SWU - MEDTECH

The Clinical Lab &

Phlebotomy Overview
with
Miss Rolaine Ann A. Polo, RMT, MPH
 PATHOLOGY LABORATORY
ORGANIZATIONAL DIVISION

Clinical
LAB
Anatomical
PATHOLOGY
LAB DIVISION
 ANATOMICAL
AREA
1. CYTOLOGY

2. HISTOLOGY/HISTOPATHOLOGY

3. CYTOGENETICS
 CLINICAL
AREA
1. HEMATOLOGY

2. CHEMISTRY

3. IMMUNOHEMATOLOGY

4. IMMUNOLOGY/SEROLOGY

5. MICROBIOLOGY

6. URINALYSIS
 CLINICAL AREA
In the clinical sections, blood,
bone marrow, microbiology
samples, urine, and other
body fluids are analyzed.
Laboratory Information System
(LIS) department – responsible for
the laboratory computer
operations, maintaining records, and
documentation for the compliance
with accrediting regulations.
CLINICAL AREA:
SECTIONS
 Hematology- is the study of the
formed (cellular) elements of the
blood.
Red blood cells (RBCs)
White blood cells (WBCs)
Platelets (Plts)
Most common fluid analyzed is whole
blood (a mixture of cells and plasma)

T O L O G Y Whole blood is obtained by using a

HEMA
collection tube with an anticoagulant
to prevent clotting.

EXAMPLE: Tubes with lavender stopper

Anticoagulant: Ethylenediaminetetraacetic
acid (EDTA)
Requires 8-10 times of immediate tube
inversion to activate

 HEMATOLOGY

PLASMA SERUM

The liquid portion of the liquid portion of the

blood obtained from a sample blood obtained if the
that has been sample is allowed to
anticoagulated; contains clot; does not contain
fibrinogen. fibrinogen.
 1. Complete Blood Count
Examples of 2.Coagulation/Hemostasis
Tests
the Tests 3. Other body fluid
Performed in analysis
4. Erythrocyte
Hematology Sedimentation Ratio
5. Bone Marrow Analysis
6. Reticulocyte Count
 Most automated area in the
laboratory
Study of components in the blood
including enzymes, hormones,
electrolytes, chemicals and
poisons.
Tests performed on serum,
plasma, urine and other body
fluids
M I S T R Y
CHE Performed primarily on serum
collected in gel barriers, but may
also be collected in tubes with
red, green, gray, or royal blue
stoppers.
 *hemolyzed – specimens that
appear red because of the release
of hemoglobin from RBCs

*Icteric – specimens that are

abnormally yellow due to excess
bilirubin

*lipemic – specimens that are too

Factors that cloudy because of increased lipids.

may affect
☆Fasting samples are preferred. (8-
Chem results 12 hours)

 Test for electrolytes

Examples of like Na, K, Cl, CO₂
Lipid panel
the Tests Total protein
Enzyme immunoassays
Performed in Fasting blood sugar
Blood gas analyses
Chemistry Therapeutic drug
monitoring
Blood urea nitrogen
Creatinine
 Section of the laboratory where blood
may be collected, stored, and prepared
for transfusion
Units of blood are collected from
donors, tested for the presence of
bloodborne pathogens (Hepatitis and
HIV), and stored for transfusions.

M A T O L O GY Blood may also be separated into

E
IMMUNOH A N K)
components including packed cells,
(BL O O D B platelets, fresh frozen plasma, and
cryoprecipitate.
 Examples of Group and type – ABO
and Rh typing
the Tests Type and crossmatch –
ABO, Rh typing and
Performed in compatibility testing
Antibody Screening
Blood banking Direct Coombs Test
Indirect Coombs Test
 The section that performs tests to
evaluate the body’s immune
response.
Detects the presence of antibodies
to bacteria, fungi, parasites,
viruses, and antibodies produced

O L O G Y / against body substances

IMMUN (autoimmunity).

SE R O L O G Y Samples are collected in tubes

with red stoppers.
Examples of Hepatitis B surface
antigen
the Tests Hepatitis Panel
VDRL and RPR for
Performed in syphilis
Anti-HIV
Immuno- Western blot confirms
serology HIV
HCG – pregnancy
Antibody titer
 Identification of pathogenic
microorganisms, effective antibiotic
therapy and infection control in the
hospital.
May be divided into:

I O L O G Y -Bacteriology
MICROB -Mycology
-Parasitology
-Virology
 Blood
Sputum
Wound
Feces
Types of Urine
Specimen GI fluid
Urine
Received in CSF
Micro
 Culture and Sensitivity –
Examples of primary procedure
performed
the Tests Gram stain
Blood culture
Performed in Acid-fast bacillus (AFB)
culture
Microbiology Fungal Culture
Occult blood
Ova and parasites –
performed on stool
sample
CLINICAL AREA:
PERSONNEL
(Philippine setting)
Laboratory Personnel

Pathologist Laboratory Manager

Medical laboratory
Physician who has
scientist a master’s
completed a 4-5
degree (preferred
year pathology
internationally) and 5
residency.
or more years of
Works both in
laboratory experience
clinical and
Responsible for
anatomical
overall technical and
pathology

administrative
management
Laboratory Personnel

Technical l L a b o r a tory
Medica
supervisor Scientist
Medical laboratory
with experience an
scientist
c h e l o r ’s degree
d A ba
expertise related to l
particular laborato
the
in medica
ry y
section/s technolog o r a tory
Reviews all the lab s l a b
results; Perform
consults the pathol
ogist for
i n g r e q u iring
abnormal results; tes t
ent
scheduling of pers
maintenance of au
onnel; independ
machines and prov
tomated
judgment rvision
ides
a l s u p e
research and Minim
developmental prot
for new test proced
ocols

ures

Laboratory Personnel

Medical Laboratory Laboratory

Technician Assistant/Receptionist
a Bachelor's of MT responsible for
graduate from coordinating the daily
accredited college administration of doctors,
medical laboratory staff, visitors, and patients
program, but failed to at a healthcare facility.
pass the board or was They schedule
not able to take the appointments, answer
boards patient inquiries, handle
Has a training in patient emergencies, and
phlebotomy, sample monitor stock and
receiving and supplies at the healthcare
facility
processing
Laboratory Personnel

Phlebotomist
medical professionals who
work in medical labs, taking
blood samples from patients
and adequately labeling them
with their information. They
conduct a wide range of tests
to identify underlying
conditions to assist Doctors
with diagnosis and patient
care.
File Edit View

Phlebotomy
and the
Healthcare
Field
 What is phlebotomy?

Phlebotomy is the collection of blood

samples for laboratory analysis to diagnose
and monitor medical conditions.
Phlebotomist is a person trained to obtain
blood samples primarily by venipuncture
and microtechniques.
 Duties of the Phlebotomist

1. Correct identification and preparation of the

patient before sample collection
2. Collection of the appropriate amount of
blood needed
3. Selection of appropriate sample containers
4. Correct labelling of all samples
5. Appropriate transportation of samples
6. Effective interaction with patients and
hospital personnel

 Duties of the Phlebotomist

7. Processing of samples for delivery to the

appropriate laboratory departments
8. Performance of computer operations and
record-keeping
9. Observation of all safety regulations, quality
control checks, and preventive maintenance
procedures
9. Attendance at continuing education programs

 Dependable, cooperative,
Professional and committed
Personal Characteristics Compassionate, courteous,
for Phlebotomists respectful
Integrity, honesty,
competence
Organized, responsible,
flexible
Appearance
Communication
a. Verbal
b. Listening
c. Body language
d. Telephone skills
 Appearance Guidelines

Clean and unwrinkled clothing

Clean, appropriate footwear
Conservative jewelry and makeup
Perfume/cologne not
recommended
Hair/facial hair clean, neat, and
trimmed
Long hair must be pulled back
Proper personal hygiene
Proper fingernail length and
maintenance
No artificial nails (Center for Disease
Control Guidelines)
 Culture Diversity Guidelines

Smile and use a friendly Be mindful of personal

tone of voice. space.

Be alert to patients’ Take time to explain

reactions. procedures.

Show respect for their

Do not stereotype. diversity.
Phlebotomy Education and
Certification

Certification requirements
Certification examinations
Computer adaptive testing
Professional organization
membership
Continuing education
Required for licensure
Maintain certification
Phlebotomist
Certification
Health-Care Delivery System

Employment settings:
1. Hospitals
2. Physician Office
Laboratories (POL)
3. Health Maintenance
Organizations (HMO)
4. Reference laboratories
5. Urgent care centers
6. Nursing homes
7. Home health-care
agencies
8. Blood donor centers
File Edit View

Regulatory,
Ethical and
Legal Issues
Agencies:
a. CLIA (CLINICAL LABORATORY IMPROVEMENT
AMENDMENTS OF 1988 – Requirements for persons
performing waived, provider- performed microscopy,
moderate-complexity, and high-complexity testing.
b. JC (JOINT COMMISSION) – Accreditation and certification of
health care organizations
c. CLSI (CLINICAL AND LABORATORY STANDARDS
INSTITUTE)– agency that develops written standards and
guidelines for sample collection, handling and processing,
and laboratory testing and reporting
d. CAP (COLLEGE OF AMERICAN PATHOLOGISTS) – Laboratory
accreditation and provision of proficiency testing
Patient’s Bill of Rights /
Patient Care Partnership
Require the phlebotomists to:
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 the confidentiality of
patient information.
 Ethics versus Medical
Law
Ethics are recommended
standards of right and
wrong.

Medical law specifies legally

required conduct of health-
care providers.
Legal Issues related

to Medicine - Tort Intentional

Law 1. Assault
A wrongful act
2. Battery
committed by one 3. Defamation
person against

another that
causes harm to the
person or his or
Unintentional
her property is
called a tort 1. Negligence

2. Malpractice

 Tort Law
Assault Battery Defamation
is the threat to is spoken or
touch another is the actual
person without harmful written
his or her touching of a words that
consent and
person with can injure a
with the
intention of his or her person’s
causing fear of consent. reputation.
harm.
 Tort Law
Malpractice Negligence
misconduct or defined as failure
lack of skill by to give
a health-care reasonable care
professional by the health-
that results in care provider.
injury to the Must be proven
patient in a malpractice

suit.

Sentinel event
An unexpected occurrence
resulting in death or
serious physical (such as
loss of a limb) or
psychological injury.
A report including the
event, a root cause
analysis, and an action
plan must be developed
for the JC.
Phlebotomists can cause a
sentinel event by patient
misidentification and
sample mislabeling.
REFERENCE:

STRASINGER, SK AND
DI LORENZO, MS (2011)
THE PHLEBOTOMY
TEXTBOOK (3RD
ed.)PHILADELPHIA; FA
DAVIS
Thank You
See you next time.