Chapter 1: History of Phlebotomy Leeches/Hirudo medicinalis (modern method)

– useful in removing excess blood and relieve symptoms

Phlebotomy
-process of collecting blood Therapeutic Phlebotomy
-the act of bloodletting as a therapeutic measure -Px with Polycythemia Vera or Hereditary
Hemochromatosis (500 mL of blood withdrawn)
Bloodletting  Polycythemia vera demonstrates an increase
-dates back to the early Egyptians in red cell mass (increased amount of rbcs
-once thought to rid the body of diseases and present with relation to the amount of
provide a cure for almost all ailments plasma present in the blood.
-practiced by barbers (known as surgeons during in  Hereditary hemochromatosis is an
the 12th century) autosomal recessive disorder that disrupts
the body’s regulation of iron
2 Basic Methods: (produced much scarring)  Iron deficiency anemia is a predictable
Venesection (most common) complication of therapeutic phlebotomy
-uses a sharp lancet-type instrument to pierce the because approximately 250 mg of iron is
veins and made them bleed removed with each unit of blood (1 unit of
-lancing the veins was thought to eliminate the bad blood = 450 cc)
blood and remove the disease
-used to reduce fever or to produce faint so an Diagnostic Phlebotomy
expectant mother would deliver her baby by the – blood sample drawn is used for Px diagnosis and
time she recovered treatment

Cupping Phlebotomy’s Role in Health Care

-as the heated glass cup (placed on a person’s
back) was cooled, it created a suction that pulled Phlebotomist
blood to the capillaries under the cup – collects blood for accurate and reliable test results as
quickly as possible and with the least discomfort to the
December 1799 patient (primary role)
–George Washington had a severe throat infection. -cross-trained in venipuncture, capillary collection,
He was bled of more than 9 pints/5 liters of blood patient care, reception duties, sample processing, and
in less than 24 hrs. and died computer work.
-some hospitals, this position is known as Patient Care
Middle of 19th century Technician
–discovery of microorganisms as causative agents
for many diseases
Centralized phlebotomy Areas of the Hospital and Health Care Setting
phlebotomist (laboratory-based personnel) is
dispatched from the laboratory to either nursing
units or outpatient areas to collect blood
samples and then bring them to the laboratory

Decentralized phlebotomy
–everyone who has contact with the patient
needs to become multiskilled in phlebotomy
-all members of the health care team share
responsibility to collect blood samples

Ex. Non-laboratory personnel (nurses, nursing

assistant)

Patient-focused care
–duties of the hospital staff revolve more around
the patient and the need to treat the patient
quickly rather than being restricted to a specific
job description
 Brings laboratory to the patient.
 Nurses need to learn how to collect blood
samples, and the phlebotomist needs to
learn some of the nursing duties.

Hybrid phlebotomy
– a blend of centralized and decentralized
phlebotomy
 (CEA), Glucose, Alanine aminotransferase (ALT),
Laboratory Sections and Their Purpose Aspartate aminotransferase (AST), Cholesterol

Administrative Office – responds to telephone Microbiology – culture samples to determine if

calls, handles specimen collection requests, and pathogenic organisms are present in a sample and
handles some specimens determines the organisms’ sensitivity to antibiotics
(culture and sensitivity)
Phlebotomy (Sample Collection) – collects Tests: Blood cultures, throat cultures, anaerobic cultures,
samples from patients and processes samples for urine cultures, parasite identification, stool culture,
testing or transport mycobacterial (tuberculosis) culture, viral culture, fungal
cultures, genital cultures, mycoplasma cultures,
Hematology – studies the blood in normal and antibiotic susceptibility testing
diseased states. Usually limited to the study of
cellular components and not the chemistry of Immunology – studies antigens and antibodies to
blood determine immunity to disease or presence of disease
Tests: CBC, Hemoglobin, Hematocrit, Platelet Tests: Human immunodeficiency virus (HIV) testing,
Count, Erythrocyte Sedimentation Rate, Body rubella, syphilis (rapid plasma regain [RPR]), hepatitis
fluid cell counts testing

Coagulation – study of blood clotting mechanisms Immunohematology (Blood Bank) – determines

as an aid in diagnosis or monitoring of patient compatibility of blood and blood products that are to be
therapy administered to patients
Tests: Prothrombin Time (PT), Activated Partial Tests: Compatibility testing, antibody screens or ABO, Rh
Thromboplastin Time (APTT), D-dimer, Factor VIII, determination
Fibrinogen assay, Heparin level, von Willebrand
factor (ristocetin) Cytogenetics – study of deficiencies related to genetic
diseases
Urinalysis – study of urine to aid in patient Tests: Chromosome analysis, prenatal chromosome
diagnosis to follow the course of a disease or the screening
body’s metabolism
Tests: Urinalysis, Reducing substance, Urine pH, Molecular Diagnostics – using polymerase chain reaction
Urine glucose (PCR) technologies to study the presence of various
diseases or infections
Chemistry – performs biochemical analysis of Tests: Methicillin-resistant Staphylococcus aureus
blood and body fluids to determine the status of a (MRSA) infections, HIV, and other infectious diseases
patient
Tests: Comprehensive metabolic panel, Iron
studies, Renal panel, Carcinoembryonic antigen
  glucose
Panels of Laboratory Tests  blood urea nitrogen (BUN)
 calcium and creatinine
Complete Blood Count
 White blood cell (leukocyte) count Renal panel
 differential white count  Sodium
 red blood cell (erythrocyte) count  Potassium
 hematocrit  Chloride
 hemoglobin  carbon dioxide (CO2 )
 red blood cell indices  glucose
 mean corpuscular volume (MCV)  blood urea nitrogen (BUN)
 mean corpuscular hemoglobin (MCH)  calcium, creatinine
 mean corpuscular hemoglobin concentration  phosphorous
(MCHC)  and albumin
 platelet (thrombocyte) count
Lipid panel
Electrolyte panel (Lytes)  cholesterol
 Sodium  triglyceride
 Potassium  high-density lipoprotein (HDL)
 Chloride  low-density lipoprotein (LDL)
 carbon dioxide (CO2 )
Comprehensive Metabolic panel
Hepatic Function panel  glucose
 Total protein  blood urea nitrogen (BUN)
 Albumin  creatinine
 total and direct bilirubin  sodium
 alkaline phosphatase  potassium
 AST, also known as serum glutamic oxaloacetic  chloride
transaminase (SGOT)  calcium
 ALT, also known as serum glutamic pyruvic  carbon dioxide (CO2 )
transaminase (SGPT)  albumin
 total protein
Basic Metabolic panel:  alkaline phosphatase
 Sodium  AST
 Potassium  ALT
 Chloride  total bilirubin
 carbon dioxide (CO2 )
 Phases of Sample Testing Postexamination – Previously known as postanalytical
phase
Preexamination – Previously known as • Process in which the results of the testing are
preanalytical phase communicated to the health care provider. These
• Includes all processes from collecting the consists of the following:
sample to having it ready for testing a. Reporting of results
• It is where a phlebotomist is mainly involved b. Ensuring accuracy and reliability of delivery of
results
Steps to collect the sample c. Follow-up to repeat testing or address physician
 The clinician’s request concerns Storage of samples after the
 Patient identification(most important step) and examination
information
 Correct sample collection Laboratories in the 21st Century
 Correct primary sample identification
 Correct use of all equipment Managed Care - a complex system developed to

 Sample preparation or centrifugation coordinate the provision of health services and health

 Proper preparation of sample aliquots benefits

 Maintaining sample integrity until the  Health maintenance organization (HMO) –

examination (analytical) process can begin required to use only certain contracted physicians
and hospitals for their care.

Examination – Previously known as analytical  Preferred provider organization (PPO) –

phase contracts with certain health care facilities but

• Includes all processes done to sample to offers more freedom (resulting to higher cost) for

achieve result patients to choose to whom they go.

 a set of operations to determine the value or

characteristics of a property. The Patient Care Partnership

 The processes that are done to perform the

test on the sample to achieve a result include Patient Rights: can be exercised on the patient’s behalf

the following: by a designated surrogate or proxy decision maker if the

a. Sample testing patient lacks decision-making capacity, is legally

b. Maintaining testing equipment and incompetent, or is a minor.

reagents
• Patient has right to considerate and respectful care
• Patient has right to receive understandable information
• Patient has right to make decisions about plan of care
and refuse treatment
• Patient has right to have an advance directive
• Patient has the right to privacy
• Patient has the right to confidentiality of his or Medical technologists work in five major areas of the
her medical records laboratory:
• Patient has the right to review records  blood banking
• Patient has right to expect that within its  chemistry
capacity and policies, a hospital will make  hematology
reasonable response to the request of a patient  immunology
for appropriate and medically indicated care  microbiology
and services
• Patient has the right to information regarding • Medical Laboratory Technician (MLT): under the
hospital business relationships that might supervision of the medical technologist, performs
impact his or her care general tests. Medical laboratory technicians have
• Patient has the right to consent or decline to special training in addition to a high school diploma or
participate in proposed research studies an associate degree.
• Patient has the right to expect continuity of
care. • Phlebotomy Technician (PBT): collects blood
• Patient has the right to be informed of samples to be used in many laboratory tests.
hospital policies and practices that relate to Phlebotomists have training in addition to a high
patient care, treatment, and responsibilities. school diploma.

The Laboratory Staff • Cytotechnologist: examines cells under the

microscope to detect signs of cancer in the earliest
• Pathologist: physician who reads and stages. Cytotechnologists must hold baccalaureate
interprets the results of laboratory tests or degrees and have special training to search out the
examines tissues under a microscope to smallest abnormalities in color, shape, or size of cells.
diagnose and monitor disease.
-5 years of training following graduation from • Histotechnologist: prepares body tissue samples for
medical school microscopic examination by the pathologist using
sophisticated techniques such as
• Medical Laboratory Scientist (MLS) or Clinical immunohistochemistry. Histotechnologists must hold
Laboratory Scientist (CLS): Holds a minimum of baccalaureate degrees and have special training to
a baccalaureate degree and is responsible for freeze, cut, mount, and stain the tissues, often while
performing a full range of laboratory tests, the patient is still in surgery, thus playing a major role
confirming the accuracy of test results, and in the diagnosis of malignancy.
reporting laboratory findings to the pathologist
and other physicians.
Professional Attitude Quality Assurance
➢ Everyone must follow professional code of • Quality is phlebotomist’s responsibility
conduct in treatment of patients • Result of test sent to physician depends on quality of

➢ Includes professional approach to all aspects sample obtained

of job and professional grooming and dress • Laboratories must have certain levels of patient
satisfaction to continue receiving payments from

Advance Directives insurance companies

➢ Documents written before incapacitating

illness that give instructions about a persons’ Quality Assurance Program – strives to guarantee that

health care, if in the future, they cannot speak all areas of the health care facility are providing the

for themselves highest quality control in order to function.

➢ A person can give someone he/she names

(an agent/proxy) the power to make health care • Most common error is CLERICAL ERROR

decisions for that person.

Total Quality Management Program – Management plan

Four categories of testing: that ensures that the quality expected can be met.

1. Waived tests – simple. Unvarying and require

a minimum of judgment and interpretation. • Establishes the assurance of adequate supplies and
personnel, up-to-date procedures, and acceptable

2. Physician-performed microscopy tests – the patient outcomes (the patient’s health improving)

physician personally looks under the

microscope and makes the judgement and Continuous Quality Improvement Program – does not

interpretation. accept the status quo; there must be constant efforts to

improve what is being done.

3. Moderate-complexity tests – require more

complex testing equipment and a moderate
amount of judgement and interpretation.
Moderate-complexity laboratories must employ
personnel with specific levels of education
.
4. High-complexity tests – require the most
complex testing equipment and a large amount
of judgement and interpretation. Highly
complex laboratories must employ personnel
with specific levels of education.
Infection Control

Nosocomial Infection
• Hospital-acquired
• Develops 48 hours after admission or within
30 days after discharge from a hospital or
health care facility

Community-Acquired Infection
• Infection picked up prior to admission
– Infection occurs before 48 hours after
admission

Types of Infection
• Local – restricted to one area of body
• Systemic –affects entire body Five Points of Standard Precautions
• Autogenous- from patient’s own flora
• Wash hands
Means of Transmission of Infection • Wear gloves
• Wear protective covering
• Contact – Direct and indirect • Wear a mask and eye protection when appropriate
• Droplet • Use designated sharps containers
• Vehicle
• Airborne Engineering Controls
• Vector-borne • Physical and mechanical devices available to the health
care associate to reduce or eliminate the potential to
Standard Precautions transfer infectious diseases
• Assumes all blood and most body fluids are – Sharps containers
potentially infectious. – Transport bags and containers
• Personal protective equipment must be worn – Self-sheathing needles and holders
for contact with all body fluids whether blood is
visible or not. Work Practice Controls
• Handwashing
Types of Body Fluids • Proper disposal of sharps
• Amniotic • Peritoneal • Avoiding eating, drinking, smoking, handling contact
• Pericardial • Synovial lenses, or applying cosmetics or lip balm in work areas
• Pleural • Edematous • Storing food and drink separate from infectious
• Seminal • Cerebrospinal materials
Housekeeping Chemical Safety
• Clean up spills • Chemicals that produce a toxic or irritant vapor must
• Decontaminate soiled areas immediately with be used only in an approved chemical hood.
a disinfectant such as 10 percent bleach made • A chemical-resistant apron and face shield should be
up fresh daily worn if there’s a danger of splashing. • Eye wash station
• Avoid picking up broken glass with hands and safety shower

Personal Protective Equipment Electrical Safety

• Masks • Most common electrical equipment a phlebotomist
• Goggles uses is a centrifuge
• Face shields • Other electrical equipment includes computers, fans,
• Gowns and space heaters.
• Gloves • Equipment must be tested for safety and proper
operation.
Needles and Sharps
• Biohazard labels must be fluorescent orange Latex Allergy
or orange red with lettering or symbols in a • Growing concern in healthcare
contrasting color. • Allergic reactions to latex
– Type IV latex allergy
Material Safety Data Sheets • Irritant contact dermatitis resulting in skin irritation
• Information that must be on file to indicate – Type I latex allergy
hazards of chemicals used in laboratory • More serious
– Does not need to be a paper file • Immunologic reaction up to anaphylactic shock
• Most healthcare facilities have these as
Internet-assessable forms Disposal of Infectious Materials
Must be by:
Fire Safety – Incineration
• National Fire Protection Association’s key – Chemical treatment
word for action: – Autoclave
RACE
– Rescue anyone in danger.
– Sound the Alarm.
– Contain the fire by closing doors and/or
windows.
– Extinguish/Evacuate.
The Human Body Body Systems
• Anatomy – Study of body’s shape and • Homeostasis – Maintaining steady state of equilibrium
• Metabolism – Making or breaking down substances so
structure
body can function
• Physiology – Study of each body part’s • Catabolism – Production of energy by breaking down
function complex compounds into simple substances
• Anabolism – Process by which the body uses simple
substances to build complex substances
Body Positions
• Median (sagittal) plane – Equal right and left Cell Structure
• Cytoplasm – Semifluid inside cell membrane
sections
• Nucleus – Brain of cell
• Proximal – Toward point of attachment to • Endoplasmic reticulum – Channel for the transport of
body material in and out of nucleus
• Distal – Farthest from point of attachment to • Mitochondria – Sites for cell respiration and energy
production
body • Golgi apparatus – Synthesize carbohydrates and
combine them with protein molecules
• Lysosomes – Digestive apparatus

Tissues of the Body

• Epithelial tissue – Covers internal and external surfaces
to provide protection
• Connective tissue – Supports and connects organs and
tissues
• Muscle tissue – Cardiac, skeletal, and smooth muscle –
tissue that has ability to shorten, thicken, or contract
• Nervous tissue – Consists of nerve cells (neurons)
allowing control and coordination of body activities

Integumentary System
• Frontal (coronal) plane – Separates front from • Epidermis – Outermost skin layer
back • Dermis – Lower skin layer containing blood vessels
• Transverse plane – Separates top from bottom
Skeletal System
• System that supports movement and provides shape to
the body
• Support provided by 206 bones
• Axial skeleton – Generally provides protection – Skull,
ribs, breastbone, and spinal column
• Appendicular skeleton – Provides anchor for the
muscles
Skeletal System
• Basic tests for Skeletal Muscle Damage: Urinary System
– Aldolase • Kidneys – Regulate amount of water and solutes the
– Alanine aminotransferase (ALT) body system expels
– Aspartate aminotransferase (AST) • Ureters – Carry urine from each kidney to the bladder
– Creatine kinase (CK) • Bladder – Reservoir for urine
– CK-MM • Urethra – Channel to push urine out of body
– Myoglobin
Substances Produced by the Urinary System
Muscular System • Renin – Regulates blood pressure
• Responsible for both internal and external • Erythropoietin – Stimulates red blood cell production
movement, body shape, and maintenance of body in the bone marrow
temperature • Vitamin D – Used by the body for the development of
• Can be striated (spindle shaped) or nonstriated teeth and bones; controls calcium and phosphorus
– Determined by how they look under microscope metabolism

• There are three types of muscles that help the Basic Tests for Urinary Disorders
body with involuntary and voluntary movement. • Blood urea nitrogen (BUN)
• Creatinine
• Cardiac – Striated involuntary muscle of heart • Microalbumin
• Skeletal – Striated muscle attached to bone for • Urinalysis
voluntary body movement • Urine calcium
• Smooth – Non-striated involuntary muscle • Urine creatinine
covering walls of digestive tract and other internal • Urine culture
body organs • Urine total protein

Nervous System Digestive System

• Provides communication lines for different body • System that helps the body absorb nutrients that the
systems: tissue cells need
– Central nervous system
• Communication lines for body systems • Ingestion – Chewing of food to break it down
– Peripheral nervous system • Peristalsis – Movement of food along digestive tract
• Nerves that connect to brain and spinal cord • Digestion – Chemical breakdown of food
– Autonomic nervous system • Absorption – Nutrients are absorbed into blood
• Carries impulses to involuntary muscles and capillaries as food moves through small intestine
glands • Defecation – Elimination of wastes from the body

Basic tests for nervous system disorders: Basic Tests for Digestive System Disorders
– Cerebrospinal fluid (CSF) analysis • Complete blood count (CBC)
• Hematology • Celiac difficile toxin
• Microbiology • Clostridium difficile toxin
• Chemistry/serological testing – Serotonin • D-xylose absorption
• Food allergy testing
Respiratory System • Helicobacter pylori tests
• Maintains body’s ability to exchange gases • Lactose intolerance test
• External respiration – Exchange between lungs • Ova and parasites
and blood – Also known as breathing or ventilation
• Internal respiration – Exchange of gases between Endocrine System
blood in the systemic capillaries and tissue cells • Composed of glands that manufacture and secrete
hormones needed in body
• Helps body maintain homeostasis
Basic Tests for Endocrine Disorders Study of Body Systems
• Adrenocorticotropic hormone (ACTH) • Cardiology – study of the heart
• Aldosterone • Dermatology – study of the skin
• Catecholamines, plasma and urine • Endocrinology – study of the endocrine glands
• Cortisol • Gastroenterology – study of the stomach and
• Dehydroepiandrosterone sulfate (DHEAS) intestines
• Electrolytes • Gynecology – study of female disease
• Estrogen • Hematology – study of the blood
• Follicle-stimulating hormone (FSH) • Neurology – study of the nerves and the brain and
• Human chorionic gonadotropin (HCG) spinal cord
• Progesterone • Oncology – study of malignant diseases and cancer
• Triiodothyronine (T3) and thyroxine (T4) • Ophthalmology – study of the eye
• Testosterone • Pathology – study of disease
• Thyroid-stimulating hormone • Psychology – study of the mind and mental disorders
• Rheumatology – study of joint diseases
Reproductive System
• Specialized sex cells or gametes produced by
gonads of both male and female sex organs
• Hormone production maintained
• Gonads of female (ovaries) produce egg cells
(ova)
• Gonads of male (testes) produce sperm

Lymphatic System
- Closely associated with circulatory system
• Primary purpose:
– Drain protein-containing fluid (interstitial fluid)
that escapes from blood capillaries

• Lymph
• Lymph nodes
• Lymph vessels
• Spleen
• Thymus gland
• Lymphoid tissue
• Intestines
• Tonsils

Functions of the Lymphatic System

• Lymph fluid (interstitial fluid) found between
blood in capillaries and tissue
• Lymph vessels – Transport lymph fluid between
capillary blood and tissue
• Lymph nodes – Produce white blood cells (WBCs)
and filter out bacteria and foreign matter
• Spleen – Removes old RBCs
• Thymus gland – Produces T-lymphocyte cells to
maintain immunity