PHLEBOTOMY or venesection act of opening a
vein by using incision or puncture methods to draw
blood for analysis or as part of therapeutic or
diagnostic measures under the physician's request.
phlebos which means vein, and
temnein which means to cut.
Evolution of Phlebotomy
Stone Age - used crude tools to cut vessels and
drain blood from the body.
Ancient Egyptians - a form of "Bloodletting" (1400
B.C.)
Hippocrates (460 - 377 BC - balance of the four
humors, removing the excess by bloodletting.
Middle ages – used to treat illness and performed
by barber-surgeons
17th and 18th century – treated as major therapy
Cupping
alternative medicine
application of special heated suction cups on the
patient's skin
incision using a fleam or lancet
Leeching
known as Hirudotherapy
uses leeches for bloodletting
used for microsurgical replantation
Role of Phlebotomist
(1) for diagnosis and treatment using blood
samples
(2) for transfusion, to remove blood at the donor
center
(3) for removal of blood for polycythemia or
therapeutic purposes
Credentials
Certification
Licensure
Continuing education
Patient – Client Interaction
(1) Reassuring and pleasant
(2) Able to communicate well
(3) Maintain positive customer relations
(4) Understand the diversity of the patients and be
able to adjust accordingly
Qualities of Professionalism
(1) Professional appearance
(2) Self-confidence
(3) Integrity
(4) Compassion
(5) Self-motivation
(6) Dependability
(7) Ethical Behavior
Communication in the healthcare setting
o Verbal Communication
o Nonverbal Communication
o Active listening
Elements in healthcare communication
Empathy Confirmation
Control Trust
Respect
Figure 1.3 Verbal Communication Loop in Health care
setting
Clinical analysis areas and the types of
procedures
Hospital
• with permanent inpatient beds
• 24-hour nursing service
• Managed by organized medical team
2 major divisions
1) Anatomical and Surgical Pathology area
2) Clinical analysis area
Clinical analysis areas
1. Hematology
2. Coagulation
3. Chemistry
4. Serology
5. Urinalysis
6. Microbiology
7. Blood bank/immunohematology
HEMATOLOGY – blood and blood forming tissues
NAME OF TEST AND PROCEDURES
1. Hematocrit (Hct) checks the hemoglobin level and the red cell count.
2. Hemoglobin (Hgb) tests the value to rule out anemia.
3. Red Blood Cell (RbC) count is used to measure the erythropoietic activity.
4. White Blood Cell (WbC) count checks the leukocyte response
5. Platelet (Plt ct) count usually used to monitor chemotherapy and radiation
conditions.
6. Differential White Count (Diff) monitors changes in the appearance or quantity of
specific cell types
7. Indices shows the changes in RBC size, weight and Hgb content
8. Mean Corpuscular hemoglobin (MCH) gives the weight of the hemoglobin in the
cell.
9. Mean Corpuscular volume (MCV) shows the size of the cell.
10. Mean Corpuscular hemoglobin concentration (MCHC) gives information on the
concentration of the hemoglobin per unit volume of RBCs.
11. Red blood distribution width (RDW) measures the size differences of the RBCs
COAGULATION – ability of blood to form and dissolve clots
NAME OF TEST AND PROCEDURES
1. Activated partial thromboplastin time (APPT) reflects the adequacy
of herapin therapy.
2. D-dimer checks the thrombin and plasmin activity
3. Fibrin split products (FSP) measures if the level is high because it
results to FDP fragments.
4. Fibrogen tests are performed to check any fibrogen deficiency.
5. Prothrombin Time (PT) or International Normalized Ratio (INR)
evaluates liver diseases or deficiency in Vitamin K
CHEMISTRY – performs most lab test for plasma, white blood, urine, etc.
NAME OF TEST AND PROCEDURES
1. Alanine amino tranferase (ALT) is used to monitor liver disease.
2. Alpha-fetoprotein (AFP) checks levels especially for prenatal
screening
3. Alkaline phosphatase (ALP) determines level to check
obstructions and bone disease.
4. Ammonia measures the level which could indicate cirrhosis and
hepatitis.
5. Amylase checks the enzyme level which could indicate liver
disease, cholesystitis, etc.
6. Aspartate amino-transferase (AST) measures the level which is
indicative of liver dysfunction.
7. Bilirubin shows the level in the bloodstream that shows red blood
destruction
8. Blood Gases (ABG) evaluates acid-base balance by measuring the
pH, partial pressure of the carbon dioxide and oxygen.
9. Blood Urea Nitrogen (BUN) checks elevated levels which leads to
impaired renal function.
10. B-type natriuretic peptide (BNP) is a cardiac marker for congestive
heart failure.
CHEMISTRY Continuation…
NAME OF TEST AND PROCEDURES
11. C-reactive protein High sensitivity (hs-CRP) detects low level of
CRP
12. Carcinoembryonic antigen (CEA) is used for early detection of
malignancy in colorectal cancer.
13. Calcium is used for monitoring effects of the renal failure.
14. Cholesterol (total) 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) shows the sodium
values that determines disorder of the kidney and adrenals.
20. Glucose is used to check diabetic problems, liver disease or
malnutrition.
CHEMISTRY Continuation…
NAME OF TEST AND PROCEDURES
21. Gamma-glutamyl transferase (GGT) is used for diagnosis of liver
specifically hepatobiliary problems.
22. Hemoglobin A1C determines the Glycohemoglobin level that
shows the diabetic control over the past months.
23. Lactate dehydrogenase checks lung, kidney and liver dysfunction.
24. Lipase shows the level that could lead to pancreatitis, pancreatic
carcinoma
25. Prostate specific antigen is a test that screens patients for
presence of prostate cancer.
26. Total Protein used to check liver and kidney disorders.
27. Triglycerides serves as index to evaluation of atherosclerosis and
lipid metabolism disorder.
28. Troponin-I used for early diagnosis of small myocardial infarcts.
29. Uric Acid tests are used to check levels that indicates gout and
renal problems.
30. Vitamin B12 and folate tests are done to check for anemia and
diseases of the small intestine.
SEROLOGY/IMMUNOLOGY – serum and autoimmune reactions
NAME OF TEST AND PROCEDURES
1. Bacterial Studies
Antinuclear antibody (ANA) shows autoimmune disorders such as
systematic lupus erythematosus
Antistreptolysin O (ASO) titer indicates streptococcal infection
Cold agglutinins checks cases of atypical pneumonia
Febrile agglutinins shows presence of antibodies to specific organisms
FTA-ABS confirms syphilis
Rapid plasma reagin (RPR) when positive it is indicative of syphilis but it
needs confirmation
Rheumatoid factor (RF) indicates rheumatoid arthritis
2. Viral Studies
Anti-HIV screens Human immunodeficiency virus
Cytomegalovirus antibody (CMV) is a confirmation test
Epstein-Barr Virus checks for presence of heterophil antibody which
indicates infectious mononucleisis
Hepatitis B surface antigen checks for presence of hepatitis entigen in
the surface of the red cells.
3. General Studies
C-reactive protein (CRP) indicates inflammation when levels are
increased
Human chorionic gonadotropin (HCG) tests are present when patient is
URINALYSIS – tests urine specimens
NAME OF TEST AND PROCEDURES
1. Physical Evaluation
Color indicates presence of blood melanin, bilirubin or urobilin in
the urine specimen
Clarity shows presence of fat, chyle bacteria which affects 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 and hemolytic
jaundice
Glucose - Glucosuria maybe a result of diabetis melitus, renal
impairments
Ketones - uncontrolled diabetes mellitus or starvation
Leukocyte - indicates urinary tract infection if there is a lot of
neutrophils
pH - indicates in acid-base balance
Protein - Proteinura is an indicateor of renal dysfunction or disorder
Nitrite - positive results could mean bacterial infection
MICROBIOLOGY – micro organisms in body fluids or tissues
NAME OF TEST AND PROCEDURES
1. Acid-fast bacili (AFB) is used to monitor treatment for TB
2. Blood culture checks presence of bacteria which indicates
bacteremia or septicemia
3. CLO test shows presence of Helicobacter pylori
4. Culture & Sensitivity (C&S) indicates infection if there is growth in
the pathogenic microorganism
5. Fungus culture and identification - used to determine the type
fungi if present
6. Gram stain - 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 - solves "etiology unknown" intestinal disorders
BLOOD BANK/IMMUNOHEMATOLOGY – blood transfusion
NAME OF TEST AND PROCEDURES
1. Antibody (Ab) screen - agglutination means presence of abnormal
antibodies in the blood
2. Direct antihuman globulin test (DAT) determines transfusion
incompatibility
3. Type and RH - shows the blood group (ABO) and type (Rh)
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
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
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watch the video:
Clinical Laboratory Areas
