Principles of Medical Laboratory Science 2

Clinical Laboratory Assistance &

Phlebotomy

Ana Marie Kia G. Cawit, RMT

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 Schedule of Activities
Jan. 15, 2024 - Start of Class

Jan. 15-19, 2024 - Adding and Dropping of Subjects

Jan. 29, 2024 - Last Day of Enrollment

Feb. 10, 2024 - Lunar NEW YEAR

Feb. 20-23. 2024 - PRELIM EXAMINATION

Feb. 24, 2024 - Mental Break

Schedule of Lessons for PRELIM
Jan. 17, 2024 - Understanding Phlebotomy (Pg. 3)

Jan. 24, 2024 - Infection Control, Safety, First Aid and Personal Wellness
(Pg. 15)

Jan. 31, 2024 - The Circulatory System (Pg. 29)

Feb. 07, 2024 - Blood Collection Equipment, Additives and Order of

Draw (Pg.49)

Feb. 14, 2o24 - Venipuncture Procedure (Pg. 57)

At the end of this lesson, the students must be
able to:

1.Describe the evolution of phlebotomy and the

role of the phlebotomists in today’s healthcare
setting.
2.Discuss the traits that form the professional
image of the phlebotomist
3. Explain the basic concepts of communication
as they relate to healthcare setting
4.Distinguish the different types of healthcare
setting
5.Enumerate the clinical analysis area of the
laboratory and the various types of laboratory
procedures performed in the respective areas.
Lesson 1 - Understanding Phlebotomy
Phlebotomy - process of collecting blood
Greek word : Phlebos - vein ; Temnein - cut (venesection)

Evolution of Phlebotomy
1. Ancient Egyptians - form of “bloodletting” as early as 1400 BC
2. Hippocrates - (460-377 BC) - believed on four humors (1.Earth - Blood and Brain;
2. Air -Phlegm and Lungs; 3. Fire - Black Bile and Spleen, 4. Water - Yellow bile and
gall bladder). Excess humor through bloodletting to keep balance.
3. Middle Ages - Barber-Surgeons - Bloodletting as part of treatment of some illness.
4. 17th and 18th centuries - treated as major therapy. “Cupping and Leeching”
A. Cupping - alternative medicine that help ease pain, in ammation or other health concerns.
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Lesson 1 - Understanding Phlebotomy
B. Leeching - hirudotherapy - uses leeches for bloodletting and microsurgical
replantation. (Hirudo medicinal - medicinal leech)
Leeches inject local vasodilator, anesthetic and hirudin (anticoagulant)

Main Goals of Phlebotomy

1. For diagnosis and treatment using blood samples
2. For transfusion, to remove blood from donor
3. Removal of blood for polycythemia or therapeutic purposes.

Main Methods used in Phlebotomy

1.Venipuncture - blood collection using a needle instead in a vein
2. Capillary Puncture - puncturing the skin
Lesson 1 - Understanding Phlebotomy
Role of Phlebotomists
1. Collect Blood Samples for laboratory testing or for transfusion
2. Delivering and transporting collected samples within appropriate
prescribed time limits.
3. Process collected blood such as centrifuging, aliquoting samples
ready for lab testing.
4. Assisting in collection of urine and non-blood sample for
patients.
5. Blood Letting - drawing blood units from donors for transfusion.
 Lesson 1 - Understanding Phlebotomy
Traits of a Phlebotomists
1. Skills and Knowledge
2. Good Manual Dexterity - not too stiff
3. Special Communication Skills
4. Good Organizational Skills
5. Thorough knowledge of laboratory specimen requirements
6. Training in phlebotomy skills coupled with standard practice

Credentials
1. Certi cation or License and continuing education
2. Accredited, Recognize and Certi ed
3. Pass the Licensure Exam
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Lesson 1 - Understanding Phlebotomy
Patient-Client Interaction
1. Reassuring and Pleasant when dealing with patients.
2. Able to communicate well despite of cultural and social difference.
3. Maintain positive customer relations
4. 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)
 Lesson 1 - Understanding Phlebotomy
Qualities of Professionalism
1. Be Professional (conservative clothing, proper personal hygiene).
2. Self Con dence
3. Integrity (honesty and consistency in action, values and beliefs)
4. Compassionate - sensitivity to needs, ability to stay calm and helpful
demeanor
5. Self-motivated, positive attitude and initiative to follow through task and
continuously look for areas of improvement.
6. Dependable, observe proper work ethic, take responsibility for their actions.
7. Good ethical behavior, conforming to standards to avoid exposing patients to
harm.
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Lesson 1 - Understanding Phlebotomy
Basic Concepts of Communication in Healthcare Setting
1. Verbal Communication - effective communication. Sender
(speaker) and Receiver (listener) are able to accurately
exchange ideas by using feedback, clarify and con rm ideas.
Use words that can be easily understood by patient.
2. Non-Verbal Communication - facial expressions and non-
verbal cues, Kinetics (body motion, language), Proxemics
(space), appearance (attire), touch (thoughtful expressions).
3. Active Listening - major part of communication.

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Lesson 1 - Understanding Phlebotomy
Healthcare Setting
1. In-patient -(non-ambulatory) - tertiary care practitioners
2. Out-patient - served by secondary care specialists on the same day

Levels of Healthcare
1. Primary Level - health units in the rural areas and sub-units operated by DOH.
2. Second Level - non-departmentalized hospitals, during symptomatic stages of an ailment.
3. Tertiary Level - medical centers, large hospital with highly technical facilities

Ambulatory care - medical care given to out-patients or follow-up check ups

Homebound services - refer to procedures, tests and services that is done in patients home
Public Health services - unit at the local level but are still under the jurisdiction of DOH.
Services are offered with little to no charge at all.
Lesson 1 - Understanding Phlebotomy
The Different Clinical Analysis Areas od the Laboratory and the Types
of Laboratory Procedures Performed

1.Hematology - blood and blood forming tissues

2.Coagulation - ability of blood to form and dissolve clots
3.Chemistry - amounts of certain chemicals in a blood sample
4. Serology/Immunology - serum and autoimmune reactions in the blood
5. Urinalysis - test of urine specimen
6.Microbiology - microorganisms in body uids or tissues
7. Bloodbank/Immunohematology - blood for transfusion
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Lesson 1 - Understanding Phlebotomy
Hematology
1. Hematocrit (hct)- hemoglobin level and red cell count
2. Hemoglobin (hgb) - values that rule out anemia
3. RBC Count - erythropoietic activity
4. WBC Count - leukocyte response
5. Platelet Count - chemotherapy and radiation conditions.
6. Differential White Blood Cell Count - Changes in the appearance or quantity of speci c 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 of the cell
10. Mean Corpuscular Hemoglobin Concentration (MCHC) - concentration of the hemoglobin per
unit volume of RBC’s
11. Red Blood Cell Distribution Width (RDW) - size differences of the RBC’s

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Lesson 1 - Understanding Phlebotomy
Coagulation
1. Activated Partial Thromboplastin Time (APTT) - adequacy
of heparin therapy
2. D-dimer - thrombin and plasmin activity
3. Fibrin Split Products (FSP) - amount of brin degradation
products (FDP’s) in the blood
4. Fibrinogen Test - Fibrinogen levels in the blood
5. Prothrombin Time (PT) or International Normalized Ratio
(INR) - liver disease or de ciency in Vitamin K
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Lesson 1 - Understanding Phlebotomy
Chemistry
1.Alanine Aminotransferase Test (ALT) - liver damage
2. Alpha-fetoprotein (AFP)-alpha-fetoprotein levels in pregnant women during the second 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 hepa-titis
5. Amylase-checks the enzyme level that could indicate liver disease, cholesystitis, etc.
6. Aspartate Aminotransferase Test (AST) - levels of aspartate ami-notransferase enzyme that may indicate liver
damage
7. Bilirubin Test Indicate red blood destruction amount of bilirubin lev-els in the bloodstream that could indicate red
blood destruction
8. Arterial Blood Gases (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
Lesson 1 - Understanding Phlebotomy
Chemistry
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 fallure
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 mus-cular dystrophy
18. Drug Analysis-monitors therapeutic range to avoid toxic levels for drugs
19. Electrolytes (sodium, potassium, chloride, CO)-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, speci cally hepatobillary problems
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Lesson 1 - Understanding Phlebotomy
Chemistry
22. Hemoglobin AC-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 Speci c 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 1-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
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 Lesson 1 - Understanding Phlebotomy
Serology/immunology
1. Bacterial Studies
1.1 Antinuclear Antibody (ANA)- shows autoimmune disorders such as systematic
lupus erythematosus
1.2 Antistreptolysin-O (ASO) Titer-indicates streptococcal infection
1.3 Cold Agglutinins-checks cases of atypical pneumonia
1.4 Febrile Agglutination Test- shows the presence of antibodies to speci c organisms
1.5 FTA-ABS-con rms syphilis
1.6 Rapid Plasma Reagin (RPR)- when positive, it is indicative of syphilis but it still
needs con rmation
1.7Rheumatold Factor (RF)- Indicates rheumatoid arthritis
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Lesson 1 - Understanding Phlebotomy
Serology/immunology
2. Viral Studies
2.1 Anti-HIV - screens human immunode ciency virus
2.2 Cytomegalovirus Antibody (CMV) - a con rmatory test for CMV antibody
2.3 Epstein-Barr Virus (EBV) - checks for the presence of heterophil antibody, which indicates
infectious mononucleosis
2.4 Hepatitis B Surface Antigen ( HBSAg) - checks for the presence of hepatitis antigen on the
surface of red cells.

3. General Studies
3.1 C-Reactive Protein (CRP) - indicates in ammation when levels are increased
3.2 Human Chorionic Gonadotropin (HCG) Test - the hormone its present when patient is
pregnant.
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 Lesson 1 - Understanding Phlebotomy
URINALYSIS
Physical Evaluation
1. Color
2. Clarity/transparency
3. Speci c Gravity

Chemical Evaluation
1. Blood
2. Bilirubin
3. Glucose
4. Ketones
5. Leukocytes
6. pH
7. Protein
8. Nitrite
9. Urobilinogen

Microscopic Evaluation - Shows the status of the urinary tract, hematuria, pyuria etc.
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Lesson 1 - Understanding Phlebotomy
Microbiology
1.Acid-Fast Bacilli (AFB) used to monitor the treatment for TB microorganisms in body uids
or tissues
2. Blood Culture - checks for the presence of bacteria indicative of bacteremia or septicemia
3. Campylobacter-like Organism (CLO) Test-shows the presence of Helicobacter pylori
4. Culture and Sensitivity (C&S) - indicates infection if there is growth in the pathogenic
microorganism
5. Fungus Culture and Identi cation - used to determine the type of fungi if present
6. Gram Stain-it is done to allow antimicrobial therapy while waiting for culture results
7. Occult Blood-checks for blood in the stool which could result from gastrointestinal
bleeding
8. Ova and Parasites (O&P) Exam - solves "etiology unknown" intestinal disorders
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Lesson 1 - Understanding Phlebotomy

BloodBank / immunohematology
1.Antibody (Ab) Screen - agglutination means presence of abnormal antibodies in the
blood
2. Direct Antihuman-globulin Test (DAT) - determines transfusion incompatibility
3. ABO and Rh Type - shows the ABO and Rh blood groups
4. Type and Crossmatch-shows the blood group and screens for antibodies in the
recipient's blood
5. Compatibility Testing - detects antibodies and antigen in both recipient's and
donor's blood
Lesson 1 - Understanding Phlebotomy
STAT Labs - usually located near the emergency
room

Reference Laboratory - large and independent

laboratory that provides specialized and con rmatory
laboratory tests for blood, urine, and tissues, and
offers as well faster turn around or processing time.

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 Assignment

Chapter Summary of Lesson 2 (Infection Control, Safety, First-

Aid, and Personal Wellness) (Pre-quiz Next Meeting)

1/4 Yellow paper - What are the common reference laboratories

in the Philippines.