MODULE 1.
UNDERSTANDING PHLEBOTOMY
-Introduction-
Phlebotomy is the process of collecting blood through the
vein by using incision or puncture methods to draw blood
for analysis or as a part of therapeutic or diagnostic
measures under physician’s request. The word is derived
from two Greek words: phlebos, which means vein, and
temnein, which means to cut. It is also called venesection.
-objectives-
Upon completion of this module, you should be able to:
1. describe the evolution of phlebotomy and the role
of phlebotomists in today’s health care system;
2. discuss the traits that form the professional image
of the phlebotomists;
3. explain the basic concepts of communication as
they relate to the healthcare setting;
4. distinguish the different types of healthcare
settings; and
5. enumerate the clinical analysis areas of the
laboratory and the various types of laboratory
procedures performed in the respective areas.
Definition of terms
Term Definition (Meriam Webster Dictionary)
Phlebotomy - Drawing of blood for transfusion,
apheresis, diagnostic testing, or
experimental procedures
-discussion-
PART 1. THE EVOLUTION OF PHLEBOTOMY AND THE
ROLE OF THE PHLEBOTOMISTS IN
TODAY'S HEALTHCARE SETTING
I. Evolution of Phlebotomy
• The practice of phlebotomy can be traced back to
the Stone Age. Back then, humans used crude
tools to cut vessels and drain blood from the body.
The ancient Egyptians also practiced phlebotomy
as a form of "bloodletting" as early as 1400 BC.
• Hippocrates (460-377 BC), a Greek physician,
believed that a person's health was dependent on
the balance of the four humors: (1) Earth-blood and
brain, (2) Air-phlegm and lungs, (3) Fire - black bile
and spleen, and (4) Water-yellow bile and
gallbladder. The removal of excess humor through
bloodletting must be performed to keep the
balance.
• During the Middle Ages, barber-surgeons
performed bloodletting as part of the treatment for
some illnesses. It was only during the 17th and 18th
centuries when phlebotomy was treated as a major
therapy. Cupping and leeching were performed by
phlebotomists using lancets and fleams.
• Cupping is an alternative medicine that helps ease
pain, inflammation, or other health-related
concerns. It involves the application of special-
heated suction cups on the patient’s skin and the
incision that is made using a fleam (lancet) which is
previously wiped with a rag.
• Leeching, also known as hirudotherapy, is a
method that uses leeches for bloodletting and is
currently used for microsurgical replantation. The
process involves placing a drop of milk on the
patient's skin and introducing Hirudo medicinalis
(medicinal leech) to the site allowing it to engorge
and fall off. It is believed that the leeches inject local
vasodilator, anesthetic, and hirudin, which is an
anticoagulant.
Figure 1.1 FLEAMS Figure 1.2 CUPPING & LEECHING
Phlebotomy has evolved from simple bloodletting in the
ancient times into a fundamental diagnostic tool in the
healthcare industry today. The main goals of the
phlebotomy practice are:
(1) for diagnosis and treatment using blood samples,
(2) for transfusion, to remove blood from the donor, and
(3) for removal of blood for polycythemia or therapeutic
purposes.
There are two main methods used in phlebotomy, namely
the venipuncture and the capillary puncture. Venipuncture
is the method of blood collection using a needle inserted in
a vein while capillary puncture is done by puncturing the
skin.
Figure 1.3
Venipuncture
Figure 1.4 Capillary
Puncture
Student assessment question 1:
Elaborately differentiate venipuncture from capillary
puncture. (5pts)
II. Role of the Phlebotomists
• The main role of phlebotomists assigned in the
clinical laboratory is to collect blood samples for
laboratory testing or for transfusion. They properly
label collected blood samples with the necessary
data to identify the patient. They are also
responsible in delivering or transporting specimens
within appropriate prescribed time limits. In other
institutions, phlebotomists also process collected
blood samples such as centrifuging, aliquoting
samples ready got laboratory testing. Sometimes,
they are asked to assist in collecting other
specimens such as urine and other non-blood
samples from patients.
• Phlebotomist are also the main players in blood-
letting activities such as drawing of blood units from
donors for transfusion to a patient requiring whole
blood or blood components.
PART 2. TRAITS THAT FORM THE PROFESSIONAL
IMAGE OF THE PHLEBOTOMISTS
Good phlebotomists possess the following skills and
knowledge:
(1) good manual dexterity;
(2) special communication skills;
(3) good organizational skills;
(4) thorough knowledge of laboratory specimen
requirements; and
(5) the training in phlebotomy skills coupled with
standard practice
I. Credentials
• Phlebotomists need to maintain certain credentials
in the continuous practice of their profession. They
should have the following: certification or license
and continuing education. They have the official
recognition and are certified to have completed the
training by an accredited body as required by the
healthcare institution. They should have passed a
certifying or licensure examination and must be
able to present documents granted by an official
regulating body for having completed the
education, experience, and examination
requirements.
• They should also have continuing education and
should attend trainings and seminars to keep them
updated on the changes, in the practice of their
profession.
Student assessment question 2:
What is Continuing Professional Education (CPE)?
As a future medical technologist, do you think you will
be willingly participating in such programs in the future?
Explain your answer. (10 pts)
II. Patient-Client Interaction
Phlebotomists should be reassuring and pleasant when
dealing with patients. They should be able to communicate
well despite cultural and social differences. They should
maintain positive customer relations especially since they
are the only contact of the patient from the clinical
laboratory, and their attitudes may affect how the patient
views the hospital services in general. Moreover, they must
understand the diversity of the patients and be able to
adjust accordingly. Patients come from various
backgrounds and have different customs and traditions,
beliefs and values, attitudes, and needs based on their
environment and culture.
III. Qualities of Professionalism
Phlebotomists are healthcare professionals in a service-
oriented industry, and are, therefore, expected to practice
professionalism at all times.
1. Professional appearance should be maintained.
Phlebotomists should wear conservative clothing
and observe proper personal hygiene always.
2. Phlebotomists must have self-confidence especially
because they would be directly expressing their
decisions and judgments to patients and fellow co-
workers
.
3. They must be persons of integrity, exhibiting
honesty and consistency in their actions, values,
and beliefs.
4. As healthcare professionals, they must show
compassion, sensitivity to the needs of others, and
the ability to stay calm and maintain a helpful
demeanor towards those in need.
5. Phlebotomists are self-motivated, having the
positive attitude and the initiative to follow through
tasks and continuously look for areas of
improvement.
6. They are dependable, observe proper work ethic,
and take personal responsibility for their actions.
7. They display good ethical behavior, conforming with
standards so as to avoid exposing patients to harm.
PART 3. BASIC CONCEPTS OF COMMUNICATION
IN THE HEALTHCARE SETTING
Phlebotomists need to have good communication skills
which are essential to ensure that the patient feels at ease
during the venipuncture procedure. Communication is.
important in the healthcare setting because of valuable
information that needs to be transmitted properly from one
person to another. The components of good communication
are as follows:
MODULE 1-UNDERSTANDING PHLEBOTOMY 2
I. Verbal Communication
• Verbal communication involves expressing ideas
through words. To be able to have effective
communication in a healthcare setting, it is
important that the sender (speaker) and receiver
(listener) are able to accurately exchange ideas by
using feedback wherein they are able to clarify and
confirm ideas hampered by vagueness, confusion,
and biases. Good phlebotomists use words that
can be easily understood by the patient.
II. Non-verbal Communication
• Phlebotomists should be keen in observing the
patient's facial expressions and other non-verbal
communication cues that could tell something
about how the patient feels. Non-verbal
communication has many dimensions and
elements that include kinesics (body motion and
language), proxemics (individual's concept and
use of space), appearance (attire), and touch
(thoughtful expression).
III. Active Listening
• Listening is major part of communication. It leads to
better understanding of situations and instructions.
Phlebotomists build rapport by listening to their
patients. They should ensure at they have
interpreted the message correctly by giving
feedback.
PART 4. THE HEALTHCARE SETTING
Healthcare facilities are categorized as:
INPATIENT (NON-AMBULATORY)
-requires patients to stay in the hospital for at
least one night to be serviced by tertiary care
practitioners
OUTPATIENT
-in which patients are served by secondary care
specialists on the same day
All patients can be serviced by primary, secondary, and
tertiary levels of healthcare (Williams-Tungpalan, 1981).
(1) Primary level - refers to health units in the rural
areas and sub-units which ·are operated by the
Department of Health.
(2) Secondary level - refers to non-departmentalized
hospitals that attend to patients during the
symptomatic stages of an ailment.
(3) Tertiary level - refers to medical centers and large
hospitals where 'services are sophisticated coupled
with highly technical facilities that can address
serious diseases.
Student assessment question 3:
Give at least three (3) hospitals/institutions that you
know for each level of healthcare. (10 pts)
There are also other healthcare services such as
ambulatory care, homebound services, and public health
services which provide services and procedures for patients
after their discharge from the hospital.
(1) Ambulatory care - is medical care given to
outpatients or patients requiring care or follow-up
check-ups after their discharge from the hospital,
which can be in the freestanding medical care
setting and hospital-owned clinics, or in the
outpatient departments and urgent care facilities.
(2) Homebound services - refer to procedures, tests,
and services provided to a patient which are done
in a patient's home or in a long-term facility.
(3) Public health services - belong to the unit at the
local level but are still under the jurisdiction of the
health department of the government. Services are
offered with little or no charge at all.
PART 5. THE DIFFERENT CLINICAL ANALYSIS
AREAS OF THE LABORATORY AND THE TYPES OF
LABORATORY PROCEDURES PERFORMED
A hospital is an institution that has permanent inpatient
beds with 24-hour nursing service along with therapeutic
and diagnostic services managed by organized medical
staff or personnel. It houses the clinical laboratory services
(clinical lab) where tests requested by physicians are
performed.
I. It has two major divisions:
1. the anatomical and surgical pathology area
- handles tests related to histology (microscopic
structure of tissues), cytology (structure of
cells), and cytogenetics (chromosomal
deficiencies and genetic disease)
2. the clinical analysis area
- is divided into seven (7) areas
Clinical Area Examples of Tests and Procedures and
what they determine
HEMATOLOGY 1. Hematocrit (Hct) -hemoglobin level and red
cell count
-blood and blood-
2. Hemoglobin (Hgb) - values that rule out
forming tissues anemia
3. Red Blood Cell (RBC) Count -
erythropoietic activity
4. White Blood Cell (WBC) Count - leukocyte
response
5. Platelet Count – chemotherapy and
radiation conditions
6. Differential White Blood Cell Count -
changes in the appearance or quantity of
specific cell types
7. Indices - show the changes in RBC size,
weight, and Hgb content
8. Mean Corpuscular Hemoglobin (MCH) -
weight of the hemoglobin in the cell
9. Mean Corpuscular Volume (MCV) – Size P
of the cell
R
I
MODULE 1-UNDERSTANDING PHLEBOTOMY 3
N
 10. Mean Corpuscular Hemoglobin
Concentration (MCHC) - concentration of the
hemoglobin per unit volume of RBCs
11. Red Blood Cell Distribution Width
(ROW) - size differences of the RBCs
COAGULATION 1. Activated Partial Thromboplastin Time
(APTT) - adequacy of heparin
-ability of blood to
therapy
form and dissolve 2. D-dimer - thrombin and plasmin activity
clots 3. Fibrin Split Products (FSP) - amount of
fibrin degradation products (FDPs) in the blood
4. Fibrinogen Test - fibrinogen levels in the
blood
5. Prothrombin Time (PT) or International
Normalize Ratio (INR) – liver diseases or
deficiency in Vitamin K
CHEMISTRY 1. Alanine Aminotransferase Test (ALT)
-amounts of -Liver damage
2. Alpha-fetoprotein (AFP) - alpha-fetoprotein
certain chemicals levels in pregnant women during the second
in a blood sample trimester of pregnancy
3. Alkaline Phosphatase (AP) Test - amount
of alkaline phosphatase enzyme in the
bloodstream
4. Ammonia – measures the level that could
indicate cirrhosis and hepatitis
5. Amylase - checks the enzyme level that
could indicate liver disease, cholecystitis, etc.
6 Aspartate Aminotransferase Test (AST) -
levels of aspartate aminotransferase enzyme
that may indicate liver damage
7. Bilirubin Test - amount of bilirubin levels in
the bloodstream that could indicate red blood
destruction
8. Arterial Blood Gas ,(ABG) - acid-base
balance by measuring the pH, partial pressure
of the carbon dioxide and oxygen
9. Blood Urea Nitrogen (BUN) - amount of
urea nitrogen found in blood, which could
determine impaired renal function
10. B-type Natriuretic Peptide (BNP) Test
-levels of the BNP hormone in the blood which
could indicate congestive heart failure
11. C-reactive Protein High Sensitivity. (hs-
CRP) - level of CRP
12. Carcinoembryonic Antigen (CEA) Test
-CEA Protein levels in the blood that may help
diagnose and manage certain types of cancers
13. Blood Calcium - total amount of calcium
in the blood, which could help determine or
monitor the effects of renal failure
14. Total Cholesterol - indicates risk of
cardiovascular diseases
15. Cortisol - shows adrenal hypofunction and
hyperfunction
16. Creatine Kinase (CK) - used to check
muscle damage
17. Creatinine - checks for cases that indicate
renal impairment or muscular dystrophy
18. Drug Analysis - monitors therapeutic
range to avoid toxic levels for drugs
19. Electrolytes (sodium, potassium,
chloride, CO2) - show the sodium values that
determine disorder of the kidney and adrenals
20. Glucose - used to check diabetes, liver
disease, or malnutrition
21. Gamma-Glutamyl Transferase (GGT)
- used for diagnosis of liver; specifically,
hepatobiliary problems
22. Hemoglobin A1C - determines
glycosylated hemoglobin level
23. Lactate dehydrogenase - checks lung,
kidney, and liver dysfunction
24. Lipase - shows the level that could lead to
either pancreatitis or pancreatic carcinoma
25. Prostate Specific Antigen (PSA) - test
that screens patients for the presence of
prostate cancer
26. Total Protein - used to check liver and
kidney disorders
27. Triglycerides - serve as index in the
evaluation of atherosclerosis and lipid
metabolism disorder
28. Troponin I - used for early diagnosis of
small myocardial infarcts
29. Uric Acid Test - used to check levels that
indicate gout and renal problems
30. Vitamin B12 and Folate Tests - used to
check for anemia and diseases of the small
intestine
SEROLOGY/ 1. Bacterial Studies
IMMUNOLOGY • Antinuclear Antibody (ANA) - shows
autoimmune disorders such as systematic
-serum and lupus erythematosus
autoimmune • Antistreptolysin-O (ASO) Titer -
reactions in the indicates streptococcal infection
blood • Cold Agglutinins - checks cases of
atypical pneumonia
• Febrile Agglutination Test - shows the
presence of antibodies to specific
organisms
• FTA-ABS - confirms syphilis
• Rapid Plasma Reagin (RPR) - when
positive, it is indicative of syphilis but it still
needs confirmation
• Rheumatoid Factor (RF) - indicates
rheumatoid arthritis
2. Viral Studies
• Anti-HIV - screens human
immunodeficiency virus
• Cytomegalovirus Antibody (CMV) - a
confirmatory test for CMV antibody
• Epstein-Barr Virus (EBV) - checks for
the presence of heterophil antibody, which
indicates infectious mononucleosis
• Hepatitis B Surface Antigen (HBSAg) -
checks for the presence of hepatitis
antigen on the surface of the red cells
3. General Studies
• C-Reactive Protein (CRP) - indicates
inflammation when levels are increased
• Human Chorionic Gonadotropin (HCG)
Test - the hormone is present when
patient is pregnant
URINALYSIS 1. Physical Evaluation
-tests urine • Color indicates the presence of blood
melanin, bilirubin or urobilin in the urine
specimen specimen
• Clarity/transparency shows the
presence of fat, chyle, or bacteria which
affect the turbidity
• Specific gravity suggests renal tubular
involvement or ADH deficiency
2. Chemical Evaluation
• Blood - hematuria could be due to
hemorrhage, infection, or trauma
• Bilirubin - helps differentiate between
obstructive jaundice and hemolytic
jaundice
• Glucose - glucosuria may be a result of
diabetes mellitus, renal impairments
• Ketones - uncontrolled diabetes mellitus
or starvation
• Leukocyte - indicates urinary tract
infection if there is a lot of neutrophils
• pH - indicates the acid-base balance
• Protein - proteinuria is an indicator of
renal dysfunction or disorder
• Nitrite - positive results could mean
bacterial infection
• Urobilinogen - increases in amount when
the patient suffers from hepatitic issues
MODULE 1-UNDERSTANDING PHLEBOTOMY 4
 3. Microscopic Evaluation Philippine Heart Cardiac Disease
• shows the status of the -urinary tract, Center (PHC)
hematuria, pyuria, etc
1. Acid-Fast Bacilli (AFB) - used to monitor Lung Center of the Anatomic pathology for
MICROBIOLOGY
the treatment for TB Philippines (LCP) pulmonary disease
-microorganisms 2. Blood Culture - checks for the presence of
in body fluids or bacteria indicative of bacteremia or septicemia
tissues
-SUMMARY-
3. Campylobacter-like Orgarism (CLO) Test
- shows the presence of Helicobacter pylori
4. Culture and Sensitivity (C&S) - indicates
infection if there is growth in the pathogenic Phlebotomists are the foundation of the laboratory; they are
microorganism
5. Fungus Culture and Identification - used our connection to patients. What would medicine be without
to determine the type of fungi if present laboratory results and people who are intimately familiar
6. Gram Stain - it is done to allow with them? On the other hand, what would the laboratory
antimicrobial therapy while waiting for culture be without specimens on which to perform these tests?
results
7. Occult Blood - checks for blood in the stool Therefore, phlebotomy is a major stepping stone for us, as
which could result from gastrointestinal medical laboratory scientists, that as we get to know various
bleeding laboratory test, we get first to master and appreciate the art
8. Ova and Parasites (O&P) Exam - solves of phlebotomy.
"etiology unknown" intestinal disorders
BLOOD BANK/ 1. Antibody (Ab) Screen - agglutination
IMMUNOHEMA- means presence of abnormal antibodies in the
blood
-reference-
TOLOGY 2. Direct Antihuman-globulin Test (DAT) -
-blood for determines transfusion incompatibility • Learning Guide for Principles of Medical
transfusion 3. ABO and Rh Type - shows the ABO and Laboratory Sciences 2
Rh blood groups
4. Type and Crossmatch - shows the blood Copyright 2020 by C&E Publishing Inc.,
group and screens for antibodies in the Bernard U. Ebuen, Nini F. Lim, Edliberto P.
recipient's blood Manahan, Jose Jurel M. Nuevo, Maria Luisa R.
5. Compatibility Testing - detects antibodies Olano, and Aileen C. Patron
and antigen in both recipient's and donor's
blood

Student assessment question 4:

Among all the sections of the clinical laboratory, what
interests you the most and why? Explain your answer.
(10 pts)

II. Stat Labs

• This laboratory facility is usually located near the
emergency room of some tertiary-care facilities so that
procedures and tests can be done immediately when
needed.

III. Reference Laboratory

• A reference laboratory is a large and independent
laboratory that provides specialized and confirmatory
laboratory tests for blood, urine, and tissues, and offers
as well faster turnaround or processing time.

List of Reference Laboratories in the Philippines:

Reference Lab: Specializes in:

Research Institute for Dengue, Influenza, TB, and
Tropical Medicine other Mycobacteria, Malaria
(RITM) and other parasites,
San Lazaro Hospital HIV/AIDS, Hepatitis, Syphillis
(SACCL) and orher STI's
East Avenue Medical environmental and occupational
Center (EAMC) health; toxicology and
micronutrient assay
National Kidney and Hematology, Prepared by:
Transplant Institute Immunohematology,
(NKTI) Immunopathology and Ruth Abigail S. Contante, RMT, LPT
Anatomic Pathology Instructor

MODULE 1-UNDERSTANDING PHLEBOTOMY 5