MLSP REVIEWER
LESSON 1
PHLEBOTOMY – process of collecting
blood through the vein by using
incision or puncture methods to draw
blood for analysis and as part of
therapeutic or diagnostic measures
under the physician’s request.
Phlebos – vein Temnein -to cut
Phlebotomy also called
“venesection”
Ancient Egyptians (1400 BC) –
phlebotomy called “bloodletting”
using crude tools.
HIPPOCRATES – a Greek physician,
believed that a person’s health was
dependent on a balance of 4 humors;
(1) Earth: blood and brain
(2) Air: phlegm and lungs
(3) Fire: black bile and spleen
(4) Water: yellow bile and gall
bladder
TH TH
MIDDLE AGES – 17 AND 18
CENTURY
Phlebotomy was a major theraphy.
Cupping - This method was done in
the ancient history which involves the
application of heated suction cups on
the patient's skin and would be
incised using a lancet.
Leeching - This method uses leeches
to extract blood from a patient. It is
also called “Hirudo Theraphy”.
Medical Leech “Hirudo Medicinalis”.
3 main goals of phlebotomy
practice
(1) for diagnosis and treatment using blood
sample
(2) for transfusion; to remove blood from
the donor
(3) for removal of blood from polycythemia
or therapeutic purposes
2 methods of Phlebotomy
Venipuncture – blood collection using a
needle inserted in vein
Capillary Puncture - done by puncturing
skin
Phlebotomists - Phlebotomists are
responsible in delivering and
transporting samples to the laboratory.
Centifuging and Aliquoting of samples
should be performed by phlebotomists.
Inpatients - are required to stay in the
hospital for at least one night. Served by
tertiary care practitioners. They are
referred as “non-ambulatory”.
Outpatients – served by secondary
care specialists on the same day. They
are referred as “ambulatory”.
Ambulatory Care - This medical care is
given to patients requiring follow up check-
ups after discharge from the hospital.
Homebound Services – procedures, ‘DAT’, ABO and RH Type, Type and
test, and services provided to a patient Crossmatch, Compatibility Testing)
which are done in a patient’s home or in a
long-term facility. Lesson 2
Public Health Services – belong to a Infection – microorganism invades the
unit of a local level but are still under the body, multiplies, and causes injury or
jurisdiction of the health department of diseases
government. Services are offered with a
little or no charge at all. Pathogen – disease-causing microbe
which could be classified as bacteria,
2 main division of Clinical Area fungi, protozoa, or virus.
-Anatomical and Surgical Pathology
Area
 Histology (microscopic structure
of tissue)
 Cytology (Structures of Cell)
 Cytogenetics (Chromosomal
Deficiencies and Genetic disease)
-Clinical Analysis Area
Divided in 7 areas:

 Hematology (Hematocrit, RBC count

and Differential White blood cell
count)
 Coagulation (Activated Partial
Thromboplastin (APTT), D-Dimer,
Fibrin Split Products (FSP),
Fibrinogen Test, Prothrombin Time
‘PT’)
 Clinical Chemistry (ammonia,
amylase, lipase and blood calcium)
 Serology/Immunology (ASO titer,
CRP test and HBsAg)
 Urinalysis (performs physical and
chemical evaluation of the urine)
 Microbiology (Acid-Fast Bacilli ‘AFB’,
Blood culture, Culture and
Sensitivity, Ova and Parasites)
 Blood Bank (Antibody (AB) Screen,
Direct Antihuman-globulin Test
Donning: SC – G – H – M – Googles (opt.)
GL
Doffing: GL- G- H- Googles (opt.) – SC- M
MOST COMMON PATHOGENS – Hepatitis B
(HBV), Hepatitis C (HCV), and Human
Immunodeficiency (HIV).
 Biohazard – any material that could
be harmful to one’s health.
Biosafety – used to prevent clinical
laboratories from harmful incidents caused
by laboratory specimens that are potential
biohazards.
1. Airborne – from splashes and
aerosols; patients w airborne
disease
2. Ingestions – hands are not sanitized
before handling food.
3. Non-Intact Skin – contamination
through breaks or cuts in the skin
4. Percutaneous – exposure through
the skin due to injuries from
needlesticks and other sharp
objects.
5. Permucosal – infection through
mucous membranes of the mouth
and nose and the conjunctiva of the
eyes.
 Electric shock
 Fire
 Radiation
First-Aid Procedures
1. Keep the airway open
2. Call for medical assistance
3. Keep the patient lying down
4. Control any bleeding or other
cause of shock
5. Keep the patient warm
CPR – Cardiopulmonary Resuscitation -
done in a person who is suffering from
cardiac arrest.
Personal Wellness
 Function: receives blood from the right atrium and pumps it
into the pulmonary artery
3) Left Atrium – upper left chamber
Function: receives oxygenated blood from the lungs and
pumps in into the left ventricle
4) Left Ventricle – lower left chamber
Function: receives blood from the left atrium and pumps it
into aorta

Valves of the Heart

LESSON 3  Right AV valve (TRICUSPID VALVE)
closes as the right ventricle
Circulatory System – is responsible for contracts preventing blood from
transporting throughout the body flowing back to the right atrium
oxygenated blood from the heart and lungs  Left AV valve (BICUSPID OR
via the arteries. Then the oxygen-depleted MITRAL VALVE) closes as the left
blood is returned to its origin through the ventricle contracts preventing the
blood from flowing back to the left
veins.
atrium
 Right semilunar valve
(PULMONARY OR PULMONIC
VALVE) closes when the right
ventricle relaxes preventing the
blood from flowing back to the right
ventricle
 Left semilunar valve (AORTIC
VALVE) closes when the left
ventricle relaxes preventing blood
from flowing back to the left
Layers of the Heart ventricle
1. Epicardium – thin, watery SEPTA
membrane on the outer layer of the
1. Interatrial Septum – partition that
heart. separates the right from the left
2. Myocardium – thick layer of cardiac atria
muscles in the middle layer of the 2. Interventicular Septum – separates
heart the right and left ventricles.
3. Endocardium – thin layer of
epithelial cells in the inner layer of
the heart
Chambers of the Heart
1) Right Atrium – upper right chamber
Function: receives deoxygenated blood from the body
2) Right Ventricle – lower right chamber
 AORTA - main artery that carries blood
away from your heart to the rest of your body
SUPERIOR VENA CAVA - carries
blood from the head, neck, arms, and chest
FUNCTIONS OF THE HEART
DISORDERS AND DIAGNOSTIC TEST
1. Angina Pectoris – chest pain
2. Aortic Stenosis – murmuring
sound produced
3. Bacterial Endocarditis –
infection happens when
bacteria enter and reside
4. Congestive heart failure –
chronic progressive condition
5. Myocardial infarction – heart
attack
6. Pericarditis – inflammation of
the pericardial
2 main division and functions of the
vascular system
Pulmonary Circulation – moves between
the right ventricle of the heart to the lungs.
During the process, oxygen absorbed and
carbon dioxide is released, after which,
oxygenated blood flows back to the left
atrium of the heart
Systematic Circulation- moves oxygenated
blood and nutrients from the left ventricle
of the heart to the rest of the body. The
deoxygenated blood with carbon dioxide
and waste flows back to the right atrium.
Structure of the Vascular System
 Arteries – thick-walled blood
vessels that carry oxygen-rich blood
from the heart to the tissues of the
body
 Arterioles – small-diameter blood
vessels that branch out from the
arteries and lead to the capillaries
 Veins – tubes with thin walls that
carry deoxygenated blood from
tissues to the heart
 Venules – very small veins that
collect blood from the capillaries
 Capillaries - fine hair-like blood
vessels that connect arterioles and
veins
Blood Vessel Structure
Layers – blood vessels 3 layers
 Tunica adventitia – (outer;
connective tissue)
 Tunica Media – (Middle, muscle and
elastic fiber)
 Tunica Intima – (inner,endothelial
cell)
b. Lumen – space inside the blood vessel
where the blood flows
c. Valves – found in the vein, these are thin
membranous leaflets that prevent the
backflow of blood
 restricting venous blood for a
period of time.
 Needle Gauge – classified
according to the diameter of
the lumen.
 Evacuated Tube System – a
closed-collection system
composed of multi-sample
LESSON 4 needle, tube holder and
GENERAL BLOOD COLLECTION evacuated tubes, to prevent
EQUIPMENT AND SUPPLIES exposure to contaminants.
 The Blood-drawing station 3 types of Phlebotomy Needles
 The Phlebotomy Chair
 Equipment Carrier 1. Multi-Sample needle
 New pair of Gloves used in ETS
 Antiseptics
 Disinfectants
 Hand Sanitizer
 Gauze Pads
 Bandages
 1x3-inch glass microscope slide
 Bandages
 Pen- no ink smear
 Watch with a timer 2. Hypodermic
 Sharp disposal Containers
Used in syringe system
 Biohazard Bags

VENIPUNCTURE EQUIPMENT
 Vein-Locating Devices –
infrared light to help health
professionals locate and assess
veins for venous access.
 Tourniquet – constricting
device applied to a patient’s 3. Winged Infusion
arm prior to venipuncture with (butterfly)
the aim of inflation the vein by Used for difficult veins

SYRINGE SYSTEM
Used as an alternative method when
drawing blood from patients with
small and difficult veins.
EVACUATED TUBE SYSTEM
Is a closed collection system that is
considered the most efficient system
for collecting blood samples.
21 G – most common needle
25 G – used for pediatric
16 G – for blood donation
ETS 23 G – color green
ETS 25 G – color blue
CATEGORIES OF ADDITIVES
USED IN BLOOD COLLECTION
 ANTICOAGULANTS –
prevent blot clots. EDTA,
Citrates, Heparin and
oxalates
 SPECIAL-USE
ANTICOAGULANTS –
include acid citrate
dextrose, citrate
phosphate dextrose, and
sodium polyanethol
 ANTIGLYCOLYTIC
AGENTS – prevent the
breakdown of glucose by
blood cells or glycolysis.
Most common “Sodium
Fluoride”
 CLOT ACTIVATORS –
enhance coagulation in
serum specimen tubes.
Platelet activator such as
glass (silica), inert clays
(celite) and diatomite.
 THIXOTROPIC GEL
SEPARATOR – inhibits
cell from metabolizing.
Between from cells and
plasma.
 TRACE ELEMENT FREE –
are made of materials
that are free of trace
element contamination.
“Royal blue” stoppers
ORDER OF DRAW
BLOOD CULTURE - YELLOW
CITRATES – LIGHT BLUE
SERUM - RED
HEPARIN - GREEN
EDTA – LAVENDER/PURPLE
FLUORIDE – GRAY
PINK – BLOOD TYPING
WHITE – MOLECULAR PEDIATRIC PUNCTURE –
DIAGNOSIS involving children below two
LIGHT BLUE – 1:9 (EDTA, SODIUM years old
CITRATE)
– Eutectic EMLA mixture of
BLACK – 1:4 (SODIUM CITRATE)
local anesthetics – used for
pain interventions
GERIATRIC VENIPUNCTURE –
LESSON 5 Elderly Patients
Venipuncture – process of
collecting or “drawing” blood
from a vein of the patient for LONG-TERM CARE PATIENTS
laboratory testing purposes.
Dialysis Patients – dorsum of
First step – Test request that the hand of patients
comes from
undergoing hemodialysis to
SPECIMEN TUBE preserve the vein
LABELLING
Long-Term Care Patients -
A. PATIENTS COMPLETE
NAME (FN, LN)
services are provided to
B. DATE OF BIRTH patients who cannot perform
C. ID NUMBER (IF regular activities due to their
APPLICABLE) health condition
D. DATE AND TIME OF
COLLECTION Home-Care Patients –
E. INITIALS OF THE services are for patients who
PHLEBOTOMIST need medical attention and
F. ADDITIONAL assistance from health
INFORMATION SUCH
AS “FASTING”
professionals from time to
time
Hospice Patients - patients
who need end-of-life care,
and mostly have a prognosis
of 6 months or less.
LESSON 6
PRE- ANALYTICAL
CONSIDERATIONS IN
PHLEBOTOMY – includes
procedures such as laboratory
handling and identification,
which takes place prior to any
laboratory testing.
Laboratory Test - used by
physicians to diagnose and
monitor the presence of a
disease.
BASAL STATE – metabolism
of the body early in the morning
or after 12 hours of fasting. This
can be influenced by age, gender,
and conditions of the body.
PROBLEM AREAS TO
AVOID AND
TROUBLESHOOTING IN
THE SITE SELECTION
 BURNS, SCARS AND
TATTOOS – veins in the
area may be difficult to
examine and blood circulation
may be impared.
 DAMAGED VEINS –
difficult to perform, it may also
produce inaccurate results.
 EDEMA – oedema,
abnormal swelling caused by
the accumulation of fluid in the
tissues. The tissues become
fragile making the task of
locating the veins harder;
caused by medications,
pregnancy, infections, and
other medical problems.
 HEMATOMA – solid
swelling or a mass of bloos in
the tissues cased by the leakage
of blood from vessels during
venipuncture. Selecting a
venipuncture site w hematoma
will be painful for patient
 because it will obstruct the
blood flow. Also lead to the
contamination of blood sample.
 MASTECTOMY – often
done to breast cancer patients.,
refers to removal of the breast
through surgery. Blood drawing
became a challenge since the
lymph flow is obstructed, and
there may be swelling and
infection after the surgery.
Tourniquet cannot be applied
because it can cause injury. It
could also change the blood
composition.
 OBESITY – condition in
which the individual is grossly
overweight. Patients who are
obese have veins that are deep
and difficult to locate. A
solution is using a longer
tourniquet or locating the
cephalic or cubital vein.
VASCULAR ACCESS SITES
(VADs)
needed for blood sampling, infusing
medication, central venous pressure
readings, and blood transfusion of a
patient. Choosing vascular access
sites is based on the needs of the
patient, purpose, and the length of the
time the device is to remain in the
body.
1) Arterial Line – thin catheter is
inserted into an artery. This is used
to monitor blood pressure
continuously.
2) Arteriovenous Shunt or Fistula –
a passageway created through
surgery, and is usually in the arms
with intention of connecting the
artery and a vein directly. This
may be created for hemodialysis
treatment or pathological process
such as erosion of arterial
aneurysm.
3) Blood sampling device - used to
avoid the use of needlestick,
prevent
4) Heparin or Saline Lock –
commonly called a “hep-lock” is
an intravenous (IV) catheter
attached to a stopcock or a cap w
diaphragm. Basic function is to
provide access for administering
medicine or drawing blood from
the patient. It is threaded in the
peripheral vein, which is in the
lower arm above the wrist for up
48 hours. It is usually flushed w
heparin or saline (to prevent
clogging) and capped for future
use.
5) Intravenous (IV) Sites – is a thin
plastic tube or catheter inserted
into a vein in the forearm to inject
a volume of fluids into the
bloodstream. Phlebotomist should
avoid collecting blood from the
arm with IV because the blood
collected could be contaminated w
IV fluid. Collection of blood from
 previously known IV sites should
be avoided for 24 to 48 hours.
6) CENTRAL VASCULAR
ACCESS DEVICE (CVADs)
Known as “indwelling line”, any
of the tubings inserted to the main
vein or artery used for blood
collection, monitoring the patient’s
pressures, and administering
medications and fluids.
3 TYPES OF CVADs
C. Peripherally Inserted
A. Central Venous Catheter Central Catheter (PICC)
– central line inserted into the – a flexible tube inserted into
large vein (subclavian) and the veins of extremities and
advanced into the superior vena then central veins.
cava

B. Implanted Port – a
surgically implanted disk-
shaped chamber attached to the
indwelling line. This is usually
placed on the upper chest just
below the collarbone
LESSON 7
CAPILLARY PUNCTURE
EQUIPMENT
 Lancet/Incision Devices –
sterile, sharp instruments that
are intended for one-time use
only. Use in making cuts in the
skin for finger or heel
procedure.
 Laser Lancet – produces a
small hole in the skin by
vaporizing water in the skin.
Eliminates the risk of sharp
injury. 2 types used in capillary
puncture: finger puncture lancet
and heel puncture lancet
 Microcollection container
– microtube, small tube used to
hold blood.
 Microhematocrit tubes
and sealants - narrow bore
tubes that are made of either
plastic or Glass. They can hold
50 to 75 µL and filled by
capillary action. One end is
sealed with sealants made of
clay or plastic.
 Microscope Slides – used
for blood films for hematology
determinations.
 Warning Devices – used to
increased the blood flow seven-
flow by warning the puncture
site
 Capillary Blood Gas
(CBG) equipment – used
for collecting capillary blood
gas (CBG) specimen, which
contains CBG collection tubes,
stirres, magnet, and plastic caps
COMPOSITION OF
CAPILLARY BLOOD
SPECIMEN
Capillary blood specimen is a
mixture of different blood and
fluid.
 Arterial blood – bright red
blood (oxygenated blood)
found in the pulmonary vein,
left chamber of the heart and
the arteries
 Venous blood - Dark red blood
(deoxygenated blood) that
travels from the peripheral
veins through the venous
system through the right
chamber of the heart
Capillary blood – preferred
specimen for infants, young
children, elderly patients, and
patients with severe burns.
Capillary Reference values –
may vary from the venous
values. Concentration of the
glucose in the blood is higher
while the Total Protein(TP),
Calcium, and potassium
concentrations is Lower.
ORDER OF DRAW
(CAPILLARY)
BLOOD GAS
SMEAR/SLIDE - RED
EDTA - LAVENDER
H EPARIN - GREEN
OXALATE - GRAY
SERUM – GOL D

PHLEBOTOMIST –
COLLECT
MEDTECH - PROCESS