PRINCIPLES OF MEDICAL LABORATORY SCIENCE 2

Reynaldo O. Tabang Jr., RMT | Lecture

PHLEBOTOMY AND THE HEALTH-CARE DELIVERY ▪ Early in Middle Ages, barber surgeons flourished.
SYSTEM ➢ By 1210, the Guild of Barber Surgeons had been
formed; it divided the surgeons into
Phlebotomy Surgeons of the Long Robe and Surgeons of the
Short Robe.
➢ Define as “an incision into a vein” ➢ Short Robe surgeons were forbidden by law to do any
➢ Comes from the Greek words phlebos, “vein” and tome, surgery except bloodletting, wound surgery,
“incision” cupping, leeching, shaving, tooth extraction, and
enema administration.

Evolution of Phlebotomy ▪ 17th and early 18th centuries

➢ Phlebotomy was considered a major therapeutic
▪ 460-377 B.C (treatment) process, and anyone willing to claim
➢ An early medical theory developed by Hippocrates medical training could perform phlebotomy.
stated that disease was the result of excess ➢ The lancet, a tool used for cutting the vein during
substance—such as blood, phlegm, black bile, and venesection, was perhaps the most prevalent medical
yellow bile—within the body. instrument of the times. The usual amount of blood
➢ One important surgical technique was venesection withdrawn was approximately 10mL, but excessive
(cutting a vein), which is used in bloodletting. phlebotomy was common.
➢ During this same period, phlebotomy was also
o Venesection – from the Latin word vena, accomplished by cupping and leeching.
“vein”, and sectio, ‘cutting”—was the o For more localized bloodletting, leeches
most common method of general were used. This procedure involved enticing
bloodletting. the Hirudo medicalis, a European.

▪ Some authorities believe phlebotomy dates back to the last ▪ Phlebotomy of TODAY
period of the Stone Age when crude tools were used to ➢ At present, the primary role of phlebotomy is the
puncture vessels and allow excess blood to drain out of collection of blood samples for laboratory analysis to
the body. diagnose and monitor medical conditions.
▪ A painting in a tomb showing the application of a leech to a ➢ A phlebotomist is a person trained to obtain blood
patient evidences bloodletting in Egypt in about 1400 B.C. samples primarily by venipuncture and micro
techniques.
o In addition to technical, clerical, and
interpersonal skills, the phlebotomist must
develop strong organizational skills to
handle a heavy workload eciently and
maintain accuracy, often under stressful
conditions.

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 Duties of the Phlebotomy Dependable, Cooperative, Committed

▪ Traditional duties ▪ Dependable

➢ Correct identification and preparation of the ➢ Reliability in completing tasks accurately and on
patient before sample collection. time, and being consistently present when needed.
➢ Collection of the appropriate amount of blood by o Patients and healthcare teams rely on
venipuncture or dermal puncture for the specified phlebotomists to collect samples
tests. accurately and promptly for diagnostic
➢ Selection of the appropriate sample containers for purposes.
the specified tests. o Dependability ensures that procedures
➢ Correct labeling of all samples with the required are followed, samples are labeled
information. correctly, and test results are not delayed.
➢ Appropriate transportation of samples back to the o Being dependable builds trust with patients
laboratory in a timely manner who may feel anxious or uneasy.
➢ Effective interaction with patients and hospital ▪ Cooperative
personnel ➢ The ability to work well with others, including
➢ Processing of samples for delivery to the patients, colleagues, and other healthcare
appropriate laboratory departments professionals.
➢ Performance of computer operations and record- o Phlebotomists are often part of a larger
keeping pertaining to phlebotomy healthcare team; cooperation ensures
➢ Observation of all safety regulations, quality smooth communication and workflow.
control checks, and preventive maintenance o This trait is crucial when coordinating with
procedures. nurses, doctors, and lab technicians,
➢ Attendance at continuing education programs especially in high-pressure situations like
emergencies.
▪ Additional Duties of Phlebotomists o Cooperative behavior helps in
➢ Training other healthcare personnel to perform understanding patients’ needs and
phlebotomy addressing their concerns
➢ Monitoring the quality of samples collected on the compassionately.
units ▪ Committed
➢ Evaluation of protocols associated with sample ➢ Dedication to one’s responsibilities, the profession,
collection and the well-being of patients
➢ Performing and monitoring point-of-care testing o Commitment to proper techniques and
(POCT) infection control protocols is vital for
➢ Performing electrocardiograms patient safety and sample integrity.
➢ Performing measurement of patient’s vital signs o Be willing to demonstrate your
➢ Collection of arterial blood samples commitment to your job and your
➢ Collection of samples from central venous access cooperation to assist fellow employees.
devices (CVADs) o A committed phlebotomist attends staff
meetings, reads pertinent memoranda,
Professional and Personal Characteristics for and observes notices placed on bulletin
Phlebotomists boards or in newsletters
▪ Phlebotomists are part of a service-oriented industry, and
specific personal and professional characteristics are Compassionate, Courteous, Respectful
necessary for them to be successful in this area
▪ It is important for phlebotomists to understand that they are ▪ Compassionate
the actual face of the laboratory because they are the ➢ Demonstrating genuine care and empathy for
people who interact with the patients. others’ feelings, experiences, and challenges.
o They must be sensitive to their needs,
BOX 1-1 Characteristics Associated with understand a patient’s concern about a
Professionalism possible diagnosis or just the fear of a
needle, and take the time to reassure each
Dependable, cooperative, committed patient.
Compassionate, courteous, respectful o A smile and a cheerful tone of voice are
Integrity, honesty, competence, simple techniques that can put a patient
Organized, responsible, flexible more at ease.
Appearance
Communication
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 o Phlebotomists must demonstrate
competence in the procedures they are
▪ Courteous trained to perform. However,
➢ Being polite, kind, and considerate in interactions overconfidence in one’s abilities can result
with others. in serious errors.
o Courteous phlebotomists introduce o Continuous education and skill
themselves to the patients before they enhancement are necessary to keep up
approach them. This also aids in identifying with advances in medical technology and
the patient as you can then ask them to practices.
state their name in the same conversation.
o Professional courtesy extends to Organized, Responsible, Flexible
colleagues, enhancing teamwork and a
supportive workplace environment. ▪ Organized
▪ Respectful ➢ The ability to structure tasks and maintain a
➢ Recognizing and honoring the dignity, rights, and systematic approach to ensure efficiency and
preferences of others. accuracy.
o Phlebotomists must also understand and o Phlebotomists must manage multiple
respect the cultural diversity of their tasks, such as preparing equipment,
patients. labeling samples, and keeping track of
o Do not expect every patient to respond to patient information, without making errors.
you in the same way and do not force your o They must also organize and prioritize
mannerisms and approach on them. their work
o Respect involves maintaining patient ▪ Responsible
confidentiality and adhering to ethical ➢ Being accountable for one’s actions and fulfilling
standards. duties with diligence and reliability.
o Respectful communication includes o Phlebotomists are entrusted with the
listening attentively to patients’ concerns safety and comfort of patients, requiring
and preferences, fostering better rapport them to take responsibility for adhering
to proper protocols and techniques.
Honesty, Integrity, Competence o Responsibility includes reporting any
issues, such as mislabeled samples or
▪ Honesty failed collections, to ensure patient safety.
➢ The quality of being truthful and transparent in all ▪ Flexible
interactions and tasks. ➢ The ability to adapt to changing situations,
o The phlebotomist should never hesitate to schedules, and patient needs without compromising
admit a mistake, because a misidentified performance.
patient or mislabeled sample can be critical o Allows phlebotomists to handle
to patient safety. emergencies, last-minute changes, or
o Patients rely on phlebotomists to provide fluctuating workloads.
accurate information about the procedure o Phlebotomists often work with diverse
and potential risks patients, requiring adaptability to different
▪ Integrity personalities, comfort levels, and medical
➢ Upholding strong moral principles and consistently conditions.
doing what is right, even when no one is watching.
o Patient confidentiality must be protected, Appearance
and patient information is never discussed
with anyone who does not have a ▪ Each organization species the dress code that it
professional need to know it. considers most appropriate, but common to all
o Integrity ensures that phlebotomists follow institutions is a neat and clean appearance that portrays
protocols, such as proper sterilization and a professional attitude to the patient.
infection control practices, to protect ▪ Remember, first impressions are lasting impressions
patients. often made within 30 seconds and the phlebotomist
▪ Competence represents the entire laboratory staff. In general, a sloppy
➢ Possessing the necessary skills, knowledge, and appearance indicates a tendency toward sloppy
ability to perform tasks effectively and efficiently. performance.
o Never perform a procedure that you have
not been trained to perform.

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▪ General Appearance Guidelines ▪ LISTENING SKILLS
➢ Clothing and lab coats must be clean and ➢ Listening skills are a key component of
unwrinkled. Clothing worn under the laboratory communication.
coat should be conservative and meet institutional ➢ Active listening involves:
requirements. Lab coats must be completely o Looking directly and attentively at the
buttoned and completely cover clothing. patient
➢ Shoes must be clean, polished, closed toed, and o Encouraging the patient to express
skidproof. feelings, anxieties, and concerns
➢ Perfume and cologne are usually not recommended o Allowing the patient time to describe why
or must be kept to a minimum. he or she is concerned
➢ Hair including facial hair must be clean, neat, and o Providing feedback to the patient through
trimmed. Long hair must be neatly pulled back. appropriate responses.
➢ Personal hygiene is extremely important because of o Encouraging patient communication by
close patient contact and careful attention should be asking questions.
paid to bathing and the use of deodorants and
mouthwashes. ▪ NONVERBAL SKILLS/BODY LANGUAGE
➢ Fingernails must be clean and short. Based on ➢ Nonverbal skills (body language) include facial
the Centers for Disease Control and Prevention expressions, posture, and eye contact.
(CDC) Handwashing Guidelines, artificial nail o If you walk briskly into the room, smile, and
extenders are not allowed. look directly at the patient while talking,
you demonstrate positive body language.
Communication Skills o Conversely, shuffling into the room,
avoiding eye contact, and gazing out the
▪ Good communication skills are needed for the window while the patient is talking
phlebotomist to function as the liaison between the o Allowing patients to maintain their zone of
laboratory and the patients, their family and visitors, comfort (space) is important in phlebotomy
and other healthcare personnel. even though you must be close to them to
▪ The three components of communication—verbal skills, collect the sample.
listening skills, and nonverbal skills or body o The zones will vary among different
language—are needed for effective communication. cultures.

▪ VERBAL SKILLS
➢ Verbal skills enable phlebotomists to introduce
themselves, explain the procedure, reassure the
patient, and help assure the patient that the
procedure is being competently performed.
➢ The tone of your voice and emphasis on certain
words also is important.
➢ Barriers to verbal communication that must be
considered include physical handicaps such as
hearing impairment; patient emotions; and the level
of patient education, age, and language proficiency.

Cultural Diversity

▪ Diversity in our population includes more than just the

diversity encountered with verbal communication. In
addition to language, culture includes the integration
of customs, beliefs, religion, and values. All of these
differences can affect patient care and communication.
▪ The Joint Commission (JC) has developed guidelines for
healthcare organizations to integrate cultural
competence into their facilities.

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▪ General Cultural Diversity Guidelines for nursing homes, home health-care agencies, clinics,
Phlebotomists and blood donor centers.
➢ Approach all patients with a smile and use a friendly
tone of voice. ▪ Hospital Organization
➢ Be alert to patient reactions to your approach and ➢ Hospitals vary in size, ranging from under 50 to
direct your actions to accommodate them. Do not force over 300 beds, and their services scale
your style on them. accordingly.
➢ Do not stereotype a particular culture; not all people of ➢ Hospitals vary not only in size but also by the type
same ethnic culture react in the same manner. of services offered and their overall mission.
➢ Remember the amount of personal space varies not ➢ Many hospitals also support outpatient clinics and
only among people but also among cultures. primary care offices, increasing the phlebotomy
➢ Plan to spend additional time explaining procedures workload.
and patient instructions. Be sure instructions are ➢ Phlebotomists may work directly in these areas or
understood by asking the patient to repeat the patients may be referred to the laboratory for
instructions to you. sample collection.

Telephone Skills ▪ Hospital Services and Departments

➢ Organizational charts are designed to define the
▪ The phlebotomy department frequently acts as a type of position of each employee with regard to
switchboard for the rest of the laboratory because of its authority, responsibility, and accountability.
location in the central processing area.
▪ Phlebotomists should have a thorough understanding of
the telephone system regarding transferring calls, placing
calls on hold, and paging personnel.

▪ Rules of proper telephone etiquette

➢ Answer the phone promptly and politely, stating the
name of the department and your name.
➢ Always check for an emergency before putting
someone on hold, and return to calls that are on hold
as soon as possible. ▪ Nursing Services
➢ Keep writing materials beside the phone to record ➢ This service deals directly with patient care.
information such as the location of emergency blood Phlebotomists interact most often with this service
collections, requests for test results, and numbers for and, in decentralized organizations, may be
returning calls. included in it.
➢ Make every attempt to help callers, and if you cannot
help them, transfer them to another person or ▪ Support Services
department that can. ➢ Support services maintain the hospital and
➢ Provide accurate and consistent information by include communications systems, tood
keeping current with laboratory policies, looking up service/dietary, housekeeping, laundry,
information published in department manuals, or engineering and maintenance, and security.
asking a supervisor.
➢ Speak clearly and make sure you understand what ▪ Fiscal Services
the caller is asking and that he or she understands ➢ Fiscal services manage the business aspect of a
the information you are providing. hospital. Included in this service are accounting,
admitting, the business office, credit and
collection, data processing, health information
HEALTH CARE DELIVERY SYSTEM management, planning, and public relations
departments that include marketing and outreach
▪ As members of the health-care delivery system, programs.
phlebotomists should have a basic knowledge of the
various health-care settings in which they may be ▪ Professional Services
employed. ➢ This service consists of the departments of the
▪ Many phlebotomists are employed by hospitals. hospital that assist the physician in the diagnosis and
▪ Other employment settings include physician office treatment of disease. The phlebotomist is included in
laboratories (POLs), health maintenance organizations this group as part of the clinical laboratory staff.
(HMOs), reference laboratories, urgent care centers,

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 THE CLINICAL LABORATORY • Philippine Lung Center
- Clinical Chemistry NRL for Pulmonary Diseases
ADMINISTRATIVE ORDER No. 2021-0037
• National Kidney and Transplant Institute (NKTI)
CLINICAL LABORATORY (CL) - Hematology and coagulation studies

A facility that is involved in the (a) pre-analytical, (b) analytical, • Philippine Heart Center
(c) and post-analytical procedures, where tests are done on - NRL pathology for Cardiac Disease
specimens from the human body to obtain information about the
health status of a patient for the prevention, diagnosis and PHYSICIAN’S OFFICE LABORATORY (POL)
treatment of diseases. These tests include, but are not limited
to, the following disciplines: anatomic pathology, clinical Refers to a doctor's office/clinic wherein CL examinations are
chemistry, clinical microscopy, endocrinology, performed for the purpose of monitoring the doctor's patients
hematology, immunology and serology, microbiology, only, wherein NO official results shall be issued. In this Order,
toxicology, as well as molecular and nuclear diagnostics. POL within the premises of a DOH-regulated facility shall be
under the supervision of the CL.
MOBILE CLINICAL LABORATORY (MCL)
SATELLITE CLINICAL LABORATORY (SCL)
A laboratory testing unit capable of performing limited CL
diagnostic procedures. It moves from one testing site to another, Refers to an extension of the main CL located within the
and it has a DOH-licensed CL as its main laboratory. facility's compound or premises. It shall have the same service
capability as the main laboratory.
NATIONAL REFERENCE LABORATORY (NRL)
CLASSIFICATION OF CLINICAL LABORATORIES
The highest level of laboratory in the country performing highly Specific guidelines: ADMINISTRATIVE ORDER No. 2021-0037
complex procedures, including confirmatory testing, that is not ➢ By OWNERSHIP
commonly performed by the lower level of laboratory. It is the
responsible entity for facilitating NEQAS to ensure compliance • Government - operated and maintained, partially or
to quality standards for regulation and licensing of all wholly, by the national government, a local
laboratories in the Philippines. government unit (provincial, city or municipal), any
➢ Provide laboratory reference/referral services for other political unit or any department, division, board
confirmatory testing. or agency thereof.
➢ Train laboratory personnel and recognize other • Private - privately owned, established and operated
training institutions. with funds through donation, principal, investment or
➢ Maintain the National External Quality Assessment other means, by any individual, corporation,
Scheme association or.
(NEQAS).
➢ Perform technical evaluation of reagents and ➢ By INSTITUTIONAL CHARACTER
diagnostic kits.
• Institution – based - a laboratory that is located within
THE SIX (6) HOSPITALS DESIGNATED AS NRL’s ARE THE the premises and operates as part of a DOH licensed
FOLLOWING: health facility.
• Non-institution - based - a laboratory that operates
• Research Institute for Tropical Medicine (RITM) independently and is not attached to any DOH
- NRL for dengue, Influenza, TB, and other licensed health facility.
Mycobacteria, Malaria and other parasites, Bacterial
enteric disease. Measles and other viral exanthems, ➢ By FUNCTION
Mycology, Enteroviruses, Antimicrobial resistance and
engineering diseases. • Clinical Pathology - Deals with the chemical and
cellular analyses of blood and other body fluids
• San Lazaro Hospital (SLH) (includes, but not limited to, clinical chemistry, clinical
- NRL for HIV/AIDS, Hepatitis, Syphilis and other STI’s microscopy, toxicology, therapeutic drug monitoring,
immunology and serology, hematology and
• East Avenue Medical Center (EAMC) coagulation), identification and examination of
- NRL for environmental and occupational health; microbes and parasites (bacteriology/parasitology
toxicology and micronutrient assay. /mycology/virology).

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• Anatomic Pathology - Provides processing and CLINICAL LABORATORY ORGANIZATIONAL CHART
examination of surgical specimens as to the
physical appearance and microscopic structure of
tissues, such as, but not limited to, surgical pathology,
cytopathology, immunohistochemical techniques,
autopsies and forensic pathology
• Molecular Pathology - Deals with the analysis of
certain genes, proteins and other molecules in
samples from organs, tissues or bodily fluids in order
to diagnose disease and/or to guide the prevention and
treatment of disease based on the principles,
techniques and tools of molecular biology as they are
applied to diagnostic medicine in the laboratory.

➢ By SERVICE CAPABILITY (CLINICAL AND

ANATOMIC PATHOLOGY) • The anatomical area is responsible for the analysis of
surgical specimens, frozen sections, biopsies, cytological
specimens, and autopsies.

• In the clinical sections, blood, bone marrow,

microbiology samples, urine, and other body fluids are
analyzed.

CLINICAL LABORATORY PERSONNEL

• Every CL shall have an adequate number of trained

personnel, depending on the workload, to provide safe,
effective and efficient services to clients.

HEAD OF THE LABORATORY (HOL)

• PATHOLOGIST
• The head of the laboratory shall be a competent and
experienced professional, with a specialized skill set
related to and proportionate to the laboratory category, to
ensure that the laboratory runs efficiently.
• The head of the laboratory is essentially responsible for
the operation of the entire laboratory, its personnel,
functions, and data, all of which shall meet the quality
assurance criteria and regulatory requirements.
• The head of the laboratory shall oversee the operation
of the CL and have administrative and technical
supervision of the activities including the mobile
clinical laboratories (MCL), remote collection
activities, and point of care testing (POCT), if
applicable
• The head of the laboratory shall supervise the staff in
accordance to the standards set by the Philippine Society
of Pathologists

REGISTERED MEDICAL TECHNOLOGIST (RMT)

• There shall be an adequate number of full-time RMTs to

conduct the laboratory procedures, including those
assigned in MCL. The number of staff shall depend on the
workload and the services being provided.

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• There shall be staff development and continuing education technique, use the correct equipment and collection tubes,
program at all levels of organization to upgrade the properly label and transport samples to the laboratory,
knowledge, attitude and skills of staff. prepare samples to be delivered to the laboratory sections,
• There shall be a designated Biosafety and Biosecurity and observe all safety and quality control policies.
Officer in-charge primarily of the risk assessment of the
DOH licensed CL. CLINICAL LABORATORY SECTIONS

• Laboratory Manager (Administrator):

➢ The laboratory manager is responsible for overall
technical and administrative management of the
laboratory, including personnel and budgets.

• Technical Supervisor:
➢ The technical supervisor is an MLS with experience
and expertise related to the particular laboratory
section or sections
➢ Responsibilities of the technical supervisor include
reviewing all laboratory test results; consulting
with the pathologist on abnormal test results;
scheduling personnel; maintaining automated
instruments by implementing preventive
maintenance procedures and quality control
measures; preparing budgets; maintaining • The clinical laboratory is divided into two areas,
reagents and supplies; orienting, evaluating, anatomical and clinical. The anatomical area is
and teaching personnel; and providing research responsible for the analysis of surgical specimens, frozen
and development protocols for new test sections, biopsies, cytological specimens, and autopsies.
procedures. Sections of the anatomical area include cytology,
histology, and cytogenetics.
MEDICAL LABORATORY TECHNICIAN
CYTOLOGY SECTION
• An MLT performs routine laboratory procedures according
to established protocol under the supervision of a • In the cytology section, cytologists (CTs) process and
technologist, supervisor, or laboratory director. examine tissue and body fluids for the presence of
• The duties of the MLT include collecting and processing abnormal cells, such as cancer cells. The Papanicolaou
biological samples for analysis, performing routine (Pap) smear is one of the most common tests performed
analytic tests, recognizing factors that affect test results, in cytology.
recognizing abnormal results and reporting them to a
supervisor, recognizing equipment malfunctions and
reporting them to a supervisor, performing quality control
and preventive maintenance procedures, maintaining
accurate records, and demonstrating laboratory technical
skills to new employees and students.

LABORATORY ASSISTANT

• The laboratory assistant has training in phlebotomy, sample

receiving and processing, quality control and preventive
maintenance of instruments, and computer data entry and
can perform basic "waived" laboratory testing. The
laboratory assistant aids the MLS or MLT by preparing
samples for testing.

PHLEBOTOMIST

• The phlebotomist collects blood from patients for laboratory

analysis.
• The phlebotomist is trained to identify the patient properly,
obtain the correct amount of blood by venipuncture or micro
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 HISTOLOGY SECTION

• In the histology section, histology technicians (HTs) and

technologists (HTLs) process and stain tissue obtained
from biopsies, surgery, autopsies, and frozen sections. A
pathologist then examines the tissue.

CYTOGENETICS

• Cytogenetics is the section in which chromosome studies

are performed to detect genetic disorders. Blood, amniotic
fluid, tissue, and bone marrow specimens are analyzed.

HEMALOGY SECTION

Hematology is the study of the formed (cellular) elements of

the blood.

COAGULATION SECTION

• In this area, the overall process of hemostasis is evaluated;

• The cellular elements, red blood cells (RBCs), white blood this includes platelets, blood vessels, coagulation factors,
cells (WBCs), and platelets (PIts) are enumerated and fibrinolysis, inhibitors, and anticoagulant therapy (heparin
classified in all body fluids and in the bone marrow. and Coumadin).
• The most common body fluid analyzed in the hematology • Plasma from a sample drawn in a tube with a light blue
section is whole blood. stopper that contains the anticoagulant sodium citrate is
o Most tests performed in the hematology section the specimen analyzed. Coagulation tests are performed
require blood that has been collected in tubes on automated instruments.
with a lavender stopper that contain the
anticoagulant ethylenediaminetetraacetic acid
(EDTA).
o Immediate inversion of this tube eight times is
critical to prevent clotting and ensure accurate
blood counts.

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 CHEMISTRY SECTION • Identification of bacteria is based on morphology, Gram
stain reactions, oxygen and nutritional requirements, and
• The clinical chemistry section is the most automated area biochemical reactions.
of the laboratory. • Fungi are identified primarily by culture growth and
• Instruments are computerized and designed to perform microscopic morphology.
single and multiple tests from small amounts of specimen. • Stool samples are concentrated and examined
• Clinical chemistry tests are performed primarily on serum microscopically for the presence of parasites, ova, or
collected in gel barrier tubes, but the serum may also be larvae.
collected in tubes with rea, green, gray, or royal blue • Viruses must be cultured in living cells, and most
stoppers. laboratories send viral specimens for culturing to
• Tests are also performed on plasma, urine, and other body specialized reference laboratories.
fluids. • Most microbiology samples are obtained from the blood,
• Serum and plasma are obtained by centrifugation, which urine, throat, sputum, genitourinary tract, wounds,
should be performed within 1 to 2 hours of collection. cerebrospinal fluid, and feces.
➢ Correct identification of pathogens depends on
proper collection and prompt transport to the
laboratory for processing.
• Phlebotomists are responsible for collecting blood
cultures and may be required to obtain throat cultures
(TCs) and instruct patients in the procedure for
collecting urine samples for culture.
➢ Specific sterile techniques must be observed in the
collection of culture samples to prevent bacterial
contamination.
• Specimens of concern include:

➢ hemolyzed specimens that appear red because

of the release of hemoglobin from
RBCS,
➢ icteric specimens that are yellow because of the
presence of excess bilirubin, and,
➢ lipemic specimens that are cloudy because of
increased lipids

MICROBIOLOGY SECTION

• The microbiology section is responsible for the identification

of pathogenic microorganisms and for hospital infection
control.
• In large laboratories, the section may be divided into
bacteriology, mycology, parasitology, and virology.
• A culture and sensitivity (C & S) test is the primary
procedure performed in microbiology. It is used to detect
and identify microorganisms and to determine the most
effective antibiotic therapy
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 • The microscopic examination identifies the presence of
cells, casts, bacteria, crystals, yeast, and parasites.
Automated systems can perform a complete UA

URINARY SECTION

• Urinalysis (UA) may be a separate laboratory section or a

part of the hematology or chemistry sections.
• UA is a routine screening procedure to detect disorders
and infections of the kidney and to detect metabolic
disorders such as diabetes mellitus.

• A routine UA consists of physical, chemical, and

microscopic examination of the urine.
• The physical examination evaluates the color, clarity,
and specific gravity of the urine.

• The chemical examination is performed using chemical

reagent strips (dipsticks) to determine pH, glucose,
ketones, protein, blood, bilirubin, urobilinogen, nitrite, and
leukocytes.

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 SEROLOGY (IMMUNNOLOGY) SECTION

• The serology (immunology) section performs tests to

evaluate the body's immune response
➢ The production of antibodies (immunoglobulins) and
cellular activation.
• Tests in the serology section detect the presence of
antibodies to bacteria, fungi, parasites, viruses, and
antibodies produced against body substances
(autoimmunity).

BLOOD BANK SECTION

• The blood bank (BB) is the section of the laboratory where

blood may be collected, stored, and prepared for
transfusion.
• It is also called the immunohematology section because
the testing procedures involve RBC antigens (Ag) and
antibodies (Ab).
• In the blood bank, blood from patients and donors is tested
for its blood group (ABO) and Rh type, the presence and
identity of abnormal antibodies, and its compatibility
(crossmatch) for use in a transfusion.

• UNITS OF BLOOD ARE COLLECTED FROM DONORS,

TESTED FOR THE PRESENCE OF BLOODBORNE
PATHOGENS SUCH AS HEPATITIS VIRUSES AND
HUMAN IMMUNODEFICIENCY VIRUS (HIV), AND
STORED FOR TRANSFUSIONS.

• DONOR BLOOD MAY ALSO BE SEPARATED INTO

COMPONENTS INCLUDING PACKED CELLS,
PLATELETS, FRESH FROZEN PLASMA, AND
CRYOPRECIPITATE.

• THESE COMPONENTS ARE STORED

SEPARATELY AND USED FOR PATIENTS WITH SAFETY AND INFECTION CONTROL
SPECIFIC NEEDS.
• SAFETY
- Covers all types of hazards in the laboratory,
including biological, chemical, and physical risks. It
ensures protection from accidents, injuries, and
harmful exposures.

• INFECTION CONTROL
- Refers to the policies, procedures, and measures used
to prevent and minimize the spread of infections in
healthcare settings, workplace, and communities.

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• Core principles of infection control include: - Vehicle: ingestion of contaminated food or water.
- Vector: parasites such as malaria transmitted by a
1. Standard Precautions: Universal practices applied to mosquito bite.
prevent infection spread, such as hand hygiene, - Breaking the Chain: Hand washing, Standard
personal protective equipment (PPE), and safe Precautions and transmission-based precautions are
disposal of waste. covered later in this chapter.
2. Transmission-Based Precautions: Measures
specific to the mode of infection transmission (e.g., 5. PORTAL OF ENTRY
airborne, droplet, or contact). - The portal of entry can be the same as the portal of
3. Environmental Controls: Cleaning, disinfection, and exit. This includes the nose, mouth, mucous
sterilization of surfaces, instruments, and spaces. membranes, and open wounds
- Medical and surgical procedures provide a very
BIOLOGICAL HAZARDS convenient portal of entry for infectious agents. This is
why all needles used in phlebotomy are packaged
• CHAIN OF INFECTION individually in sterile containers and a needle is never
- The chain of infection refers to the process by which used more than once or from a container that has been
infections are transmitted from one person (or source) opened.
to another. - Breaking the Chain: Disinfection and sterilization and
strict adherence to Standard Precautions and
(6) COMPONENTS OF INFECTION CONTROL transmission-based precautions are used to block the
portal of entry.
- INFECTIOUS AGENT
- RESERVIOR 6. SUSCEPTIBLE HOST
- PORTAL OF EXIT - This can be another patient or the health-care
- MODE OF TRANSMISSION provider.
- PORTAL OF ENTRY - Patients receiving chemotherapy and
- SUSCEPTIBLE HOST immunocompromised patients are very
susceptible hosts. The immune system is still
1. INFECTIOUS AGENT developing in newborns and infants and begins to
- Infectious agents consist of bacteria, fungi, parasites, weaken as people age, making these groups of
and viruses. patients more susceptible to infection.
- Breaking the Chain: Early detection and treatment of - Breaking the Chain: Observation of special
infectious agents. precautions when working in the nursery and in
isolation rooms designated for protection of
2. RESERVIOR susceptible patients. Workers must stay current
- A place where the infectious agent can live and with the required health-care workers'
possibly multiply immunizations and tests. Maintenance of a healthy
- Humans, Animals, Insects, Fomites, Water, Soil lifestyle is very important for the healthcare worker.
- Breaking the Chain: Disinfecting the work area kills
the infectious agent and eliminates the reservoir.

3. PORTAL OF EXIT
- When the reservoir is a human or an animal this can
be through the nose. mouth, and mucous membranes
and in blood or other body fluids. Phlebotomists
provide a portal of exit when they collect blood.
- Breaking the Chain: Disposing of needles and lancets
in sealed sharps containers and other contaminated
materials in biohazard containers and keeping tubes
and sample containers sealed.

4. MODE OF TRANSMISSION
- Direct contact: unprotected host touches or is
touched by the reservoir
- Droplet: the host inhales material from the reservoir
such as aerosol droplets from an infected person.
- Airborne: inhalation of dried aerosol nuclei circulating
on air currents or attached to dust particles
J. AUTO | 13
 3. Contaminated Medical Equipment & Instruments
✓ Reusing unsterilized tools (e.g., catheters,
surgical instruments).
✓ Improper cleaning of stethoscopes, blood
pressure cuffs, and ventilators.
4. Poor Aseptic Techniques
✓ Not following sterile procedures during IV
insertions, surgeries, or wound care.
✓ Allowing cross-contamination in catheterized or
immunocompromised patients.

TRANSMISSION PREVENTION PROCEDURES

NOSOCOMIAL/HEALTH-CARE-AQUIRED INFECTIONS • Preventing the transmission of microorganisms from

infected reservoirs to susceptible hosts is critical in
• The term nosocomial infection has been used to controlling the spread of infection.
designate an infection acquired by a patient during a • Procedures used to prevent microorganism transmission
hospital stay. include hand hygiene, the wearing of personal
• health-care-acquired infection (HAI) refers to an protective equipment (PPE), isolation of highly infective
infection acquired by a patient as the result of a health- or highly susceptible patients, and proper disposal of
care procedure that may or may not require a hospital contaminated materials.
stay.
HANDWASHING
COMMON TYPES OF HAIs
Handwashing is a cornerstone of infection control. It is the
• Bloodborne Infections (Hepatitis B, Hepatitis C, HIV) most effective and simplest method to prevent the spread of
✓ Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), pathogens.
HIV
✓ Needlestick injuries, improper handling of Which to Choose?
contaminated needles and blood products • Use soap and water when your hands are visibly dirty or
• Surgical Site Infections (SSI) after handling potentially harmful pathogens like norovirus or
✓ Staphylococcus aureus C. difficile.
✓ Contaminated surgical tools, poor wound care, • Use alcohol-based hand rub for quick disinfection when
improper hand hygiene your hands are not visibly dirty, especially in healthcare or
• Methicillin-Resistant Staphylococcus aureus (MRSA) public settings.
Infection
✓ Methicillin-resistant Staphylococcus aureus (MRSA)
✓ Direct contact with infected wounds, contaminated
hands or equipment
• Central Line-Associated Bloodstream Infections
(CLABSI)
✓ Staphylococcus aureus, Enterobacter, Candida spp.
✓ Contaminated IV lines, poor insertion technique,
inadequate skin disinfection.

HOW HEALTHCARE PERSONNEL CONTRIBUTE TO HAIs:

1. Poor Hand Hygiene

✓ Not washing or sanitizing hands properly between
patient interactions.
✓ Using contaminated gloves and not changing them
between tasks.
2. Improper Use of Personal Protective Equipment
(PPE)
✓ Not wearing gloves, masks, or gowns properly.
✓ Reusing disposable PPE.

J. AUTO | 14
 PERSONAL PROTECTIVE EQUIPMENT (PPE)

• PPE encountered by the phlebotomist includes gloves,

gowns, masks, goggles, face shields, and respirators.

GLOVES

• In light of the COVID-19 pandemic, the practice of using

double gloves has been adapted and is still
recommended.
• Wear appropriate size of gloves
• Do not reuse gloves
• Change visibly soiled gloves or if there is suspicion
of splashes.
• Do not wear gloves outside the laboratory
• Wearing gloves can give laboratory personnels a false
sense of safety.

LABORATORY GOWN

• Appropriate size and materials (waterproof)

BOUFFANT CAP
• Covers the whole arm and has elastic cuffs
• Length should be up to knee when standing and should
• All hair must be tucked inside
entirely cover the lap when sitting
• Adjust the elastic band to ensure a secure and snug fit,
• Do not wear outside of the laboratory
covering the entire scalp and ears
FACE PROTECTIVE EQUIPMENT
LABORATORY SHOES/SHOE COVER
• GOOGLE/ FACE SHIELD
• Shoes must cover the toes, upper part of the feet, and
✓Face shields also protect the mucous membranes from
have closure to the back of the heel.
splashes.
• A dedicated laboratory shoes should be available in the
• SURGICAL MASKS
facility.
✓ Use certified surgical masks that are meant to help
block large-particle droplets and splashes
IMPORTANCE OF PROPER DONNNING AND DOFFING
✓ Surgical masks are not intended to be used more than
once.
1. PREVENTS SELF CONTAMINATION
✓ Wash your hands after handling the used mask.
2. ENSURES MAXIMUM PROTECTION
• RESPIRATORS
3. REDUCES CROSS CONTAMINATION
✓ Respirators are designed to achieve a very close facial
4. COMPLIANCE WITH SAFETY STANDARDS
fit and very efficient filtration of airborne particles.
✓ Note that the edges of the respirator are designed to
STANDARD PRECAUTIONS
form a seal around the nose and mouth.
✓ Surgical N95 Respirators are commonly used in
• Assumes that every person in the healthcare setting is
healthcare settings
potentially infected or colonized by an organism that
could be transmitted.
• Applies to all blood and body fluids, mucous membranes,
and nonintact skin and stresses hand washing.

FIRE/EXPLOSIVE HAZARDS

• Phlebotomists should be familiar with these procedures

and with the basic steps to follow when a fire is
discovered.
• Initial steps to follow when a fire is discovered are
identified by the code word RACE:
✓ Rescue - anyone in immediate danger

J. AUTO | 15
 ✓ Alarm - activate the institutional fire alarm BIOLOGICAL WASTE DISPOSAL
system
✓ Contain - close all doors to potentially • Phlebotomy equipment and supplies contaminated with
affected areas blood and body fluids must be disposed of in containers
✓ Extinguish/Evacuate - extinguish the fire, if clearly marked with the biohazard symbol or red or
possible, or evacuate, closing the door yellow color coding
• The National Fire Protection Association (NFPA) • alcohol pads, gauze, bandages, disposable tourniquets,
classifies fires with regard to the type of burning material gloves, masks, gowns, and specimens
and also classifies the type of fire extinguisher that is used • Contaminated non-disposable equipment, blood spills,
to control them. and blood and body fluid processing areas must be
• The code word PASS can be used to remember the steps disinfected. The most commonly used disinfectant is a
in the operation. 1:10 dilution of sodium hypochlorite (household
1. Pull pin bleach) prepared weekly and stored in a plastic.
2. Aim at base of fire • The bleach should be allowed to air dry on the
3. Squeeze handles contaminated area before removal.
4. Sweep nozzle, side to side
SHARP DISPOSAL

• A primary concern for phlebotomists is possible exposure

to bloodborne pathogens caused by accidental puncture
with a contaminated needle or lancet.
• It is essential that safety precautions be followed at all
times when sharp hazards are present
• The number one personal safety rule when using needles
is to never recap a needle.
• Many safety devices are available for needle disposal,
and they provide a variety of safeguards, including
PHYSICAL HAZARDS needle holders that become a sheath, needles that
automatically resheath or become blunt, and needles
• Physical hazards are not unique to the health-care with attached sheaths.
setting, and routine safety precautions observed outside
the workplace can usually be applied. CHEMICAL HAZARD
• General precautions that phlebotomists should observe
include: • Many of these preservatives can be hazardous when
1. Avoid running in rooms and hallways. they are not properly handled.
2. Be alert for wet floors. • Chemicals should never be mixed together unless
3. Bend the knees when lifting heavy objects or patients. specific instructions are followed, and they must be
4. Keep long hair tied back and remove dangling jewelry added in the order specified.
to avoid contact with equipment and patients. • This is particularly important when combining acid and
5. Wear comfortable, closed-toe shoes with nonskid water
soles that provide maximum support.
6. Maintain a clean, organized work area.

• When skin or eye contact occurs, the best first aid is to

flush the area immediately with water for at least 15
minutes and then seek medical attention.
• Do not try to neutralize chemicals spilled on the skin.
Phlebotomists must know the location of and how to use
J. AUTO | 16
 the emergency shower and eyewash station in the WASTE MANAGEMENT
laboratory
• An Material Safety Data Sheet (MSDS) contains Refers to the guidelines and best practices for the proper
information on physical and chemical characteristics, fire, handling, segregation, treatment, and disposal of laboratory
explosion reactivity, health hazards, primary routes of waste to ensure safety and compliance with environmental and
entry, exposure limits and carcinogenic potential, health standards.
precautions for safe handling, spill clean-up, and
emergency first aid information DIFFERENT TYPES OF WASTE
• Importance of MSDS in a Clinical Laboratory:
✓ Ensures Safe Handling of Chemicals • Infectious Waste
✓ Prevents Chemical Accidents (spills, fires, ✓ Waste suspected to contain pathogens that
exposures) could cause infections.
✓ Guides Emergency Responses (first aid, fire- ✓ Ex：
fighting, spill control) o Laboratory cultures and stocks
✓ Complies with Safety Regulations (OSHA, o Items contaminated with blood or body
WHO, EPA, ISO) fluids (dressings, swabs, gloves)
✓ Protects Laboratory Workers & the o Waste from isolation wards of patients
Environment with infectious diseases
• Pathological Waste
RADIOACTIVE HAZARDS ✓ Human tissues, organs, body parts, and animal
carcasses used in research.
• Phlebotomists may come in contact with radioactivity ✓ Ex:
while drawing blood from patients in the radiology o Body parts removed during surgery
department or from patients receiving radioactive o Biopsy samples
treatments and, in the laboratory, when procedures using o Animal tissues used in research
radioisotopes are performed. • Sharps Waste
• Phlebotomists should be familiar with the radioactive ✓ Items that can puncture or cut skin and pose a
symbol. risk of infection.
✓ Ex:
ELECTRICAL HAZARDS o Needles, syringes, scalpels, lancets
o Surgical blades
• The same general rules of electrical safety observed o Broken glass, pipettes
outside the workplace apply. Keep in mind that the • General Non-Hazardous Waste
danger of water or fluid coming in contact with ✓ Waste that does not pose a biological, chemical,
equipment is greater in the hospital setting. or physical risk.
• Phlebotomists should be observant for any dangerous ✓ Ex:
conditions such as frayed cords and overloaded circuits, o Office paper and packaging materials
and they should report these items to the appropriate o Food waste
persons. o Disposable items without exposure to
• As an additional precaution when drawing blood or hazardous substances
performing other procedures, phlebotomists should avoid • Chemical Waste
contact with electrical equipment in the patient's room ✓ Waste containing hazardous or toxic chemicals.
because current from improperly grounded equipment ✓ Ex:
can pass through the phlebotomist and metal needle to o Laboratory reagents and solvents
the patient. o Disinfectants and cleaning agents’
• It is important to remove the electrical source Heavy metal-containing items
immediately. (thermometers, batteries)
• Turning off the circuit breaker and moving the equipment • Pharmaceutical Waste
using a nonconductive glass or wood object are safe ✓ Unused, expired, or contaminated drugs and
procedures to follow. vaccines.
• The victim should receive immediate medical assistance ✓ Ex:
following discontinuation of the electricity. o Expired antibiotics
Cardiopulmonary resuscitation (CPR) may be necessary o Discarded chemotherapy drugs
o Unused vaccines

J. AUTO | 17
 Waste Segregation and Color- Coding System CIRCULATORY SYSTEM
THREE MAIN COMPONENTS OF THE CIRCULATORY
SYSTEM:
COLO TYPE DESCRIPTIO EXAMPLE
R N
Infectious Waste Waste o HEART
Waste contaminated contaminate o BLOOD VESSEL
with blood and d with blood o BLOOD
body fluids, and body
laboratory fluids, BLOOD VESSEL:
cultures, used laboratory
o ARTERY
gloves, cultures,
dressing used gloves, o VEINS
materials, and dressing o CAPILLARY
other items materials,
that pose an and other BLOOD VESSEL STRUCTURE
infection risk. items that
pose an • Tunica externa
infection risk.
✓ the outer layer composed of connective
Sharps Waste needles, Used
syringes, needles and tissue.
scalpels, syringes; • Tunica media
broken glass, used ✓ the middle layer composed of smooth muscle
and other scalpels and elastic tissue.
sharp objects • Tunica intima
that may cause
✓ the inner layer composed of a lining of
injury and
transmit epithelial cells.
infections.
General Non- Non- Office paper
Hazardous contaminated and
Waste similar to packaging;
household disposable
waste, such as items not in
paper, contact with
cardboard, and infectious
food waste agents
Anatomical or Human Biopsy
Pathological tissues, tissues;
Waste organs, and Placenta and
body parts. other
surgical
specimens
Pharmaceutica Expired or Discarded
l Waste unused antibiotics;
medicines, Empty
drugs, and vaccine vials;
vaccine vials Expired over-
(non- the-counter
hazardous) drugs
Chemical Waste Laboratory
Waste containing reagents;
hazardous Disinfectants
chemicals, and cleaning
disinfectants, agents
solvents, and
heavy metals.
Biodegradable Food waste
Waste and other
(noninfectious) biodegradable,
non-infectious
waste.

J. AUTO | 18
 ARTERIES

• large thick-walled blood vessels that carry blood away

from the heart
• Propel oxygen-rich blood away from the heart to the
capillaries.
• Arteries branch into smaller thinner vessels called
arterioles that connects to the capillaries

Arteries have large thick-walled compared to veins

1. Aids in pumping of blood
2. Maintain normal blood pressure
3. Give arteries the strength to resist high pressure cause by PHLEBOTOMY RELATED VASCULAR ANATOMY
contraction of heart ventricles
• Antecubital Fossa
✓ shallow depression in the arm that is anterior
to the elbow.
✓ It is the first-choice location for venipuncture
because several major arm veins lie close to
the surface, making them relatively easy to
locate and penetrate
✓ These major superficial veins are referred as
antecubital veins.
✓ The anatomical arrangement of antecubital
veins varies slightly from person to person;
however, two basic vein arrangements,
referred to as the Hand M-shaped patterns
VEINS • H-shaped pattern
✓ The H - shaped pattern is displayed by
• have thinner walls than arteries approximately 70% of the population
• carry oxygen-poor blood, carbon dioxide, and other ✓ This pattern forms an "H" shape with the
waste products back to the heart. median cubital vein acting as the connecting
• The thinner walls of veins have less elastic tissue and bridge between the cephalic and basilic
less connective tissue than arteries because the BP in veins.
the veins is very low • Median Cubital
• Veins have one-way valves to keep blood flowing in ✓ First choice
one direction as the blood flows through the veins by ✓ Large, well-anchored, and easily accessible,
skeletal muscle contraction. least painful and less prone to complications,
• Venules are small veins that connect capillaries to Lower risk of hitting nearby arteries or
larger veins. nerves.
• Most of the blood tests are performed on venous blood • Cephalic
• Veins of choice for venipuncture ✓ Second choice
✓ Cephalic ✓ lateral side of the forearm and upper arm,
✓ Median cubital often visible and superficial, Easier to access
✓ Basilic in obese patients,
✓ However, it is less anchored, can roll, and
may be more uncomfortable for patients.
• Basilic
✓ Third choice
✓ Medial side of the arm, close to the brachial
artery and median nerve, not well anchored,
tends to roll during needle insertion, Higher
risk of puncturing the brachial artery or
damaging the median nerve, less
comfortable for the patient.

J. AUTO | 19
• M-shaped pattern
✓ Represents about 20-30% of individuals the
median antebrachial vein passes up to the
center of the forearm and gives 2 branches
1. the median cephalic: connecting to the
cephalic vein
2. the median basilic: connecting to the
basilic vein
✓ Median vein of forearm (Median antebrachial
vein)

ORDER OF CHOICE

1. Median vein (antebrachial vein) PATHWAY OF BLOOD TRHOUGH THE HEART

- it is well anchored, tends to be less painful to
puncture, not close to major nerves or arteries
as the others, making it generally the safest
one to use
2. Median vein of forearm (or median cephalic vein)
- Preferred for its accessibility and lower risk of
hitting the artery or nerve.
3. Median basilic vein
- Last choice because it is closer to the brachial
artery and nerve.

CAPILLARIES

• Smallest blood vessels

• They consist of a single layer of epithelial cells to allow
exchanges of oxygen, carbon dioxide, nutrients, and
waste pro - ducts between the blood and tissue cells.
The blood in capillaries is a mixture of arterial and
venous blood.

HEART

• The heart is a hollow muscular organ located in the

thoracic cavity between the lungs and slightly to the left
of the body midline that consists of two pumps to
circulate blood throughout the circulatory system.
• it is enclosed in a membranous sac called the
pericardium
• The heart has four chambers and is divided into right
and left halves by a partition called the septum
• Each side has an upper chamber called an atrium to
collect blood and a lower chamber called a ventricle
to pump blood from the heart.
• The right side is the "pump" for the pulmonary
circulation, and the left side is the "pump" for the
systemic circulation.

J. AUTO | 20
 CARDIAC CYCLE

• The cardiac cycle is the contraction phase (systole)

and the relaxation phase (diastole) of the cardiac
muscle that occurs in one heartbeat.
• Cardiac muscle is under involuntary control; therefore,
the electrical impulses of the cardiac cycle are
essential to produce rhythmic contraction and
relaxation of the heart muscle.
• The cardiac cycle is measured with an
(ELECTROCARDIOGRAM) ECG by placing
electrodes connected to a recorder on the patient's
arms, legs, and chest.

STEPS IN THE CARDIAC CYCLE

1. The sinoatrial (SA) node, located in the upper right

atrium, is the pacemaker of the heart and initiates
the heartbeat.
2. The atrioventricular (AV) node located in the lower
interatrial septum receives the electrical impulse and
both the right and left atria contract forcing blood to the
ventricles.
3. The impulse passes to the AV bundle that separates
into right and left bundle branches.
4. In the right and left bundle branches the impulse travels
to the Purkinje fibers contract, covering the ventricles,
causing them to contract, forcing blood into the aorta
and pulmonary artery.
5. The cycle starts again
RED BLOOD CELLS/ ERYTHROCYTES
PULSE RATE / HEART RATE
• Erythrocytes (RBCs) are a nuclear biconcave disk that
• The heart contracts approximately 60 to 80 times per are approximately 7.2 microns in diameter.
minute, which represents the heart rate or pulse rate. • Contain the protein hemoglobin to transport oxygen
• The pulse is most easily detected by palpation where and carbon dioxide.
an artery crosses over a bone or firm tissue. • There are approximately 4.5 to 6.0 million erythrocytes
• Common pulse sites are the temporal, carotid, per microliter (uL) of blood, with men having slightly
brachial, and radial arteries higher values than women.
• The normal life span for an erythrocyte is 120 days.
BLOOD PRESSURE (BP) o Macrophages in the liver and spleen remove
the old erythrocytes from the bloodstream
• BP is the pressure exerted by the blood on the walls of and destroy them.
blood vessels during contraction and relaxation of the
ventricles. BLOOD GROUP AND TYPE
• The systolic pressure is the higher of the two
numbers and indicates the BP during contraction of • The surface of erythrocytes contains antigens that
the ventricles. The diastolic pressure is the lower determine the blood group and type of an individual,
number and is the BP when the ventricles are relaxed frequently referred to as the person's ABO group and
BLOOD PRESSURE (BP) Rh type.
BLOOD • The plasma of an individual contains naturally
occurring antibodies (Abs) for those antigens not
• Blood is the body's main fluid for transporting nutrients, present on the erythrocytes
waste products, gases, and hormones through the
circulatory system
• An average adult has a blood volume of 5 to 6 Liters

J. AUTO | 21
 ✓ Prevention: Ensure the patient is seated or
lying down during the procedure.

• Infection
✓ Rare but possible if proper aseptic
techniques are not followed. •
✓ Prevention: Use sterile equipment and
maintain good hygiene.

• Nerve Damage
✓ Occurs if the needle hits a nerve during
venipuncture.
✓ Symptoms: Sharp pain, numbness, or
tingling in the arm.

Rh TYPE

• The presence or absence of the RBC antigen called

the Rh factor or D antigen determines whether a
person is type Rh-positive or Rh-negative.
• Rh-negative people do not have natural antibodies to
the Rh factor but will form antibodies if they receive Rh-
positive blood.
o A second transfusion of Rh-positive blood will
cause a transfusion reaction.

Phlebotomy- Related Complications

• Hematoma Formation
✓ Caused by blood leaking into surrounding
tissue during or after venipuncture.
✓ Prevention: Apply pressure after needle
removal and ensure proper needle insertion.

• Hemolysis
✓ Destruction of red blood cells due to improper
blood draw techniques (e.g., shaking the
tube, using a small needle with high suction).
✓ Leads to inaccurate lab results

• Syncope (Fainting)
✓ A common reaction due to anxiety, pain, or
sudden drop in blood pressure during
phlebotomy.
J. AUTO | 22
 WHITE BLOOD CELLS/ LEUKOCYTES

• Leukocytes provide immunity to certain diseases by

producing antibodies and destroying harmful
pathogens by phagocytosis.
• The normal number of leukocytes for an adult is 4,500
to 11,000 per uL of blood.
• Five types of leukocytes are present in the blood,
each with a specific function and they are
distinguished by their morphology
✓ neutrophils
✓ lymphocytes
✓ monocytes
✓ eosinophils
✓ basophils

NEUTROPHILS
• 40-60%
• The most numerous leukocytes, provide protection
against infection through phagocytosis.
• Neutrophils are called segmented or
polymorphonuclear cells because the nucleus has
several lobes.
• The number of neutrophils increases in bacterial
infections

J. AUTO | 23
 LYMPHOCYTES BASOPHILS
• 20-40% • 0-1
• the second most numerous leukocytes, provide the • The least common of the leukocytes.
body with immune capability by means of B and T • The cytoplasm contains large granules that stain
lymphocytes. purple-black and release histamine in the inflammation
• The lymphocyte has a large round purple nucleus with process and heparin to prevent abnormal blood
a rim of sky-blue cytoplasm. clotting
• The number of lymphocytes increases in viral
infections

MONOCYTES PLATELETS/ THROMBOCYTES

• 3-8% • small, irregularly shaped disks formed from the
• The largest circulating leukocytes and act as powerful cytoplasm of very large cells in the bone marrow called
phagocytes to digest foreign material. the megakaryocytes.
• The cytoplasm has a fine blue-gray appearance with • Platelets have a life span of 9 to 12 days.
vacuoles and a large, irregular nucleus. • The average number of platelets is between 140,000
• A tissue monocyte is known as a macrophage. The and 440,000 per uL of blood.
number of monocytes increases in intracellular • Platelets play a vital role in blood clotting in all stages
infections and tuberculosis of the coagulation mechanism

EOSINOPHIL
• 1-3% COAGULATION / HEMOSTASIS
• The granules in cytoplasm of eosinophils stain red • Hemostasis is the process of forming a blood clot to
orange, and the nucleus has only two lobes. stop the leakage of blood when injury to a blood vessel
•Eosinophils detoxify foreign proteins and increase in occurs and lysing the clot when the injury has been
allergies, skin infections, and parasitic infections repaired.
• A complex coagulation mechanism that involves blood
vessels, platelets, and the coagulation factors
maintains hemostasis.

J. AUTO | 24
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