PRINCIPLES OF MEDICAL LABORATORY SCIENCE - LECTURE
M2: UNDERSTANDING PHLEBOTOMY
FRANCHEZKA ALLIANA SANTOS
FEBRUARY 12, 2022
INTRODUCTION
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. It is derived from the two Greek words.
• Phlebos meaning “vein”
• Temnein means “to cut”
• Venesection – The other name of Phlebotomy.
The Evolution of Phlebotomy
• Humans used crude tools to cut vessels
and drain blood from the body.
Stone Age • It is thought to be an effort in getting rid of
evil spirit or cleanse the body of
impurities.
1400 BC • Ancient Egyptians also practiced this as a
form of bloodletting.
• Hippocrates, a Greek physician, believed
that a person’s health was dependent on
the balance of the four humors which are
as follows:
o Blood and Brain – Earth
o Phlegm and Lungs – Air
o Black Bile and Spleen – Fire
460 to 377 BC o Yellow Bile and Gallbladder –
Water
• Excess humor or blood is removed by
bloodletting.
• It was thought that disease resulted from an
excess of one or more of these substances,
and that removing the excess would restore
health.
• The most common surgical technique used
for bloodletting was called venesection.
• Withdrawing large quantities of blood from a
patient while trying to cure or prevent illness
or disease was common.
• Barber-surgeons performed bloodletting as
part of the treatment for some illnesses.
• Trivia: Barber pole represents the rod that
the patient held tightly to show the barber
where the veins are located.
o Red and white stripes:
Middle Ages Represent the bloodied and clean
or Medieval bandages used during the
Period procedure. After the procedure,
they will be washed and hung
outside which will be twisted by the
wind forming the familiar spiral
pattern.
o Blue: signifies the color of the
vein.
17th to 18th • Phlebotomy was treated as a major
Century therapy.
o Anyone willing to claim medical.
o training could perform phlebotomy.
• Lancet – A tool for cutting veins, was the
most prevalent medical instrument of the
time.
o The usual amount of blood
withdrawn was approximately 10
mL, but excessive phlebotomy
was also common.
• Cupping – It involves the application of
special heated suction cups on the
patient's skin and the incision which is
made using a lancet (fleam).
o An alternative medicine procedure
to help ease pain and inflammation
and other health related concerns.
Note: The typical fleam was a wide double-edged
blade at right angles to the handle. Eventually,
multiple fleams were attached and folded into a
brass case for easy carrying. Fleams were also
used for general phlebotomy to open a vein, or
sometimes an artery, to remove large amounts of
blood. The blades were wiped clean with only a
rag; therefore, they undoubtedly transmitted blood-
borne infections from patient to patient.
• Leeching or Hirudotherapy – It involves
placing a drop of milk or blood on the
patient's skin and introducing Hirudo
medicinalis (medicinal leech) to the site,
allowing it to engorge and fall off.
• This is a method that uses leeches for
bloodletting and is currently used for
microsurgical replantation.
o Milk or blood is dropped to the
skin to encourage attachment of
the medicinal leech.
o Leeches secrete important
substances in their saliva and are
as follows:
▪ a local vasodilator – a
substance that increases
the diameter of blood
vessels.
▪ anesthetic
▪ hirudin – an
anticoagulant which
prevents blood clotting.
The practice of phlebotomy continues to this day;
however, principles and methods have improved
dramatically. Today, phlebotomy is performed to:
• To obtain blood for screening and
diagnostic purposes and to monitor
prescribed treatment.
• To remove blood for transfusions at a
donor center.
• To remove blood for therapeutic
purposes, such as treatment for
polycythemia, a disorder involving the
overproduction of red blood cells.
• Diagnostic Purpose: The collection of
Today blood samples for laboratory analysis to
diagnose and monitor medical conditions.
• Therapeutic Phlebotomy: used as a
treatment for blood disorders such as
hemochromatosis, sickle cell disease,
and polycythemia vera.
o To remove extra red blood cells
seen in hemochromatosis.
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 o Remove unusually shaped red
blood cells in sickle cell disease.
o Remove extra iron in the blood
seen in hemochromatosis.
o This procedure is performed to
minimize patient discomfort and
with aseptic techniques.
• There are two main methods used in
Phlebotomy:
o Venipuncture – It is the method of
blood collection using a needle
inserted in a vein.
o Capillary Puncture – through
puncturing the skin with a lancet or
special incision device.
The Roles and Responsibilities of a Phlebotomist as Per Ebuen
• Person trained to obtain blood samples
primarily by venipuncture and
microtechniques.
• The only personal contact a patient has is
with the laboratory.
• Phlebotomists leave a lasting impression of
the quality of the laboratory.
• It is important for a phlebotomist to be
Phlebotomist familiar with the anatomy and physiology
related to laboratory testing and phlebotomy
techniques. As well as the collection and
transport requirements for tests performed in
all sections of the laboratory, the
documentation, patient records, healthcare
systems, and interpersonal skills needed to
provide quality patient care
• Assesses the patient’s physical status.
Phlebotomist • Review the test order forms.
Duties
• Determines the best puncture site for the
Overview
procedure.
• Knows the right order for drawing blood
samples.
• Uses the right tubes for each test.
• Monitors the patient for signs of any
complications.
• Labels the test tubes and sends them to the
laboratory for analysis.
• Correct identification and preparation of
the patient before sample collection.
o 2 identifiers: birthday and name
• Collection of the appropriate amount of
blood by venipuncture or capillary puncture
for the specified tests.
• Selection of the appropriate sample
containers for the specified tests.
• Correct labeling of all samples with the
required information.
• Appropriate transportation of samples
Traditional back to the laboratory in a timely manner.
Duties • Effective interaction with patients and
hospital personnel.
o Pleasing personality
• Processing of samples for delivery to the
appropriate laboratory departments.
• Performance of computer operations and
recordkeeping pertaining to phlebotomy.
• Observation of all safety regulations,
quality control checks, and preventive
maintenance procedures.
• Attendance at continuing education
programs.
The Roles and Responsibilities of a Phlebotomist According to
McCal
• Prepare patients and site for specimen
collection following nationally recognized
Typical Duties standards and institution’s guidelines.
• Collect venipuncture and capillary
specimens for testing following nationally
recognized standards and institutional
procedures.
• Prepare specimens for proper transport,
ensuring the integrity and stability of the
sample.
• Adhere to all HIPAA and confidentiality
guidelines, including all Code of Conduct
and Integrity programs instituted by the
employer.
• Transport and dispatch samples efficiently
by prioritizing specimens to ensure desired
turnaround times.
• Comply with safety rules, policies, and
guidelines for the area, department, and
institution.
• Provide quality customer service for all
internal and external customers.
• Assist in collecting and documenting
monthly workload and recording data.
• Perform quality-control protocols as
specified in standard operating procedures
and perform and document instrument and
equipment maintenance.
• Participate in continuing education (CE)
programs such as Quality, Safety, Lean/Six
Sigma, and Customer Service.
• Collect and perform POCT following all
standard operating procedures.
Traditional • Prepare drafts of procedures for laboratory
Duties tests according to standard format.
• Perform appropriate laboratory computer
information operations.
•
Provide proper instruction to
patients/customers for container specimen
collection.
• Perform front office duties required by
institution including scheduling, coding,
itinerary updates, and obtaining Advance
Beneficiary Notice (ABN).
• Train new technicians and students in duties
and responsibilities.
Patient-Client Interaction
• Factors that are critical in providing a
healthcare service that meets the needs
of diverse populations:
o Health-related needs of
patients and their families
related to the environments
where they live.
Recognizing o Beliefs and values that shape
Diversity a person’s approach to health
and illness.
o Knowledge of customs and
traditions related to health
and healing.
o Attitudes toward seeking help
from a healthcare provider.
•
• It is the conduct and qualities that
characterize a professional person.
• General Appearance and Grooming
directly influence whether the
Professionalism phlebotomist are perceived as a
professional.
• A phlebotomist should display attitudes,
personal characteristics, and
behaviors consistent with accepted
standards of professional conduct.
• All patients in a healthcare setting have
Patients’ rights rights and should be informed of these
rights when care is initiated.
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 • Privacy of medical records and the ability
to get a copy from them.
• The healthcare provider must:
o Recognize that all patient
information is private and
confidential.
o Bound by ethical standards
Confidentiality and various laws to maintain
the confidentiality of each
person’s health information.
o All questions relating to patient
information should be referred
to the proper authority.
Health Insurance • Required all healthcare providers to
Portability and obtain a patient’s consent in writing
Accountability before disclosing medical information
Act of 1996 such as patient’s test results, treatment,
or condition to any unauthorized person.
• Defined as the means by which
information is exchanged or transmitted,
communication is one of the most
important processes that takes place in
the healthcare system.
• Communication involves using words,
Communication sounds, writing, or other means to
Skills express or exchange information when
interacting with one or more persons.
• Effective communication in the
workplace can improve productivity,
reduce errors resulting from
miscommunication, and help
organizations run smoothly. T
• There are three components:
o Verbal Communication –
expressing your ideas through
words that can be easily
understood by the patient.
o Non-verbal communication
– observing patients’ facial
expression and other
nonverbal cues which could
tell something.
o Active Listening – ability to
listen and comprehend what is
being told.
Telephone Skills • To maintain a professional image, every
person given the responsibility of
answering the phone should review
proper protocol.
• Each one should be taught how to
answer, put someone on hold, and
transfer calls properly.
Qualities of Professionalism
• Professional appearance should be
maintained.
Professionalism • Phlebotomists should wear conservative
clothing and observe proper personal
hygiene always.
• Phlebotomists must have self-confidence
especially because they would be
directly expressing their decisions and
Self-Confidence
judgements to patients and fellow co-
workers.
• It is the ability to trust your personal
decision and judgement
Integrity • Exhibits honesty and consistency in
their actions, beliefs, and values.
• Sensitivity to the needs of others, and
Compassion the ability to stay calm, and maintain a
helpful demeanor towards those in need.
• It is having the positive attitude and the
initiative to follow through tasks and
Self-Motivation continuously look for areas and
improvement.
• Dependable, observe proper work ethic,
Dependability and take personal responsibility for their
actions.
Ethical • They display a good ethical behavior by
Behavior conforming with the standards to avoid
harming the patients in any way.
TESTS AND PROCEDURES IN CLINICAL ANALYSIS AREAS
Clinical Area Examples of Tests and Procedures
• Hematocrit (Hct) – Hemoglobin level
and red cell count.
• Hemoglobin (Hgb) – values that rule
out anemia.
• Red Blood Cell (RBC) Count –
Erythropoietic activity.
• White Blood Cell (WBC) Count –
Leukocyte response.
• Platelet Count - chemotherapy and
radiation conditions
• Differential White Blood Cell Count
– changes in the appearance or
Hematology – It quantity of specific cell types
focuses on blood • Indices – show the changes in RBC
and blood-forming size, weight, and Hgb content
tissues.
• 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
• Activated Partial Thromboplastin
Time (APTT) - adequacy of heparin
therapy
• D-dimer - thrombin and plasmin
activity
• Fibrin Split Products (FSP) - amount
Coagulation – ability of fibrin degradation products (FDPs)
of blood to form and in the blood
dissolve clot. • Fibrinogen Test - fibrinogen levels in
the blood
• Prothrombin Time (PT) or
International Normalized Ratio (IN) -
liver diseases or deficiency in Vitamin
K
Chemistry – • Alanine Aminotransferase Test
amounts of certain (ALT) - liver damage
chemicals in a blood • Alpha-fetoprotein (AFP) - alpha-
sample. fetoprotein levels in pregnant women
during the second trimester of
pregnancy
• Alkaline Phosphatase (AP) Test -
amount of alkaline phosphatase
enzyme in the bloodstream
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• Ammonia - measures the level that • Vitamin B12 and Folate Tests - used
could indicate cirrhosis and hepatitis to check for anemia and diseases of
• Amylase - checks the enzyme level the small intestine
that could indicate liver disease, Serology or • Bacterial Studies
cholesystitis, etc. Immunology – o Antinuclear Antibody
• Aspartate Aminotransferase Test serum and (ANA) - shows autoimmune
(AST) - levels of aspartate autoimmune disorders such as systematic
aminotransferase enzyme that may reactions in the lupus erythematosus
indicate liver damage blood. o Antistreptolysin-O (ASO)
• Bilirubin Test - amount of bilirubin Titer - indicates
levels in the bloodstream that could streptococcal infection
indicate red blood destruction o Cold Agglutinins - checks
• Arterial Blood Gases (ABG) - acid- cases of atypical pneumonia
base balance by measuring the ph, o Febrile Agglutination Test -
partial pressure of the carbon dioxide shows the presence of
and oxygen antibodies to specific
• Blood Urea Nitrogen (BUN) - amount organisms
of urea nitrogen found in blood, which o FTA-ABS - confirms syphilis
could determine impaired renal o Rapid Plasma Reagin
function (RPR) - when positive, it is
• B-type Natriuretic Peptide (BNP) indicative of syphilis but it still
Test - levels of the BNP hormone in needs confirmation
the blood which could indicate o Rheumatoid Factor (RF) -
congestive heart failure indicates rheumatoid arthritis
• C-reactive Protein High Sensitivity • Viral Studies
(hs-CRP) - level of CRP o Anti-HIV - screens human
• Carcinoembryonic Antigen (CEA) immunodeficiency virus
Test - CEA protein levels in the blood o Cytomegalovirus Antibody
that may help diagnose and manage (CMV) - a confirmatory test
certain types of cancers for CMV antibody
• Blood Calcium - total amount of o Epstein-Barr Virus (EBV) -
calcium in the blood, which could help checks for the presence of
determine or monitor the effects of heterophil antibody, which
renal failure indicates infectious
• Total Cholesterol - indicates risk of mononucleosis
cardiovascular diseases o Hepatitis B Surface
Antigen (HBSAg) - checks
• Cortisol - shows adrenal hypofunction
for the presence of hepatitis
and hyperfunction
antigen on the surface of the
• Creatine Kinase (CK) - used to check
red cells
muscle damage
• General Studies
• Creatinine - checks for cases that
o C-Reactive Protein (CRP) -
indicate renal impairment or muscular
indicates inflammation when
dystrophy
levels are increased
• Drug Analysis - monitors therapeutic o Human Chorionic
range to avoid toxic levels for drugs Gonadotropin (HCG) Test -
• Electrolytes (sodium, potassium, the hormone is present when
chloride, CO2) - show the sodium patient is pregnant
values that determine disorder of the Urinalysis – tests • Physical Evaluation
kidney and adrenals urine specimen o Color indicates the presence
• Glucose - used to check diabetes, of blood melanin, blirubin, or
liver disease, or malnutrition urobilin in the urine
• Gamma-Glutamyl Transferase specimen.
(GGT) - used for diagnosis of liver, o Clarty/transparency shows
specifically hepatobiliary problems the presence of fat, chyle, or
• Hemoglobin A1C - determines bacteria
glycosylated hemoglobin level o Specinc gravity suggests
• Lactate dehydrogenase - checks renal tubular Involvement or
lung, kidney, and liver dysfunction ADH deficiency, which affect
• Lipase - shows the level that could the turbidity.
lead to either pancreatitis or pancreatic • Chemical Evaluation
carcinoma o Blood - hematuria could be
• Prostate Specific Antigen (PS) - test due to hemorrhage,
that screens patients for the presence intection, or trauma
of prostate cancer o Bilirubin - helps differentiate
• Total Protein - used to check liver and between obstructive
kidney disorders jaundice and hemolytic
• Triglycerides - serve as index in the jaundice
evaluation of atherosclerosis and lipid o Glucose - glucosuria may be
metabolism disorder a result of diabetes mellitus,
• Troponin I - used for early diagnosis renal impairments
of small myocardial infarcts o Ketones - uncontrolled
• Uric Acid Test - used to check levels diabetes mellitus or
that indicate gout and renal problems starvation

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 o Leukocyte - indicates
urinary tract infection if there
is a lot of neutrophils
o pH - indicates the acid-base
balance
o Protein - proteinura is an
indicator of renal dystunction
or disorder
o Nitrite - positive results
could mean bacterial
infection
o Urobilinogen - increases in
amount when the patient
suffers from hepatitic issues.
• Microscopic Evaluation – shows the
status of the urinary tract, hematuria,
pyuria, etc.
Microbiology – • Acid-Fast Bacilli (AFB) - used to
microorganisms in monitor the treatment for TB
body fluids or • Blood Culture - checks for the
tissues. presence of bacteria indicative of
bacteremia or septicemia
• Campylobacter-like Organism
(CLO) Test - shows 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
• Antibody (Ab) Screen - agglutination
means presence of abnormal
antibodies in the blood.
• Direct Antihuman-globulin Test
(DAT) - determines transfusion
Blood Bank or incompatibility.
Immunohematology • ABO and Rh Type - shows the ABO
– blood for and Rh blood groups.
transfusion • Type and Crossmatch - shows the
blood group and screens for antibodies
in the recipient's blood
• Compatibility Testing - detects
antibodies and antigen in both
recipient's and donor's blood.
EDUCATION AND LICENSING