PMLS 2 (2nd Semester)

EXAMPLES: Bacillus subtilis, Naegleria gruberi

1. (LAB) Lab Safety: A Review and infectious canine hepatitis virus.
2. (LEC) Phlebotomy
3. (LAB) Phlebotomy • Risk Group 2 (BIOSAFETY LEVEL 2)
(Venipuncture) Materials - Most common
4. (LEC) Review of Blood ✓ Lab. Type – primary health
services, diagnostic services,
research.
✓ Lab. Practices – GMT, protective
1st Topic – (LAB) Lab Safety: A Review
clothing, biohazard sign.
• Risk Management Process ✓ Safety Equipment – Open bench
- Basis for classifying plus BSC for potential aerosols.
microorganisms into risk groups EXAMPLES: Hepatitis B virus, HIV,
and biosafety levels. salmonellae, Toxoplasma species.
Risk Management Process:
1.) Identification of Risks
• Risk Group 3 (CONTAINMENT
2.) Risk Assessment
BIOSAFETY LEVEL 3)
3.) Risk Mitigation Plan
✓ Lab. Type – special diagnostic
4.) Implementation and monitoring
services, research
5.) Review and update risk plan
✓ Lab. Practices – as level 2 plus
Risk Assessment + Risk Management = Risk
special clothing (HAZMAT),
Characterization
controlled access, directional
Classification of Infectious Microorganisms
airflow.
by Risk Groups:
✓ Safety Equipment – BSC and other
• Risk Group 1 primary devices for all activities.
- No or low individual or community (NOT OPEN BENCH)
risk. Unlikely to cause disease. EXAMPLES: Mycobacterium Tuberculosis, St.
• Risk Group 2 Louis encephalitis virus, and Coxiella.
- Moderate individual risk. Low
community risk. With treatments • Risk Group 4 (BIOSAFETY LEVEL 4,
available. MAXIMUM CONTAINMENT)
• Risk Group 3 ✓ Lab. Type – dangerous pathogen
- High Individual risk. Low units.
community risk. Effective and ✓ Lab. Practices – as level 3 plus
preventive treatments are airlock entry, shower exit, special
available. (can cause death) waste disposal.
• Risk Group 4 ✓ Safety Equipment – Class III BSC
- High individual and high or positive pressure suits with
community risk. Effective and Class II BSCs, double ended
preventive treatments are NOT autoclave (positive pressure).
USUALLY available. EXAMPLES: Marburg and Crimean-Congo
Biosafety Levels, Practices, and Equipment hemorrhagic fever, Ebola.
• Risk Group 1 (BIOSAFETY LEVEL 1)
✓ Lab. Type – basic teaching, research BIOSAFETY – protects people from germs.
✓ Lab. Practices – GMT (Good BIOSECURITY – protects germs from people.
Microbiological Techniques)
✓ Safety Equipment – None, Open Bench

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Chain of Infection
1.) Infectious Agents
2.) Reservoir
3.) Portal of Exit
4.) Mode of Transmission
5.) Portal of Entry
6.) Susceptible Host
Laboratory Safety Measures
a.) Standard Precautions:
- Handwashing, PPE, Proper
handling of blood and other body
fluids.
b.) Biohazard universal precautions

Microbial control, sterilization, and

disinfection.
Proper (Thorough) Handwashing

Personal Protection (BASIC)

DONNING DOFFING
(put on) (take off)
Gown Gloves
Mask Headcap
Headcap Gown
Gloves Mask

Made on Jan. 16, 2024

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2nd Topic – (LEC) Phlebotomy - Cupping and leeching were

Phlebotomy performed by phlebotomists using
- Process of collecting blood lancets and fleams.
through the vein by using incision Cupping – alternative medicine that helps
or puncture methods to draw ease pain, inflammation, or other health-
blood for analysis or as part of related concerns.
therapeutic or diagnostic - Involves the application of special
measures under the physicians’ heated suction cups on the
request. patient’s skin and the incision that
- Derived from 2 Greek words: is made using a fleam (lancet)
Phlebos – vein which is previously wiped with a
Temnein – to cut rag.
Also called venesection. Leeching – also known as hirudotherapy.
Army Lancet (1953) – to obtain blood - A method that uses leeches for
samples and was used to prick pus in the bloodletting and is currently used
body. for microsurgical replantation.
Galen of Pergamon - Hirudo medicinalis (medicinal
- discovered blood in arteries and leech) to the site, allowing it to
veins. engorge and fall off.
- Stagnated throughout the Modern Phlebotomy
extremities. • Diagnosis and management of
The Evolution of Phlebotomy and the Role disease.
of the Phlebotomists in Today’s Healthcare • Remove blood for transfusions.
setting • Therapeutic measures:
- Polycythemia (excess production
Evolution of Phlebotomy of RBCs.)
- Can be traced back to the Stone - Hemochromatosis (abnormal
Age. processing of iron.)
- Ancient Egyptians practiced Phlebotomist’s role
phlebotomy as a form of • Collect blood samples for laboratory
“bloodletting” as early as 1400 testing or transfusion (blood-letting).
BC. • Proper specimen labelling.
Hippocrates (460-377 BC), Greek physician – • Delivery, Transportation and
believed that a person’s health was dependent processing.
on the balance of the four (4) humors: • May even collect other non-blood
(1) Earth – blood and brain specimens.
(2) Air – phlegm and lungs Phlebotomy in Health Care
(3) Fire – black bile and spleen
• Centralized
(4) Water – yellow bile and gall bladder.
- Phlebotomist is part of lab teams
Middle Ages
and dispatched to hospital units to
- Barber-surgeons performed
collect blood samples.
bloodletting as part of the
• Decentralized
treatment for some illness.
- All members of the healthcare
- Army lancet 1953
team share responsibility to
17th and 18th centuries
collect blood samples.
- Phlebotomy treated as a major
therapy.

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A Phlebotomist should possess: - Non-departmentalized hospitals

1.) Good Manual dexterity. that attend to patients during the
2.) Special communication skills. symptomatic stages of an ailment.
3.) Good Organizational skills 3.) Tertiary
4.) Thorough knowledge of lab specimen - Medical centers and large
requirements. hospitals where services are
5.) Sufficient training in phlebo skills and sophisticated coupled with highly
standard practice. technical facilities that can
Professional Attitude address serious diseases.
- Follow professional code of Services
conduct in treatment of patients. • Ambulatory care
- Includes professional approach to - Medical care given to outpatients
all aspects of job and professional or patients requiring care or follow-
grooming and dress. up check-ups after their discharge
Communication in Healthcare from the hospital.
- Good communication is essential - Can be in the freestanding medical
to ensure patients are at ease. care setting and hospital-owned
- Also for transmittance of clinics, or in the outpatient
information. departments and urgent care
- Component of good facilities.
communication: • Homebound services
a.) Verbal - Procedures, tests, and services
- Expressing ideas through words. provided to a patient which are
b.) Non-verbal done in a patient’s home or in a
- Kinesics (body motion and long-term facility.
language) • Public services
- Proxemics (individual’s concept - Belong to the unit at the local level
and use of space) but are still under the jurisdiction
- Appearance (Attire) of the health department of the
- Touch (Thoughtful expression) government. Services are offered
c.) Active Listening with little or no charge at all.
The Healthcare Setting Areas of the Laboratory
Healthcare facilities: Hospital – an institution that has permanent
• Inpatient (or non-ambulatory) inpatient beds with 24-hour nursing service
- Requires patients to stay in the along with therapeutic and diagnostic services
hospital for at least one night to be managed by organized medical staff or
serviced by tertiary care personnel.
practitioners. - Two major divisions (anatomical
• Outpatient and surgical pathology area and
- Patients are served by secondary the clinical analysis area).
care specialists on the same day. ANATOMICAL AND SURGICAL PATHOLOGY
Levels AREA: Histology (microscopic structure of
1.) Primary tissues), Cytology (structure of cells),
- Health units in the rural areas and Cytogenetics (chromosomal deficiencies and
sub-units which are operated by genetic disease).
the Department of Health.
2.) Secondary 1.) Phlebotomy
2.) Chemistry

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– amounts of certain chemicals in a precancerous, malignant, and

blood sample. infectious conditions.
3.) Hematology Cytotechnologists usually work
– blood and blood-forming tissues. closely with a pathologist.
4.) Coagulation • Histotechnologist
– ability of blood to form and dissolve - work alongside pathologists in
clots. medical laboratories to prepare
5.) Histology and analyze tissue samples.
6.) Urinalysis Patient Rights
– tests urine specimen. Patient has right to…
7.) Microbiology a.) …considerate and respectful care.
– microorganisms in body fluids or b.) …receive understandable information.
tissues. c.) …make decisions about plan of care
8.) Immunology and refuse treatment.
– serum and autoimmune reactions in d.) …have an advance directive.
the blood. e.) …privacy.
9.) Immunohematology (blood bank) f.) …confidentiality of his or her medical
– blood for transfusion. records.
10.) Cytology g.) …review records.
11.) Molecular Diagnostics h.) …expect that within its capacity and
Laboratory Staff policies, a hospital will make
(DISCLAIMER:meanings have been searched) reasonable response to the request of
• Pathologist a patient for appropriate and medically
- medical professional with indicated care and services.
specialized training to diagnose i.) …information regarding hospital
medical conditions using business relationships that might
laboratory tests and techniques. impact his or her care.
• Medical Laboratory Scientist j.) …consent or decline to participate in
- typically responsible for proposed research studies.
conducting a variety of tests on k.) …expect continuity of care.
patient samples l.) …be informed of hospital policies and
• Medical Laboratory Technician practices that relate to patient care,
- work under the supervision of a treatment, and responsibilities.
medical technologist or physician
to perform tests that help Bedside Labelling
physicians diagnose and treat - Immediately label the specimen
diseases. after collection.
• Phlebotomy technician Patient Identification (MOST IMPORTANT)
- A phlebotomy technician is a - Full name said by the PATIENT.
medical professional who assists Made on Jan. 24, 2024
phlebotomists with blood work
and the accompanying
administrative tasks.
• Cytotechnologist
- evaluate patients' cell samples
and are trained to notice subtle
changes to accurately detect

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3rd Topic: (LAB) Phlebotomy (Venipuncture)

Materials
1.) Personal Protective Equipment
(PPE)
2.) Cleaning Agent
- Routine use (Alcohol pad, cotton)
- Blood culture and blood gases
- Alcohol testing, allergies
3.) Cotton
4.) Gauze
5.) Sharps Container
- Discard needles, lancets
- Biohazard marking
- Puncture resistant
- NEVER recap, bend-break
needles.
6.) Tourniquet
- Slow venous blood flow
- Makes veins more prominent.
- NEVER leave for 1 min.
- AVOID rigorous fist clenching or
hand pumping. ( Potassium,
Lactic acid, LD)
- Latex allergy
7.) Needle
- NEVER reuse a needle
- NEVER use if shield is broken.
- NEVER recap, bend, or break. COMMON:
- Drop immediately into sharps White – 16G
container after use. Pink – 18G
- Size of needle is indicated by Green – 21G (For Venipuncture)
Gauge: Blue – 23G (For Venipuncture)
(Larger gauge number, smaller the Orange – 25G
needle diameter)
(21,23 routinely used.) NEEDLES
• Needle color and gauge size:

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Multi-sample Needle: 10.) Blood Collection Tubes

- Contain a vacuum.
- Used with vacutainer and syringe
systems.
- Stoppers universal color coded;
indicates content.
- Have an expiration date.
Citrate (4 times mix, coagulation test)
Gold (5 times)

Blood Tube without anticoagulant

Butterfly Needle

- Most often used with syringe.

- Expensive, thus not used for
routine draws.
- Used for small, fragile veins.
- Increased risk of needle stick
injury.
8.) Tube Holder/Vacutainer Adapter
- Threaded
- Flanges
9.) Syringe
- Graduated
Parts of the Syringe:

Blood Tube with anticoagulant

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Syringe Safety Devices

1.) Vacutainer

Labeling Blood collection tubes

• Black indelible marker (waterproof)
- Never pencil.
- Legal document.
- Print legibly.
• Required information: 5 items
- Patient name
- Identification number
- Date of draw (mm,dd,yyyy)
- Time of draw (military time)
ORDER OF DRAW - Phlebotomist signature, first
You – Yellow (blood culture) initial, last name.
Better – Blue (citrate) Vacutainer or syringe
Remember – Red or gold (serum, separator) • Vacutainer (Closed system)
Girls – Green (Heparin)
Love – Lavender (EDTA)
Gray – Gray (Flouride)

- Most often used.

- Most economical
- Quick
- Least risk of accidental needle
stick
• Syringe (Open system)

- More control
- Reposition easily.
- Will see “flash” of blood in syringe
hub when vein successfully
entered.

Made on Feb. 01, 2024

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4th Topic: (LEC) Review of Blood In vitro (outside)

- Spontaneous reaction.
Blood Function - Triggered by glass or poor drawing
1.) Supplies nutrients to tissue: technique.
O2, hormones, glucose. Clotting factors + calcium thrombin
2.) Removes end-products of Fibrinogen + thrombin fibrin strands.
metabolism: Anticoagulants
CO2, urea, creatinine.
3.) Provides defense mechanism:
WBC, antibodies.
4.) Prevents blood loss:
Platelets, coagulation proteins.
Blood Composition

- Remove calcium.
- Neutralize thrombin.
- Whole Blood (not centrifuged yet)
- Plasma
- Serum
Blood with Anticoagulant
Formed Elements (~45%) - Clotting is prevented and
- RBC irreversible.
- WBC - Mix: completely invert 8-10x
- Platelets - Whole blood
Fluid component (~55%) - Centrifuge > Plasma
- Water (~92%) (Plasma contains fibrinogen)
- Protein (~7%) (Lavender)
- Etc. (minerals) Blood without Anticoagulant
Coagulation (process of clotting) - Spontaneous clotting occurs and
is irreversible.
- Fibrinogen > Fibrin strands.
- Serum (no fibrinogen)
- Fibrin strands entrap cells.
- Centrifuge > Serum.
(red – 30-60 mins to clot)
Plasma/Serum Appearance
• Normal: clear and yellow
• Abnormal:
- Hemolyzed = pink to red
(ruptured RBC)
In Vivo (inside) - Icteric = dark orange yellow
- Blood is fluid. (bilirubin)
- Clot is formed to protect injured - Lipemic = cloudy (fat,
vessel. triglycerides)

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Modes of Transmission

Blood Collection Tubes

Safety: Infection Control

• Handwashing
- Primary means of preventing
spread of infection (especially
nosocomial).
- Minimum 15 secs, soap, friction.
- Wash hands before and after each
blood draw.
• PPE
- Lab coat
Type and amount of specimen: - Gloves
• Dependent upon: - Mask
- Test • Standard Precautions at all times.
Whole blood: EDTA or heparin? Equipment:
Plasma: EDTA or heparin? 1. PPE: gloves, lab coat, mask.
Serum: trace free? Separator gel 2. Cleaning agents
interference? - Alcohol pads: routine.
- Amount of sample needed to - Povidone iodine: blood culture
perform test. collection and blood gases.
- Multiple labs needing the same - Soap and water: alcohol testing,
specimen at the same time. allergies.
Valid Test Results Require: 3. Cotton balls, gauze
• Trained personnel 4. Bandage, tape (use caution with
- Causes of pre-analytical error. children)
- Invalid test results. 5. Sharps Container:
• Quality control - Discard needles, lancets
• Quality assurance - Biohazard making
• Sophisticated instruments - Puncture resistant
Safety practices - NEVER recap, bend break
For infection to spread: needles.
1.) Infectious substance: HBU, HCV, HIV. Safety: Engineering controls
2.) Mode of transmission. - PPE
3.) Susceptible host - Sharps container
- Safer medical devices.
Made on Feb. 01, 2024.

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