PHLEBOTOMY AND THE HEALTH

CARE DELIVERY SYSTEM

 DEFINITION OF PHLEBOTOMY
Phlebotomy is the act of drawing or removing blood
from the circulatory system through a cut (incision) or 
puncture in order to obtain a sample for analysis and
diagnosis. Phlebotomy was known as bloodletting when
it was first used during the ancient Egyptians.
 HISTORY OF PHLEBOTOMY
Phlebotomy’s history actually began as “bloodletting,”
which was first practiced by the ancient Egyptians around
1000 BC. It was believed that literally letting blood out of
the body would cure diseases like acne or the plague, and
some believed that the practice would even cast out evil
spirits.
Bloodletting became popular and spread to the Greeks
and the romans and then through Europe in the medieval
era.
The thought surrounding the practice was that blood was
stagnant in the extremities. Releasing the stagnant blood
would cure the patient by forcing the blood to move.
• Middle ages, bloodletting was not performed by
physicians, but by barber-surgeons. These barber-
surgeons also performed amputations and pulled
teeth.
1800’s
• The popularity of bloodletting was high.
• They also used ‘cupping’, a method of blistering the
skin so blood could be released from the blisters.
• Leeches were also used to suck up blood (apparently
they can suck up ten times their body weight in blood).
• Bloodletting at the time was used to cure acne, asthma,
cancer, cholera, coma, convulsions, diabetes, epilepsy
and much more.
 QUALITIES OF A PHLEBOTOMIST:
1. Compassion. a phlebotomist’s primary duty is drawing
blood. Because some patients or clients are afraid of
having their blood drawn, it is especially important that
phlebotomists are caring and understanding while
performing their duties in order to make the patient
feel as comfortable and at ease as possible.
2. Steady hands. a phlebotomy technician with steady
hands is a phlebotomy technician who is valued by
 patients. Such a phlebotomist is valued due to his
or her ability to control hand movements during
venipuncture procedures.
3. Be patient. one of the greatest qualities that any
phlebotomist could possess is a high level of patience.
As a phlebotomist who works with countless
patients from various cultural backgrounds and
individuals of various age groups, patience is a
necessity.
4. Hand–eye coordination. drawing blood is a
complicated task that phlebotomist must do several times a
day. They are responsible for drawing blood from many
patients, and they must perform their duties successfully on
the first attempt, or their patients will experience
discomfort or pain.
5. Calm tone of voice. when working with the public, a
calm tone voice is very important. Although a phlebotomist
may occasionally encounter a disgruntled patient, he or
she is still expected to
 exhibit calmness. Regardless of a patient’s
mannerism, the professional phlebotomist should still
address such patient appropriately by thoroughly
answering questions and providing him or her with
information necessary to complete any phlebotomy
procedure.
6. Detail oriented. phlebotomists must draw the
correct vials of blood for the tests ordered, track vials
of blood, and enter data into a database.
7. Be Responsible. the diagnostic testing and the early
treatment of any health condition begins with the correct
steps taken by a phlebotomist. Such steps include
correct patient identification, correct venipuncture
procedures and labeling of evacuated tubes. A mistake
in any phlebotomy process could lead to contaminated
blood specimens or a patient being misdiagnosed with a
medical condition that may not exist.
Communication Skills in Healthcare
Communication skills in a healthcare setting include the
way you use to:
• explaining diagnosis, investigation and treatment.
• involving the patient in the decision-making.
• communicating with relatives.
• communicating with other health care professionals.
• breaking bad news.
• breaking bad news.
• seeking informed consent/clarification for an
invasive procedure or obtaining consent for a post-
mortem.
• dealing with anxious patients or relatives.
• giving instructions on discharge.
• giving advice on lifestyle, health promotion or risk
factors.
 Although communication is not our goal in medical
encounter, this will help us establish a rapport and
friendly environment. Our goal is to figure out what is
going wrong with the patient physically and
psychologically in order to help them. A good
communication skill is a wonderful magical means to
achieve our goal, which is the patient’s well being.
 DIFFERENT TYPES OF HEALTHCARE
SETTINGS:
1. General hospital. a hospital that provides a range of
different services for patients of various age groups and
with varying disease conditions.
2. Specialized hospital. a hospital admitting primarily
patients suffering from a specific disease or affection of
one system, or reserved for the diagnosis and treatment
of conditions affecting a specific age group or of a
long-term nature.
3. District/first-level referral hospital. a hospital at the
first referral level that is responsible for a district or a
defined geographical area containing a defined
population and governed by a politico-administrative
organization such as a district health management team.
The District hospital has the following functions:
–it is an important support for other health services and
for health care in general in the district;

-it provides wide-ranging technical and administrative

support and education and training for primary health
care;
–it provides an effective, affordable health-care service
for a defined population, with their full participation, in
cooperation with agencies in the district that have
similar
concerns.
4. Primary Health-care Centre. a center that provides
services which are usually the first point of contact with
a health professional. They include services provided by
general practitioners, dentists, community nurses,
pharmacists and midwives, among others.
5. Birth centers. a birth center is a healthcare facility for
childbirth that focuses on the midwifery model. They
aim to create a birth environment that feels more
comfortable to the mother and allows for a cost-
effective, family-inclusive birth.
5. Blood banks. blood banks allow donors to donate
blood and platelets while also storing and sorting blood
into components that can be used most effectively by
patients.
6. Clinics and Medical offices. the definition of a clinic
is “a facility for diagnosis and treatment of outpatients.”
7. Dialysis centers. dialysis is a process that filters and
cleans the blood artificially—the work functioning
kidneys normally take on.
8. Hospice homes. it represents a philosophy of care
provision for dying patients as well as official networks
that offer hospice care.
9. Mental Health and Addiction treatment centers.
mental health treatment facilities sometimes exist as a
general institution for any mental health issue and are
sometimes
specialized. Examples of these kinds of facilities are
suicidal thoughts (or suicidal ideation) treatment,
depression treatment, trauma and post-traumatic stress
disorder (PTSD) treatment, treatment for anxiety
disorders, behavioral disorders and more.
10. Nursing homes. nursing homes offer a living
situation for patients whose medical needs aren’t severe
enough for hospitalization, but are too serious to
manage at home.
11. Orthopedic and other Rehabilitation centers
orthopedic centers deal in everything from athletic
injuries to therapy for patients with disabilities. They
typically offer evaluation and diagnosis of the problem,
as well as prevention, treatment and rehabilitation work
involving bone, tendon, ligament, muscle and joint
conditions.
12. Reference Laboratory – it is a large and
independent lab. that provides specialized and
confirmatory lab. Tests on blood, urine, and tissues and
offers faster turnaround or processing time.
Clinical Laboratory has two major divisions:
1. Anatomical and Surgical Pathology – handles tests
related to Histology (microscopic structure of
tissues)
2. Clinical Analysis Area which is divided into 7 areas:
-Hematology -Serology/Immunology
-Chemistry -Microbiology
-Urinalysis
-Blood Bank/Immunohematology
         
Different Sections in the Laboratory:
Clinical Microscopy this section performs routine and
special tests on patients’ urine and
fecal samples. These samples are
chemically analyzed and examined
in the microscope.
A routine urinalysis consists of physical, chemical,
and microscopic examination of urine. The physical
examination evaluates the color, clarity, and specific
gravity of the urine. The chemical examination is
performed using chemical reagent strips (dipsticks) to
determine pH, glucose, ketones, protein, blood, bilirubin,
urobilinogen, nitrite, and leukocytes. The microscopic
examination identifies the presence of cells, casts,
bacteria, crystals, yeast, and parasites (automated system
can perform UA). Urine samples should be examined
within 2 hours after collection. For routine examination a
first morning sample is preferred because it is more
concentrated.
Hematology The hematology section performs
routine and special tests on the
components of whole blood such as the red
blood cells, white blood cells, and platelet.
The section also performs cell counts,
differential counts, and other
microscopic examination of
 cerebrospinal fluid (CSF) and other
body fluids.
The most common body fluid analyzed in
hematology section is whole blood (a mixture of cells
and plasma). This specimen is obtained by using a
collection tube with anticoagulant to prevent clotting
of the blood. The lavender stopper that contains EDTA
(ethylenediaminetetraacetic acid).
The liquid portion of blood is called plasma if it is
obtained from a sample that has been anticoagulated. If
the sample is allowed to clot, the liquid portion is called
serum. The major difference between plasma and serum
is that plasma contains the protein fibrinogen and serum
does not.
Tests Performed in the Hematology Section:
A complete blood count (CBC) is the primary
analysis performed in hematology section. Very often it
is ordered on a STAT basis.
TEST FUNCTION
Complete Blood
Count Determines the percentage of the different types of
Differential count white blood cells and evaluates red blood cell and
platelet morphology (may be examined
microscopically on a peripheral blood smear
stained with Wright’s stain)
 TEST FUNCTION
Hematocrit (Hct) Determines the volume of red blood cells packed by
centrifugation (expressed as percent)
Hemoglobin (Hgb) Determines the oxygen-carrying capacity of red
blood cells
Platelet count Determines the number of platelets in circulating
blood
Red blood cell Determines the number of red blood cells in
(RBC) count circulating blood
White blood cell Determines the number of white blood cells in
(WBC) count circulating blood
 TEST FUNCTION
Mean corpuscular Determines the amount of hemoglobin in a red
hemoglobin (MCH) blood cell
Mean corpuscular Determines the weight of hemoglobin in a red
hemoglobin blood cell and compares it with the size of the cell
concentration (expressed as percent)
(MCHC)
Mean corpuscular Determines the size of red blood cells
volume (MCV)
Body fluid analysis Determines the number and type of cells in various
body fluids
Bone marrow Determines the number and type of cells in the
bone marrow
 TEST FUNCTION
Erythrocyte Determines the rate of red blood cell sedimentation
sedimentation rate (non-specific test for inflammatory disorders)
(ESR)
Reticulocyte (Retic) Evaluates bone marrow production of red blood
count cells
Sickle cell Screening test for Hgb S (sickle cell anemia)

Special stains Determine the type of leukemia or other cellular

disorders.
Microbiology microbiology section is where
patients’ samples are examined
microscopically for agents of
infectious diseases. Specimens that
can be examined may come from
wounds, throats, eye, blood, body
fluids, and many other body sites.   The
agents that are detected may be bacteria
(aerobic, anaerobic, acid fast), fungi
(molds
 and yeasts), parasites, or viruses.
TEST FUNCTION
Acid-fast bacillus (AFB) culture Detects acid-fast bacteria, including
Mycobacterium tuberculosis
Blood culture Detects bacteria and fungi in the
blood
Culture and Sensitivity (C & S) Detects microbial infection and
determines antibiotic treatment
Fungal culture Detects the presence of and
determines the type of fungi
Gram stain Detects the presence of and aids in
the identification of bacteria
 A Culture and Sensitivity (C & S) test is the primary
procedure performed in microbiology. It is used to
detect and identify microorganisms and to determine the
most effective antibiotic therapy.
Histopathology & histopathology section is where
Cytology surgical specimens are examined at
the microscopic level for pathologic
diagnosis and interpretation.
Cytology section examines smears of
body fluids for evidence of
inflammation, cancer, and other conditions.
Serology serology section is where patients’
blood samples are examined for the
presence of antibodies produced against
infectious agents that causes hepatitis, measles,
and HIV.
Donor Serology donor serology section specifically
examines donors’ blood samples for
the presence of antibodies. This is to ensure the
blood that will be used for patient
administration is free of infectious diseases.
Tests Performed in the Serology (Immunology)
Section:
TEST FUNCTION
Anti-HIV Screening test for human immunodeficiency virus
Antistreptolysin O Detects various Streptococcus infection
(ASO) screen
C-reactive protein Elevated levels indicate inflammatory disorders
(CRP)
Cold agglutinins Elevated levels indicate atypical (Mycoplasma)
pneumonia
Cytomegalovirus Detects cytomegalovirus infection
antibody (CMV)
Febrile agglutinins Detects antibodies to microorganisms causing
fever
 TEST
Fluorescent treponemal
antibody-absorbed (FTA-
ABS)
Hepatitis A antibody
Hepatitis B surface antigen
(HBsAg)
Hepatitis C antibody
Human chorionic
gonadotropin (HCG)
Immunoglobulin (IgG, IgA,
IgM) levels
FUNCTION
Confirmatory test for syphilis
Detects hepatitis A current or past infection
Detects hepatitis B infection
Detects hepatitis C infection
Hormone found in the urine and serum
during pregnancy
Evaluate the function of the immune system
 TEST FUNCTION
Rapid plasma regain (RPR) Screening test for syphilis
Rheumatoid arthritis (RA) Detects autoantibodies present in rheumatoid
arthritis
Rubella titer Evaluates immunity to German measles
Venereal Disease Research Screening test for syphilis
Laboratory (VDRL)
Western blot Confirmatory test for human
immunodeficiency virus
Blood Bank blood bank prepares blood
components, derivatives, and products for
transfusion. Blood bank ensures that the donor
is free of infectious diseases.
They are also in charge of ensuring
that there is a supply of various blood
products that are readily available for patient
administration.
 Blood bank is also called Immunohematology section
because the testing procedures involve RBC antigens
(Ag) and antibodies (Ab). In blood bank, blood from
patient and donor is tested for its blood group (ABO)
and Rh type, the presence and identity of abnormal
antibodies, and its compatibility (crossmatch) for use in
a transfusion.
Sample Collection and Handling:
Blood bank samples are collected in plain red
 (serum), lavender, or pink (plasma) stopper tubes.
Tests Performed in the Blood Bank Section:
TEST FUNCTION
Antibody screen (indirect Detects abnormal antibodies in serum
antiglobulin test)
Direct antihuman globulin Detects abnormal antibodies on red blood
test (DAT) or direct Coombs cells
Group and type ABO and Rh typing
Type and crossmatch (T & ABO, Rh typing, and compatibility test
C)
Type and screen ABO, Rh typing, and antibody screen
Drug Testing the drug testing laboratory performs
screening tests for prohibited drugs.
Immunology is the section where blood samples
are analyzed to quantify tumor
markers and thyroid hormones.
Out Patient this is where out-patients go to have
Receiving & their blood samples taken or submit
Releasing Area specimen to be analyzed by the
laboratory. This is also where out-
 patients can claim the results of their
laboratory requests.
Newborn Screening this section provides an assessment
if a baby has conditions that can
affect its long-term health or survival. An
example of which is a congenital metabolic
disorder that may lead to mental retardation
or even death if left untreated.
Clinical Chemistry this section is where patients’
blood and other body fluids are checked
for various chemical components.
Instruments are computerized and
designed to perform single and multiple tests
from small amounts of specimen.
Sample Collection and Handling (for Clinical
Chemistry)
Clinical chemistry tests are performed primarily on
serum collected in gel barrier tubes, but the serum may
 also be collected in tubes with red, green, gray, or royal
blue stoppers. Tests are also performed on plasma,
urine, and other body fluids.
Tests Performed in the Chemistry Section:
TEST FUNCTION
Alanine aminotransferase Elevated levels indicate liver disorders
(ALT)
Albumin Decreased levels indicate liver or kidney
disorders or malnutrition
Alcohol Elevated levels indicate intoxication
 TEST FUNCTION
Alkaline phosphatase Elevated levels indicate bone or liver
(ALP) disorders
Amylase Elevated levels indicate pancreatitis
Arterial blood gases Determine the acidity or alkalinity and
(ABGs) oxygen and carbon dioxide levels of blood
Aspartate aminotransferaseElevated levels indicate myocardial
(AST) infarction or liver disorders.
Bilirubin Elevated levels indicate liver or hemolytic
disorders
Blood urea nitrogen (BUN) Elevated levels indicate kidney disorders
Calcium (Ca) Mineral associated with bone,
musculoskeletal, or endocrine disorders
 TEST FUNCTION
Cholesterol Elevated levels indicate coronary risk
Creatinine kinase (CK) Elevated levels indicate myocardial
infarction or other muscle damage
Creatinine Elevated levels indicate kidney disorders
Creatinine clearance Urine and serum test to measure glomerular
filtration rate
Drug screening Detects drug abuse and monitors
therapeutic drugs
Electrolytes (CO2, Cl, Na, Evaluate body fluid balance
K)
Glucose Elevated levels indicate diabetes mellitus
Glucose tolerance test Detects diabetes mellitus or hypoglycemia
(GTT)
 TEST FUNCTION
Hemoglobin A1C Monitors diabetes mellitus
High-density lipoprotein Assesses coronary risk
(HDL)
Iron Decreased levels indicate iron deficiency
anemia
Lactic dehydrogenase Elevated levels indicate myocardial
(LD[LDH]) infarction or lung or liver disorders
Lead Elevated levels indicate poisoning
Lipase Elevated levels indicate pancreatitis
Low-density lipoprotein Assesses coronary risk
(LDL)
 TEST FUNCTION
Magnesium Cation involved in neuromuscular
excitability of muscle tissue
Myoglobin Early indicator of myocardial infarction
Phosphorus Mineral associated with skeletal or
endocrine disorders
Prostate-specific antigen Screening for prostatic cancer
(PSA)
Protein Decreased levels associated with liver or
kidney disorders
Total protein (TP) Decreased levels indicate liver or kidney
disorders
 TEST FUNCTION
Triglycerides Used to assess coronary risk
Troponin and T Early indicators of myocardial infarction
Uric acid Elevated levels indicate kidney disorders or
gout
END