Certification
center
3. Remove blood for therapeutic purposes, ● a voluntary process by which an agency
such as treatment for polycythemia, a disorder grants recognition to an individual who has met
involving the overproduction of red blood cells certain prerequisites in a particular technical area
● indicates the completion of defined
Phlebotomy is primarily accomplished by one of academic and training requirements and the
two procedures: attainment of a satisfactory score on an
1. Venipuncture, which involves collecting examination.
blood by penetrating a vein with a needle and ● Certification programs
syringe or other collection apparatus ● Basic Phlebotomy procedure by PNRC
2. Capillary puncture, which involves ● Blood Donation Procedure
collecting blood after puncturing the skin with a
lancet. Licensure
● Licensure is the act of granting a license.
The term phlebotomist is applied to any individual ● License in healthcare is an official
who has been trained in the various techniques document or permit granted by a state agency that
used to obtain blood for laboratory testing or blood gives legal permission for a person to work in a
donations. particular health profession.
● must meet specific education and
A competent clinical phlebotomist must have good experience requirements and pass an examination
manual dexterity, special communication skills, before the license is granted
good organizational skills, and a thorough ● PRC license (MLT, RMT)
knowledge of laboratory specimen requirements
and departmental policies. Continuing Education
● Continuing education is designed to
DUTIES AND RESPONSIBILITIES OF A update the knowledge or skills of participants and
PHLEBOTOMIST is generally geared to a learning activity or course
of study for a specific group of health
1. Prepares patient for collection procedures professionals, such as phlebotomists
associated with laboratory samples ● ASCPi, PAMET, PASMETH, PCQACL,
2. Collect routine skin puncture and venous PSMLS.
specimens for testing as required
3. Prepare specimen for transport to ensure PHLEBOTOMIST COMPETENCIES
stability of the sample • Recognizing Diversity
4. Maintain patient confidentiality • Professionalism
5. Perform quality control checks while • Self-Confidence
carrying out clerical, clinical, and technical duties • Integrity
6. Transport specimen to the laboratory • Compassion
7. Comply with all the procedures instituted • Self-Motivation
in the procedure manual • Dependability
8. Promote good relations with patients and • Ethical Behavior
hospital personnel • Confidentiality
9. Assist is collecting and documenting
monthly workload and recording data Three Components of Communication skills
10. Maintain safe working conditions 1. Ability to listen
11. Perform appropriate laboratory 2. Verbal skills - It involves a sender
computer operations (speaker), a receiver (listener), and, when
12. Participate in continuing education complete, a process called feedback, creating
programs what is referred to as the communication feedback
13. Collect and perform point-of-care testing loop
14. Perform quality control checks on POCT • Examples of communication barriers
devices • Language limitations
15. Perform skin tests • Cultural diversity
16. Prepare and process specimen • Emotions
17. Collect urine drug testing specimen • Age
18. Perform electrocardiography • Physical disabilities such as hearing loss
3. Nonverbal skills - It has been stated that Areas in the Clinical Laboratory
80% of language is unspoken. One-dimensional
Clinical labs offer test procedures to aid physicians
● Kinesics - study of nonverbal in diagnosis of diseases. It has two major
communication is also called kinesics; it includes divisions:
characteristics of body motion and language such • Anatomical and surgical pathology –
as facial expression, gestures, and eye contact. related to the tests such as histology, cytology and
o If the verbal and nonverbal messages do cytogenetics.
not match, it is called a KINESIC SLIP. When this
happens, people tend to trust what they see rather • Clinical Analysis area – divided in to
than what they hear. seven different areas.
o when a patient is anxious, nonverbal
signs may include tight eyebrows, an intense Clinical Area Test Procedures
frown, narrowed eyes, or a downcast mouth Hematology Hematocrit
● Proxemics is the study of an individual’s – blood and
Hemoglobin
concept and use of space. blood-formin
o Every individual is surrounded by an g tissues Red Blood Cell Count
invisible “bubble” of personal territory
White Blood Cell Count

in which he or she feels most comfortable Platelet Count

o It is often necessary, in the healthcare Differential and WBC count
setting, to enter personal or intimate zones
o not carefully handled, the patient may feel RBC Indices (MCV, MCH, MCHC,
threatened, insecure, or out of control. RDW)

Coagulation Activated Partial Thromboplastin

APPEARANCE ETIQUETTE – part of Time (APTT)
hematology,
D-Dimer test
ability to
• Phlebotomist’s physical appearance form and Fibrin split products
should communicate cleanliness and confidence. dissolve clots
Lab coats, when worn, should completely cover Fibrinogen Tests
the clothing underneath and should be clean and Prothrombin time
pressed. Shoes should be conservative and
polished. Close attention should be paid to Clinical Test Procedures
Area
personal hygiene. Bathing and deodorant use
should be a daily routine. Clincal
Chemistry
Alanine
aminotransferase
Alphafetoprotein
(AFP)
– amounts (ALT)
of certain
THE HEALTH CARE SETTING chemicals
Alkaline Ammonia
phosphatase (ALP)
in the
Healthcare facilities are categorized as inpatient blood Amylase Aspartate
that requires the patient to stay at the hospital for sample aminotransferase
(AST)
at least a night and outpatient in which patients are
Bilirubin tests Arterial Blood Gas
served and dismissed the same day. (ABG)

Blood Urea B-Natriuretic

nitrogen (BUN) peptide (BNP)
Healthcare has 3 levels of service:
C-Reactive protein Carcinoembryoni
(CRP) c Antigen (CEA)

• Primary healthcare – refers to the health Blood Calcium Cholesterol

units in rural areas and sub-units. Cortisol Creatine Kinase

Creatinine Drug Analysis

• Secondary healthcare – refers to non- Electrolytes Glucose

Gamma Hemoglobin A1C

departmentalized hospitals that attend to patients glutamyltransferase
during the symptomatic stages of an ailment. (GGT)

Lactate Lipase
Dehydrogenase
• Tertiary healthcare – larger hospitals and (LD)

medical centers that has sophisticated services Prostate Specific

Antigen (PSA)
Total Protein

coupled with highly technical facilities that can Triglycerides Troponin

address serious illnesses.
 Gram staining

Ova and Parasites

STAT and Reference Lab STAT labs
Blood Bank/ Antibody Screen
• Established in the emergency room Immunohematolog
Direct Antihuman Globulin
y – transfusion and
Reference laboratory test
blood components.
• Large independent laboratory that ABO and Rh Typing
receives specimen from many facilities in the area.
Type and Crossmatching
• Provide routine and specialized analysis
Compatibility testing
of the specimen

• Offer fast turnaround time and reduced

cost