PMLS 2 – L1: Understanding Phlebotomy o removal of blood for polycythemia –

donation of blood
Phlebotomy o therapeutic purposes – yung iron store sa
o It is the process of collecting blood using body: si RBC meron siyang hemoglobin
incision or puncture methods. na may 2 structures. Heme: andun si iron.
o Used for analysis or as part of therapeutic Globin: Chains. It also reduce blood
or diagnostic measures under the volume.
physician's request. Role of Phlebotomists
o phlebos which means vein, and temnein
which means to cut
Evolution of Phlebotomy

Cupping
o alternative medicine Traits that form the professional image of the
o application of special heated suction cups phlebotomists
on the patient's skin 1. Good manual dexterity – coordinated
o incision using a fleam or lancet hands and finger movements
Leeching 2. Special communication skills – different
o known as Hirudotherapy level of communication (alam dapat kung
o uses leeches for bloodletting • used for pano makipag communicate at and it may
microsurgical replantation vary. For ex: if elders na need mahunahon
o Hirudomedicinalis magsalita para di magulat)
Additional Information 3. Good organizational skills
- Other word for phlebotomy is Venesection 4. Thorough knowledge of laboratory
- 4 humors of the body: Blood, Phlegm, specimen requirements – alam kung
Yellow Bile and Black Bile anong tube sequence
- Pag walang physician’s request, hindi 5. Training in phlebotomy skills coupled with
pwedeng magcollect ng blood. standard practice – kailangan trained ang
- 460 – 377 B.C and era ni Hippocrates phlebotomists
- Barber Surgeons ay nag blood letting at
amputations
- Bawal ang pre labelling ng vials or blood
container to avoid interchange of
samples.
Main Goals of Phlebotomy Practice
o diagnosis and treatment using blood
samples
o transfusion, to remove blood at the donor
center
Credentials The healthcare setting
o A credential is a piece of any document o In patient – stay in sa hospital ng 1 night.
that details a qualification, competence, Tertiary level
or authority issued to an individual. o Out patient – within the day. Secondary
• Certification level
• Licensure o Healthcare services provided for patients
• Continuing education after their discharge from the hospital:
Patient – Client Interaction • Ambulatory care – free standing.
o Reassuring and pleasant Hospital owned clinics. Out patient
o Able to communicate well department and care facilities
o Maintain positive customer relations • Homebound services – Patient’s
o Understand the diversity of the patients home
and be able to adjust accordingly • Public health services – unit at the
o Medtechs ay parang nasa “costumer local level. Under the jurisdiction of
service” field dahil hindi ganoon kadami the local department
ang interaction with patients Levels of Health care
Qualities of Professionalism o Primary – health units sa rural area.
1. Professional Appearance – conservative Operated ng DOH. Immediate response
clothing with proper protective equipment or first line
and proper hygiene o Secondary – Endorsement. Non
2. Self – Confidence – ability to trust departamentalized during symptomatic
personal decisions and judgements o Tertiary – Large hospitals. Pwede na mag
3. Integrity – honest and consistent cater ng dialysis
4. Dependability – being sensitive and calm Clinical Analysis areas and the types of
5. Self – Motivation – having the positive laboratory procedures performed
attitude and initiative sa task o Hospital
6. Compassion – Learn to admit your • With permanent inpatient beds
mistakes • 24-hour nursing service
7. Ethical Behavior – conforming with the • Managed by organized medical
standards to avoid harming the patients team
Basic concepts of communication in a health • Clinical lab services
care setting • 2 major divisions Anatomical and
o Components of Good Communication Surgical Pathology (sila ang
• Verbal Communication naghahandle ng tests sa histology,
• Nonverbal Communication cytology, histopathology) &
• Active listening Clinical analysis area (lahat ng
Elements in Healthcare communication tests except sa nakaindicate sa
1. Empathy – ability to understand the taas)
feelings of other Clinical Analysis Areas
2. Control 1. Hematology
3. Respect 2. Coagulation
4. Confrimation 3. Chemistry
5. Trust – pinaka importante 4. Serology
5. Urinalysis
6. Microbiology
 7. Blood bank/Immunohematology Clinical Chemistry
Hematology 1. Alanine amino tranferase (ALT) is used to
1. Hematocrit (Hct) checks the hemoglobin monitor liver disease.
level and the red cell count. 2. Alpha-fetoprotein (AFP) checks levels
2. Hemoglobin (Hgb) tests the value to rule especially for prenatal screening
out anemia. 3. Alkaline phosphatase (ALP) determines
3. Red Blood Cell (RbC) count is used to level to check obstructions and bone
measure the erythropoietic activity. disease.
4. White Blood Cell (WbC) count checks the 4. Ammonia measures the level which could
leukocyte response indicate cirrhosis and hepatitis.
5. Platelet (Plt ct) count usually used to 5. Amylase checks the enzyme level which
monitor chemotherapy and radiation could indicate liver disease, cholesystitis,
conditions. etc.
6. Differential White Count (Diff) monitors 6. Aspartate amino-transferase (AST)
changes in the appearance or quantity of measures the level which is indicative of
specific cell types liver dysfunction.
7. Indices shows the changes in RBC size, 7. Bilirubin shows the level in the
weight and Hgb content bloodstream that shows red blood
8. Mean Corpuscular hemoglobin (MCH) destruction
gives the weight of the hemoglobin in the 8. Blood Gases (ABG) evaluates acid-base
cell. balance by measuring the pH, partial
9. Mean Corpuscular volume (MCV) shows pressure of the carbon dioxide and
the size of the cell. oxygen.
10. Mean Corpuscular hemoglobin 9. Blood Urea Nitrogen (BUN) checks
concentration (MCHC) gives information elevated levels which leads to impaired
on the concentration of the hemoglobin renal function.
per unit volume of RBCs. 10. B-type natriuretic peptide (BNP) is a
11. Red blood distribution width (RDW) cardiac marker for congestive heart
measures the size differences of the failure.
RBCs Immunology and Serology
Coagulation 1. Bacterial Studies
1. Activated partial thromboplastin time o Antinuclear antibody (ANA) shows
(APPT) reflects the adequacy of herapin autoimmune disorders such as systematic
therapy. lupus erythematosus
2. D-dimer checks the thrombin and plasmin o Antistreptolysin O (ASO) titer indicates
activity streptococcal infection
3. Fibrin split products (FSP) measures if the o Cold agglutinins checks cases of atypical
level is high because it results to FDP pneumonia
fragments. o Febrile agglutinins shows presence of
4. Fibrogen tests are performed to check antibodies to specific organisms
any fibrogen deficiency. o FTA-ABS confirms syphilis
5. Prothrombin Time (PT) or International o Rapid plasma reagin (RPR) when positive
Normalized Ratio (INR) evaluates liver it is indicative of syphilis but it needs
diseases or deficiency in Vitamin K confirmation
o Rheumatoid factor (RF) indicates
rheumatoid arthritis
 2. Viral Studies Microbiology
o Anti-HIV screens Human 1. Acid-fast bacilli (AFB) is used to monitor
immunodeficiency virus treatment for TB
o Cytomegalovirus antibody (CMV) is a 2. Blood culture checks presence of
confirmation test bacteria which indicates bacteremia or
o Epstein-Barr Virus checks for presence of septicemia
heterophil antibody which indicates 3. CLO test shows presence of Helicobacter
infectious mononucleisis pylori
o Hepatitis B surface antigen checks for 4. Culture & Sensitivity (C&S) indicates
presence of hepatitis antigen in the infection if there is growth in the
surface of the red cell pathogenic microorganism
3. General Studies 5. Fungus culture and identification - used to
o C-reactive protein (CRP) indicates determine the type fungi if present
inflammation when levels are increased 6. Gram stain - done to allow antimicrobial
o Human chorionic gonadotrophin (HCG) therapy while waiting for culture results
tests are present when patient is pregnant 7. Occult blood - checks for blood in the
Clinical Microscopy stool which could result from
1. Physical Evaluation gastrointestinal bleeding
o Color indicates presence of blood 8. Ova and parasites - solves "etiology
melanin, bilirubin or urobilin in the urine unknown" intestinal disorders
specimen Blood Bank/Immunohematology
o Clarity shows presence of fat, chyle 1. Antibody (Ab) screen - agglutination
bacteria which affects the turbidity means presence of abnormal antibodies
o Specific Gravity suggests renal tubular in the blood
involvement or ADH deficiency 2. Direct antihuman globulin test (DAT)
2. Chemical Evaluation determines transfusion incompatibility
o Blood - Hematuria could be due to 3. Type and RH - shows the blood group
hemorrhage, infection or trauma (ABO) and type (Rh)
o Bilirubin - helps differentiate between 4. Type and crossmatch shows the blood
obstructive and hemolytic jaundice group and screens for antibodies in the
o Glucose - Glucosuria maybe a result of recipient's blood
diabetis melitus, renal impairments 5. Compatibility testing - detects antibodies
o Ketones - uncontrolled diabetes mellitus and antigen in both recipient's and
or starvation donor's blood
o Leukocyte - indicates urinary tract STAT Laboratory
infection if there is a lot of neutrophils o Established in the emergency room.
o pH - indicates in acid-base balance o Stat Labs are intended to:
o Protein - Proteinura is an indicateor of • ↓ Patient’ s length of hospital stay
renal dysfunction or disorder • ↓Turnaround time
o Nitrite - positive results could mean • ↑ Patient convenience
bacterial infection • ↑ Physician - client satisfaction
o Urolibinogen - increases in amount when • ↓ Costs
patient suffers from hepatitic issues
3. Microscopic Evaluation - shows the status
of the urinary tract, hematuria, pyuria, etc.
Reference Laboratory
o Large independent laboratory that
receives specimen from many facilities in
the area.
o Provides routine and specialized analysis
of the specimen.
o Offer fast turnaround time and reduced
cost
o DOH – designated External Quality
Assurance System (EQAS)
Additional Information
- Poikilocutosis – variation in shape (rbc)
- Anisocytosis – variation in size (rbc)
- Thrombosis – development of clot
- Clotting time and bleeding time
- Rouleaux Formation – incompatible sa
blood bag unit. Stacking of RBC
- NSS or Normal saline solution ang
ginagamit pang wash ng blood bag