PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2

Instructor: Jordan Salugao, RMT; Al-Hadad Kalon, RMT; Ivan Chandler Bagorio, RMT
CHAPTER 1 – PHLEBOTOMY INTRODUCTION

SHORT HISTORY OF THE HEALTH CARE SYSTEM

• 460-377 B.C - Hippocrates • The lancet, a tool used for cutting the vein
• stated that disease was the result of excess during venesection
substance-such as blood, phlegm, black bile, • amount of blood withdrawn was
and yellow bile-within the body. approximately 10 mL, but excessive
• 1400 B.C phlebotomy was common.
• application of a leech to a patient evidences
bloodletting in Egypt in about 1400 B.C.
• Middle Ages
• in the Middle Ages, barber–surgeons TYPES OF BLOOD LETTING TECHNIQUES
flourished. By 1210, Cupping
• the Guild of Barber–Surgeons had been o Cupping involved the application of a
formed; Long Robe and Surgeons of the heated suction apparatus, called the “cup,”
Short Robe. to the skin to draw the blood
• Short Robe surgeons were forbidden by o They readily transmitted a host of
law to do any surgery except blood-borne infections from patient to
bloodletting, wound surgery, cupping, patient.
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

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).
o procedures:
Arteriotomy
o It was potentially a very dangerous method.
o It was usually performed on the superficial
temporal artery or one of its branches.
o artery was partially cut through a single
incision.
Scarification
o Scarificators contains from 1-20 blades and
were similar in appearance to the lancet.
o Cupping devices were made of glass, a
gourd, or an animal’s horn.
o
PHLEBOTOMY TODAY
1. Obtain blood for diagnostic purposes and to
monitor prescribed treatment
2. Remove blood for transfusions at a donor
center
3. Remove blood for therapeutic purposes, such as
treatment for polycythemia, a disorder involving
the overproduction of red blood cells
Phlebotomy is primarily accomplished by one of two
1. Venipuncture, which involves collecting blood
by penetrating a vein with a needle and syringe
or other collection apparatus
2. Capillary puncture, which involves collecting
blood after puncturing the skin with a lancet.
The term phlebotomist is applied to any individual who
has been trained in the various techniques used to
obtain blood for laboratory testing or blood donations.
A competent clinical phlebotomist must have good
manual dexterity, special communication skills, good
organizational skills, and a thorough knowledge of
laboratory specimen requirements and departmental
policies.
DUTIES AND RESPONSIBILITIES OF A PHLEBOTOMIST
1. Prepares patient for collection procedures
associated with laboratory samples
 2. Collect routine skin puncture and venous
specimens for testing as required
3. Prepare specimen for transport to ensure
stability of the sample
4. Maintain patient confidentiality
5. Perform quality control checks while carrying
out clerical, clinical, and technical duties
6. Transport specimen to the laboratory
7. Comply with all the procedures instituted in the
procedure manual
8. Promote good relations with patients and
hospital personnel
9. Assist is collecting and documenting monthly
workload and recording data
10. Maintain safe working conditions
11. Perform appropriate laboratory computer
operations
12. Participate in continuing education programs
13. Collect and perform point-of-care testing
14. Perform quality control checks on POCT devices
15. Perform skin tests
16. Prepare and process specimen
17. Collect urine drug testing specimen
18. Perform electrocardiography
19. Perform front-office duties, current procedural
terminology coding and paperwork.
RECOGNITION OF PHLEBOTOMIST
Certification
● a voluntary process by which an agency grants
recognition to an individual who has met certain
prerequisites in a particular technical area
● indicates the completion of defined academic and
training requirements and the attainment of a
satisfactory score on an examination.
● Certification programs
● Basic Phlebotomy procedure by PNRC
● Blood Donation Procedure
Licensure
● Licensure is the act of granting a license.
● License in healthcare is an official document or
permit granted by a state agency that gives legal
permission for a person to work in a particular
health profession.
● must meet specific education and experience
requirements and pass an examination before the
license is granted
● PRC license (MLT, RMT)
Continuing Education
● Continuing education is designed to update the
knowledge or skills of participants and is generally
geared to a learning activity or course of study for
a specific group of health professionals, such as
phlebotomists
● ASCPi, PAMET, PASMETH, PCQACL, PSMLS.
PHLEBOTOMIST COMPETENCIES
• Recognizing Diversity
• Professionalism
• Self-Confidence
• Integrity
• Compassion
• Self-Motivation
• Dependability
• Ethical Behavior
• Confidentiality
Three Components of Communication skills
1. Ability to listen
2. Verbal skills - It involves a sender (speaker), a
receiver (listener), and, when complete, a
process called feedback, creating what is
referred to as the communication feedback loop
• Examples of communication barriers
• Language limitations
• Cultural diversity
• Emotions
• Age
• Physical disabilities such as hearing loss
3. Nonverbal skills - It has been stated that 80% of
language is unspoken. One-dimensional
● Kinesics - study of nonverbal communication is
also called kinesics; it includes characteristics of
body motion and language such as facial
expression, gestures, and eye contact.
o If the verbal and nonverbal messages do
not match, it is called a KINESIC SLIP.
When this happens, people tend to
trust what they see rather than what
they hear.
 o when a patient is anxious, nonverbal Areas in the Clinical Laboratory
signs may include tight eyebrows, an
Clinical labs offers test procedures to aid physicians in
intense frown, narrowed eyes, or a
diagnosis of diseases. It has two major divisions:
downcast mouth
● Proxemics is the study of an individual’s concept • Anatomical and surgical pathology – related to
and use of space. the tests such as histology, cytology and
o Every individual is surrounded by an cytogenetics.
invisible “bubble” of personal territory
• Clinical Analysis area – divided in to seven
in which he or she feels most
different areas.
comfortable
o It is often necessary, in the healthcare
setting, to enter personal or intimate
zones Clinical Area Test Procedures
o not carefully handled, the patient may
Hematology Hematocrit
feel threatened, insecure, or out of
– blood and
control. Hemoglobin
blood-formin
APPEARANCE ETIQUETTE g tissues Red Blood Cell Count
• Phlebotomist’s physical appearance should White Blood Cell Count
communicate cleanliness and confidence. Lab
coats, when worn, should completely cover the Platelet Count
clothing underneath and should be clean and Differential and WBC count
pressed. Shoes should be conservative and
polished. Close attention should be paid to RBC Indices (MCV, MCH, MCHC,
personal hygiene. Bathing and deodorant use RDW)
should be a daily routine. Coagulation Activated Partial Thromboplastin
THE HEALTH CARE SETTING – part of Time (APTT)
hematology,
Healthcare facilities are categorized as inpatient that D-Dimer test
ability to
requires the patient to stay at the hospital for at least a form and Fibrin split products
night and outpatient in which patients are served and dissolve clots
dismissed the same day. Fibrinogen Tests

Healthcare has 3 levels of service: Prothrombin time

• Primary healthcare – refers to the health units

in rural areas and sub-units.
Clinical Test Procedures
• Secondary healthcare – refers to Area
non-departmentalized hospitals that attend to
patients during the symptomatic stages of an Clincal Alanine Alphafetoprotein
ailment. Chemistry aminotransferase (AFP)
– amounts (ALT)
• Tertiary healthcare – larger hospitals and of certain
medical centers that has sophisticated services Alkaline Ammonia
chemicals
coupled with highly technical facilities that can phosphatase (ALP)
in the
address serious illnesses. blood Amylase Aspartate
sample aminotransferase
(AST)
 Bilirubin tests Arterial Blood Gas - Anti-HIV
(ABG) - Cytomegaloviru
s Antibody
Blood Urea B-Natriuretic
- Epstein-Barr
nitrogen (BUN) peptide (BNP)
Virus
C-Reactive protein Carcinoembryoni - Hepatitis B
(CRP) c Antigen (CEA) surface antigen
(HBsAg)
Blood Calcium Cholesterol
General Studies
Cortisol Creatine Kinase
- CRP
Creatinine Drug Analysis - Human
Electrolytes Glucose Chorionic
Gonadotropin
Gamma Hemoglobin A1C
glutamyltransferase
(GGT) Clinical Test Procedures
Lactate Lipase Area
Dehydrogenase
Clinical Physical Other Body
(LD)
Microscopy Evaluation Fluid Analysis
Prostate Specific Total Protein – test urine - Color - Stool
Antigen (PSA) and other - Clarity - Cerebrospin
body fluid - Specific al Fluid (CSF)
Triglycerides Troponin
specimen Gravity - Synovial
Uric Acid Vitamin level fluid
Chemical
tests - Amniotic
Evaluation
fluid
- Blood
- Gastric fluid
- Bilirubin
Clinical Area Test Procedures - Peritoneal
- Glucose
fluid
Serology/Immunolog Bacterial Studies - Ketones
- Pleural fluid
y - serum and - Leukocyte
- Pericardial
- Antinuclear - pH
autoimmune fluid
antibody - Protein
reactions to blood - Semen
- Antistreptolysin - Nitrite
- Sweat
O - Urobilino
- Vaginal
- Cold Agglutinins gen
secretions
- Febrile
Microscopic - Sputum
Agglutination
tests Evaluation
- FTA-ABS
- Rapid Plasma
Reagin
- Rheumatoid
Clinical Area Test Procedures
factor

Viral Studies Microbiology – Acid Fast Bacilli

microorganism in
Blood Culture
 body fluids and Culture and Sensitivity
tisuses
Fungus Culture and
Identification

Gram staining

Ova and Parasites

Blood Bank/ Antibody Screen
Immunohematolog
y – transfusion and Direct Antihuman Globulin
blood components. test

ABO and Rh Typing

Type and Crossmatching

Compatibility testing

STAT and Reference Lab

STAT labs
• Established in the emergency room
Reference laboratory
• Large independent laboratory that receives
specimen from many facilities in the area.
• Provide routine and specialized analysis of the
specimen
• Offer fast turnaround time and reduced cost