MT 52:

PRINCIPLES IN MEDICAL
LABORATORY SCIENCE 2
2nd Semester, SY 2024 - 2025
UNDERSTANDING PHLEBOTOMY
A.The Evolution of Phlebotomy
B.The Role of Phlebotomist in Today’s Healthcare
Setting
C. Traits that form the Professional Image of the
Phlebotomist
D.Basic Concepts of Communication
PHLEBOTOMY: A Historical Perspective
• An early medical theory developed by Hippocrates (460–377
B.C.) stated that disease was the result of excess substance—
such as blood, phlegm, black bile, and yellow bile—within
the body. It was thought that removal of the excess would
restore balance.
• Venesection— which comes from the Latin words vena,
“vein,” and sectio, “cutting”—was the most common method
of general bloodletting.
• Venesection is another word for phlebotomy, which comes
from the Greek words phlebos, “vein,” and tome, “incision.”
PHLEBOTOMY: A Historical Perspective
Period of the Stone Age
• crude tools were used to puncture vessels and allow
excess blood to drain out of the body
• application of a leech to a patient evidences
bloodletting in Egypt in about 1400 B.C.
PHLEBOTOMY: A Historical Perspective
During the 17th and early 18th centuries
• Phlebotomy was considered a major therapeutic (treatment)
process.
• The lancet, a tool used for cutting the vein during
venesection, was perhaps the most prevalent medical
instrument of the times.
• Phlebotomy was also accomplished by cupping and leeching.
PHLEBOTOMY: A Historical Perspective
Cupping
• involved the application of a heated suction apparatus,
called the “cup,” to the skin to draw the blood to the surface
• the capillaries in that area were severed by making a series
of parallel incisions with a lancet or fleam
• Fleams - used for general phlebotomy to open an artery or,
more commonly, a vein to remove large amounts of blood
TYPICAL FLEAMS
PHLEBOTOMY: A Historical Perspective
Leeching
• procedure involved enticing the Hirudo medicinalis, a
European medicinal leech, to the spot needing bloodletting
with a drop of milk or blood on the patient’s skin
• Value of leech therapy:
• Worm’s saliva → contains a local vasodilator (substance that
increases the diameter of blood vessels), a local anesthetic, and
hirudin, an anticoagulant (a substance that prevents clotting).
A LEECH JAR A TOE WITH LEECH
PHLEBOTOMY TODAY
Today, phlebotomy is performed to:
• Obtain blood for diagnostic purposes and to monitor
prescribed treatment
• Remove blood for transfusions at a donor center
• Remove blood for therapeutic purposes, such as treatment
for polycythemia
PHLEBOTOMY TODAY
Phlebotomy is primarily accomplished by one of two
procedures:
• Venipuncture, which involves collecting blood by
penetrating a vein with a needle and syringe or other
collection apparatus
• Capillary puncture, which involves collecting blood
after puncturing the skin with a lancet
PHLEBOTOMIST
• is applied to any individual who has been trained in the
various techniques used to obtain blood for laboratory
testing or blood donations
• a competent clinical phlebotomist must have:
• good manual dexterity,
• special communication skills,
• good organizational skills, and
• a thorough knowledge of laboratory specimen requirements and
departmental policies
DUTIES AND RESPONSIBILITIES OF A PHLEBOTOMIST

• Prepare patients for collection procedures associated with

laboratory samples.
• Collect routine skin puncture and venous specimens for
testing as required.
• Prepare specimens for transport to ensure stability of
sample.
• Maintain patient confidentiality.
• Perform quality-control checks while carrying out clerical,
clinical, and technical duties.
DUTIES AND RESPONSIBILITIES OF A PHLEBOTOMIST

• Transport specimens to the laboratory.

• Comply with all procedures instituted in the procedure
manual.
• Promote good relations with patients and hospital
personnel.
• Assist in collecting and documenting monthly workload
and recording data.
• Maintain safe working conditions.
DUTIES AND RESPONSIBILITIES OF A PHLEBOTOMIST

• Perform appropriate laboratory computer operations.

• Participate in continuing education programs.
• Collect and perform point-of-care testing (POCT).
• Perform quality-control checks on POCT instruments.
• Perform skin tests.
DUTIES AND RESPONSIBILITIES OF A PHLEBOTOMIST

• Prepare and process specimens.

• Collect urine drug screen specimens.
• Perform electrocardiography.
• Perform front-office duties, current procedural
terminology coding, and paperwork.
OFFICIAL RECOGNITION
Certification
• is a voluntary process by which an agency grants recognition to an
individual who has met certain prerequisites in a particular technical
area
• indicates the completion of defined academic and training
requirements and the attainment of a satisfactory score on an
examination
• is confirmed by the awarding of a title or designation
OFFICIAL RECOGNITION
Licensure
• is the act of granting a license
• A license in healthcare is an official document or permit
granted by a state agency that gives legal permission for a
person to work in a particular health profession.
• As a demonstration of continued competency, states
normally require periodic license renewal, by either
reexamination or proof of continuing education.
OFFICIAL RECOGNITION
Continuing Education
• is designed to update the knowledge or skills of participants and is
generally geared to a learning activity or course of study for a specific
group of health professionals, such as phlebotomists
• organizations that sponsor workshops, seminars, and self-study
programs that award continuing education units (CEUs):
✓ American Society for Clinical Pathology (ASCP),
✓ American Society for Clinical Laboratory Sciences (ASCLS), and
✓American Medical Technologists (AMT)
• The most widely accepted CEU standard, developed by the International
Association for Continuing Education and Training (IACET), is that 10 contact
hours equal one CEU.
PATIENT-CLIENT INTERACTION
a. Recognizing Diversity
Critical factors in providing healthcare services that meet the needs of
diverse populations include understanding the:
• Beliefs and values that shape a person’s approach to health and
illness
• Health-related needs of patients and their families according to the
environments in which they live
• Knowledge of customs and traditions related to health and healing
• Attitudes toward seeking help from healthcare providers
PATIENT-CLIENT INTERACTION
b. Professionalism
▪ is defined as the conduct and qualities that characterize a
professional person
▪ conservative clothing, proper personal hygiene, and physical
well-being contribute to a professional appearance
▪ a person performing phlebotomy is required to display
attitudes, personal characteristics, and behaviors consistent
with accepted standards of professional conduct
Personal behaviors and characteristics that make up a
professional image:
SELF-CONFIDENCE
• many factors affect being perceived as self-confident; for
example, erect posture, professional appearance, courage,
and tactfulness in communication
INTEGRITY
• has to do with a personal feeling of “wholeness” deriving
from honesty and consistency of character
• professional standards of integrity or honesty require a
person to do what is right regardless of the circumstances
and in all situations and interactions
COMPASSION
• being sensitive to a person’s needs and willing to offer
reassurance in a caring and humane way

SELF-MOTIVATION
• is a direct reflection of a person’s attitude toward life
• takes initiative to follow through on tasks, consistently strives
to improve and correct behavior, and takes advantage of
every learning opportunity that may come along
DEPENDABILITY
• dependability and work ethic go hand in hand
• an individual who is dependable and takes personal
responsibility for his or her actions is extremely refreshing in
today’s environment

ETHICAL BEHAVIOR
• there are policies designed to regulate what should or should not
be done by those who work in the healthcare setting
→ code of ethics
• the Hippocratic oath includes the phrase primum non nocere,
which means “first do no harm.”
NOTE:
The primary objective in any
healthcare professional’s code
of ethics must always be to
safeguard the patient’s
welfare.
 BASIC CONCEPTS OF COMMUNICATION
IN THE HEALTHCARE SETTINGS
COMMUNICATION
✓is a skill
✓as the means by which information is exchanged or
transmitted
✓has three components:
▪ verbal skills,
▪ nonverbal skills, and
▪ the ability to listen
COMMUNICATION COMPONENTS
A. VERBAL COMMUNICATION
▪the most obvious form of communication
▪involves a sender (speaker), a receiver (listener), and,
when complete, a process called feedback, creating
what is referred to as the communication feedback
loop
COMMUNICATION COMPONENTS

B. ACTIVE LISTENING
• effective communication requires that the listener
participates
• is always a two-way process
• ordinary person can absorb verbal messages at about 500 to
600 words per minute, and the average speaking rate is only
125 to 150 words per minute
• is the foundation of good interpersonal communication
COMMUNICATION COMPONENTS
C. NONVERBAL COMMUNICATION
• it has been stated that 80% of language is unspoken
• is multidimensional and involves the following elements:
a. Kinesics
- the study of nonverbal communication
- it includes characteristics of body motion and language
such as facial expression, gestures, and eye contact
COMMUNICATION COMPONENTS
NONVERBAL COMMUNICATION
a. Kinesics
• Body language
• is often conveyed unintentionally
• plays a major role in communication
• if the verbal and nonverbal messages do not match, it is
called a kinesic slip
These are nonverbal facial cues. Can you
match the sketches with the correct affects?
1. Happy
2. Sad
3. Surprise
4. Fear
5. Anger
6. Disgust
COMMUNICATION COMPONENTS
NONVERBAL COMMUNICATION
b. Proxemics
▪ is the study of an individual’s concept and use of space
▪every individual is surrounded by an invisible “bubble”
of personal territory in which he or she feels most
comfortable
COMMUNICATION COMPONENTS
NONVERBAL COMMUNICATION

c. Appearance
✓ appearance makes a statement
✓ the right image portrays a trustworthy
professional
COMMUNICATION COMPONENTS
c. Appearance
1. Lab coats should completely cover the clothing
underneath and should be clean and pressed.
2. Shoes should be conservative and polished.
3. Close attention should be paid to personal
hygiene.
4. Bathing and deodorant use should be a daily
routine.
COMMUNICATION COMPONENTS
c. Appearance
5. Strong perfumes or colognes should be avoided.
6. Hair and nails should be clean and natural-looking.
7. Long hair must be pulled back and fingernails kept
short for safety’s sake.
8. According to current CDC hand hygiene guidelines,
healthcare workers with direct patient contact
CANNOT wear artificial nails or extenders.
COMMUNICATION COMPONENTS
d. Touch
• can take a variety of forms and convey many
different meanings
• “therapeutic touch”
• is a necessary part of the phlebotomy procedure
• there may even be a risk of the patient
questioning the appropriateness of touching
 ELEMENTS IN HEALTHCARE COMMUNICATION
1. EMPATHY
• involves putting yourself in the place of another and attempting to
feel like that person
• thoughtful and sensitive people generally have a high degree of
empathy
2. CONTROL
• feeling in control is essential to an individual’s sense of well-being
• recognizing fear in patients stems from a perceived lack of control
 ELEMENTS IN HEALTHCARE COMMUNICATION
3. RESPECT AND CONFIRMATION
✓Respect is shown in both a positive feeling for a person
and in specific action demonstrating that positive
feeling.
✓It is an attitude that conveys an understanding of the
importance of that person.
✓ The effect of honoring and respecting the person as a
unique individual is confirmation of the patient’s
presence and needs.
 Disconfirming VS Confirming exchange
with a patient:
a. “Oh, you’re the one with no veins” or “You’re the bleeder,
right?”
b. “Mrs. Jones, I seem to remember that we had a hard time
finding a suitable vein last time we drew your blood.”

OR
“Mr. Smith, wasn’t there a problem getting the site to stop
bleeding after the draw last time?”
 ELEMENTS IN HEALTHCARE COMMUNICATION
4. TRUST
▪It is the unquestioning belief by the patient that health
professionals are performing their job responsibilities
as well as they possibly can.
▪Note: Phlebotomists spend very little time with each
patient.
▪ The phlebotomist must do everything possible to win the
patient’s confidence by consistently appearing
knowledgeable, honest, and sincere.
 Telephone Communication in the
Healthcare Setting
• Telephone is used 24 hours a day in the laboratory.
• To phlebotomists or laboratory clerks, it becomes just
another source of stress.
• To promote good communication, proper telephone
etiquette should be followed.
PROPER TELEPHONE ETIQUETTE
1. Answer promptly.
2. State your name and department.
3. Be helpful.
4. Prioritize calls.
5. Transfer and put on hold properly.
6. Be prepared to record information.
7. Know the laboratory’s policies.
8. Defuse hostile situations.
9. Try to assist everyone.
LABORATORY ACTIVITY NO. 1:

A. Identify the different clinical analysis areas of the

laboratory and write a brief description of each area.
B. Identify the different types of laboratory procedures
or tests performed in each of the areas of the
laboratory.
INSTRUCTIONS:

1. Use short bondpaper

2. Margins: 1 inch for left margin; half-inch all sides
3. *Name (Surname, First Name, MI.)
*Year/Section
*Date of Submission
*Place at the back of the last sheet of bondpaper.
UNDERSTANDING PHLEBOTOMY
D. The Different Types of Healthcare Settings
E. The Different Clinical Analysis Areas of the
Laboratory and the Types of Laboratory Tests/
Procedures Offered Per Section
HEALTHCARE SETTING

2 general categories of facilities:

a. Inpatient (nonambulatory)
b. Outpatient (ambulatory)
CLASSIFICATION OF CLINICAL LABORATORIES

A.Classification by Ownership:
1. Government
2. Private
CLASSIFICATION OF CLINICAL LABORATORIES
B. Classification by Function:
1. Clinical Pathology
- Clinical Chemistry, Hematology, Immunohematology,
Microbiology, Clinical Microscopy, Endocrinology,
Molecular Biology, Toxicology and Therapeutic Drug
Monitoring and other similar disciplines
2. Anatomic Pathology
- Surgical Pathology, Immunohistopathology, Cytology,
Autopsy, Forensic Pathology and Molecular Pathology
CLASSIFICATION OF CLINICAL LABORATORIES
C. Classification by Institutional Character:
1. Institution Based
2. Freestanding
CLASSIFICATION OF CLINICAL LABORATORIES
D. Classification by Service Capability:
1. General Clinical Laboratory
A. Primary
• Routine Hematology (Complete Blood Count – includes
Hemoglobin, Hematocrit, WBC Count, Differential Count)
• Qualitative Platelet Determination
• Routine Urinalysis
• Routine Fecalysis
• Blood typing – for hospital based
CLASSIFICATION OF CLINICAL LABORATORIES
D. Classification by Service Capability:
1. General Clinical Laboratory
B. Secondary
• The minimum service capabilities of a primary laboratory plus the following:
• Routine Clinical Chemistry
• Blood Glucose, Blood Uric Acid, Blood Creatinine, Blood Total Cholesterol
• Quantitative Platelet Determination
• Cross Matching – for hospital based
• Gram Staining – for hospital based
• KOH - for hospital based
CLASSIFICATION OF CLINICAL LABORATORIES
D. Classification by Service Capability:
1. General Clinical Laboratory
C. Tertiary
• The minimum service capabilities of a secondary laboratory plus the following:
• Special Chemistry
• Special Hematology, including Coagulation procedures
• Immunology/Serology
• Microbiology
• Culture and Sensitivity
D. Limited Service Capability (for institution-based only)
• such as dialysis centers and social hygiene clinics
2. Special Clinical Laboratory
PERSONNEL (AO No. 2007-0027)
1. Every clinical laboratory shall be headed and managed by a
pathologist, certified either as a Clinical Pathologist, an Anatomic
Pathologist, or both by the Philippine Board of Pathology.
2. There shall be an adequate number of medical technologists and
other health professionals with documented training and
experience to conduct the laboratory procedures.
3. There shall be staff development and continuing education
programs at all levels of organization to upgrade the knowledge,
attitude and skills of the staff.
 THE CLINICAL ANALYSIS
AREAS/ SECTIONS OF THE
LABORATORY
A. CLINICAL MICROSCOPY
CLINICAL ANALYSIS AREAS/ SECTIONS
OF THE LABORATORY

A. Clinical Microscopy
Services:
- Urinalysis
- Stool Analysis / Fecalysis
- Special Tests
B. HEMATOLOGY
CLINICAL ANALYSIS AREAS/ SECTIONS
OF THE LABORATORY
B. Hematology
Services:
- Complete Blood Count
Hemogram for Complete Blood Count Assay:
▪ Hematocrit (Hct)
▪ Hemoglobin (Hgb)
▪ Red Blood Cell Count (RBC count)
▪ White Blood Cell Count (WBC count)
▪ Platelet Count (Plt count)
▪ Differential Count (Diff count)
▪ Indices (Mean Cell Volume (MCV), Mean Cell Hemoglobin (MCH), Mean Cell
Hemoglobin Concentration (MCHC))
▪ Red Blood Cell Distribution Width (RDW)
CLINICAL ANALYSIS AREAS/ SECTIONS
OF THE LABORATORY
B. Hematology
- Peripheral Blood Smears
- Coagulation
- Erythrocyte Sedimentation Rate (ESR)
- Lupus Erythematosus cells (LE cells)
- Osmotic Fragility Test (OFT)
- Reticulocyte Count (Retic count)
- Sickle Cell Screen
COAGULATION
C. CLINICAL CHEMISTRY
CLINICAL ANALYSIS AREAS/ SECTIONS
OF THE LABORATORY
C. Clinical Chemistry
Services:
- Blood Glucose
- Total Cholesterol
- Blood Uric Acid (BUA)
- Blood Creatinine
- Blood Urea Nitrogen (BUN)
Other Special Tests: Liver Profile; Lipid Profile, Enzymes,
Electrolytes, Blood Gases, and Tests for Other Body Fluids
CLINICAL ANALYSIS AREAS/ SECTIONS
OF THE LABORATORY
D. Immunology/Serology
Services:
- Antinuclear Antibody (ANA)
- Antistreptolysin O (ASO) titer
- Fluorescent Treponemal Antibody Absorption test (FTA-ABS)
- Rapid Plasma Reagin (RPR)
- C-reactive Protein (CRP)
- Hepatitis B surface Antigen (HBsAg)
- HIV test
E. MICROBIOLOGY
CLINICAL ANALYSIS AREAS/ SECTIONS
OF THE LABORATORY
E. Microbiology
Services:
- Gram Stain
- KOH
- Acid-Fast Bacilli Stain
- Culture and Sensitivity
F. BLOOD BANK/ IMMUNOHEMATOLOGY
CLINICAL ANALYSIS AREAS/ SECTIONS
OF THE LABORATORY
F. Blood Bank/Immunohematology
Services:
- Type and Rh
- Type and Cross match
- Compatibility Testing
- Antihuman Globulin Test
CLINICAL ANALYSIS AREAS/ SECTIONS
OF THE LABORATORY
G. Anatomic Pathology (HISTOPATHOLOGY SECTION)
Services:
- Surgical Pathology
- Cytology
- Frozen Section
- Autopsy
CLINICAL ANALYSIS AREAS/ SECTIONS
OF THE LABORATORY
G. Anatomical Pathology (HISTOPATHOLOGY SECTION)
- Frozen Section
REFERENCE LABORATORIES
• are large independent laboratories that receive
specimens from many different facilities located in the
same city, other cities in the same state, or even cities
that are out of state
• provide routine and more specialized analysis of
blood, urine, tissue, and other patient specimens
• offer fast turnaround times (TATs) and reduced costs
•As provided in Department Order No. 393-E
s. 2000, five institutions were designated as
the National Reference Laboratories
 Quality assurance in the clinical laboratory
At present, the designated NRL-EQAS are the following:
1. National Kidney and Transplant Institute – Hematology and
Coagulation
2. Research Institute for Tropical Medicine – Microbiology (
identification and antibiotic susceptibility testing) and Parasitology (
Identification of ova and quantitation of malaria)
3. Lung Center of the Philippines – Clinical Chemistry (for testing 10
analytes, namely glucose, creatinine, total protein, albumin, BUN,
uric acid, cholesterol, sodium, potassium, chloride)
 Quality assurance in the clinical
laboratory

4. East Avenue Medical Center – Drugs of abuse (methamphetamine

and cannabinoids)
5. San Lazaro Hospital STD-AIDS Cooperative Center Laboratory –
HBsAg, HIV, HCV)