Phlebotomy Notes

Phlebotomy

  • Phlebotomy is the process of collecting blood through a vein, involving incision and puncture methods.
  • The term originates from two Greek words: "Phlebos" (vein) and "Temnein" (cut).
  • Also referred to as venesection.
  • The goal of phlebotomy is for diagnosis, transfusion, removal of blood for polycythemia, or therapeutic purposes.
  • Two main methods: venipuncture and capillary puncture.

Evolution of Phlebotomy

  • Stone Age (1400 BC): Crude tools were used.
  • Time of the Ancient Egyptians: "Bloodletting" was introduced.
  • Hippocrates (460-377 BC):
    • Greek physician.
    • Proposed the theory of the four humors: blood, phlegm, stool, and bile.
    • Bloodletting was practiced to balance these humors.
  • Middle Ages: Barber-surgeons performed bloodletting for treatment.
  • 17th & 18th centuries: Phlebotomy was a major therapy.
  • Cupping:
    • An alternative medicine used to help ease pain and inflammation.
    • Involves the use of special cups.
  • Leeching or “Hirudotherapy”:
    • Uses leeches for bloodletting.
    • Used for microsurgical replantation.
    • Hirudo Medicinalis (medicinal leech) is used for leeching.
    • Leeches contain:
      • Vasodilator
      • Anesthetic
      • Hirudin (anticoagulant)

Roles of Phlebotomy

  • To collect blood samples
  • To deliver and transport collected samples.
  • To assist in collecting other specimens (urine & non-blood).

Credentials

  • Certification or license (passed the licensure exam) and continuing education (attending seminars & meetings).

Qualities of Professionalism

  • Professional appearance
  • Self-confidence
  • Integrity
  • Compassion
  • Self-motivated: have a positive attitude
  • Dependable
  • Ethical behavior

3 Components of Good Communication

  • Verbal: Expressing ideas through words.
  • Non-verbal: Observation.
  • Active listening: Listening.
  • FEEDBACK is the proof that the communication went well.

HOSPITAL FEEDBACK

  • Inpatient (non-ambulatory): Requires patients to stay in the hospital for at least 1 night.
  • Outpatient: Patients are served by a secondary care specialist on the same day.
  • Primary level
    • Health units in rural areas
    • Sub-units operated by the Department of Health (DOH)
  • Secondary level
    • Non-departmentalized hospitals
  • Tertiary level:
    • Medical centers & large hospitals
    • Highly technical and offers sophisticated services
    • Can address serious diseases
  • Ambulatory care:
    • Medical care given to outpatients or patients who require follow up check-ups
    • Can be done in free-standing medical care & hospital owned clinics
  • Homebound services:
    • Procedures, tests, and services done in a patient’s home or in a long term facility
  • Public health services:
    • Belongs to the unit at the local level
    • Under the health department of the government
    • Services offered with little to no charge
  • Hospital - an institution that has permanent inpatient beds & 24-hour nursing services
  • the 2 major divisions of a Hospital:
    • Anatomical and surgical pathology:
      • Histology - tissues
      • Cytology - cells
      • Cytogenetics - chromosomal
    • Clinical analysis (divided into 7 areas)
      • Hematology
      • Coagulation
      • Chemistry
      • Serology or Immunology
      • Urinalysis
      • Microbiology
      • Blood bank or immunohematology

Serology or Immunology section:

  1. Bacterial Studies:
    • Antinuclear Antibody (ANA) - shows autoimmune disorders such as systemic lupus erythematosus
    • Antistreptolysin-O-(ASO) Titer - indicates streptococcal infection
    • Cold Agglutinins - checks cases of atypical pneumonia
    • Febrile Agglutination Test - shows the presence of antibodies to specific organisms
    • FTA-ABS - confirms syphilis
    • Rapid Plasma Reagin (RPR) - when positive, it is indicative of syphilis, but it still needs confirmation
    • Rheumatoid Factor (RF) - indicates rheumatoid arthritis
  2. Viral Studies:
    • Anti-HIV - screens for human immunodeficiency virus
    • Cytomegalovirus Antibody(CMV) - a confirmatory test for CMV antibody
    • Epstein-Barr Virus (EBV) - checks for the presence of heterophil
    • Hepatitis B. Surface Antigen-(HBSAg) - checks for the presence of hepatitis antigen on the surface of the red cells
  3. General Studies:
    • C-Reactive Protein (CRP) - indicates inflammation when levels are increased
    • Human Chorionic Gonadotropin (HCG) Test- the hormone is present when the patient is pregnant

Immunohematology section:

  • Blood for transfusion test procedures under this section
  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
  • Stat labs “agad-agad” - test procedure that are immediately done or prioritized
  • Reference laboratory:
    • Large and independent laboratory that provides confirmatory tests for blood, urine, and tissues
    • Has faster turnaround time