Phlebotomy /venesection

- process of collecting blood through the vein by using

incision or puncture methods to draw blood for analysis or Clinical analysis areas and the type of procedures
as part of therapeutic or diagnostic measures under the
physician's request. Hospital
- with permanent inpatient beds
phlebos - vein - 24 hour nursing service
temnein - to cut - managed by organized medical team

2 Major divisions
Evolution of Phlebotomy
- Anatomical and Surgical Pathology area
- Clinical analysis area
Stone Age - humans used crude tools to cut the vessels.
Clinical analysis areas
Ancient Egyptians (1400 BC)- practiced
1. Hematology
"bloodletting".
2. Coagulation
3. Chemistry
Hippocrates (460-377 BC) - balance of the four humors,
4. Serology
removing the excess by bloodletting.
5. Urinalysis
6. Microbiology
Middle Ages- used to treat illness and performed by
7. Blood bank/ immunohematology
Phlebotomy
barber-surgeons.
Hematology - blood and blood forming tissues
17th and 18th century- treated as major therapy.
NAME OF TEST AND PROCEDURES
Cupping
- alternative medicine 1.Hematocrit (Hct) - checks the hemoglobin level and the red
- application of special heated suction cups on the cell count.
patient's skin 2.Hemoglobin (Hgb) - tests the value to rule out anemia.
- incision using fleam or lancet. 3.Red Blood Cell (RbC) count - is used to measure the
erythropoietic activity.
4.White Blood Cell (WbC) count - checks the leukocyte response
Leeching 5.Platelet (Plt ct) - count usually used to monitor
- known as Hirudotherapy chemotherapy and radiation conditions.
- uses leeches for bloodletting 6.Differential White Count (Diff) - monitors changes in the
- used for microsurgical replantation appearance or quantity of specific cell types
7.Indices - shows the changes in RBC size, weight and Hgb
Role of Phlebotomist content
8.Mean Corpuscular hemoglobin (MCH) -gives the weight of the
(1) for diagnosis and treatment using blood samples. hemoglobin in the cell.
(2) for transfusion, to remove blood at the donor. 9.Mean Corpuscular volume (MCV) shows the size of the cell.
(3) for removal of blood for polycythemia or 10.Mean Corpuscular hemoglobin concentration (MCHC) gives
therapeutic purposes. information on the concentration of the hemoglobin per unit
volume of RBCs.
Credentials 11.Red blood distribution width (RDW) measures the size
differences of the RBCs
- certification
- licensure
- continuing education COAGULATION – ability of blood to form and dissolve clots

Patient - Client Interaction NAME OF TEST AND PROCEDURES

(1) Reassuring and pleasant
(2) Able to communicate 1.Activated partial thromboplastin time (APPT) - reflects
(3) Maintain positive customer relations the adequacy of herapin therapy.
(4) Understand the diversity of the patients and be 2.D-dimer - checks the thrombin and plasmin activity
able to adjust accordingly 3.Fibrin split products (FSP) - measures if the level is
high because it results to FDP fragments.
Qualities of Professionalism 4.Fibrogen - tests are performed to check any fibrogen
(1) Professional Appearance deficiency.
(2) Self-confidence
5.Prothrombin Time (PT) or International Normalized Ratio
(3) Integrity
(INR) - evaluates liver diseases or deficiency in Vitamin K
(4) Compassion
(5) Self-motivation
(6) Dependability Chemistry - performs most lab test for plasma, white blood,
(7) Ethical Behavior NAME OF TEST AND PROCEDURES
Communication in the Healthcare setting 1.Alanine amino tranferase (ALT) is used to monitor liver
- Verbal Communication disease.
- Nonverbal Communication 2.Alpha-fetoprotein (AFP) checks levels especially for
- Active listening prenatal screening
3.Alkaline phosphatase (ALP) determines level to check
Elements in healthcare communication obstructions and bone disease.
- Empathy - Confirmation 4.Ammonia measures the level which could indicate cirrhosis
- Control - Trust and hepatitis.
- Respect 5.Amylase checks the enzyme level which could indicate
liver disease, cholesystitis, etc.
6.Aspartate amino-transferase (AST) measures the level
which is indicative of liver dysfunction.
7.Bilirubin shows the level in the bloodstream that shows
red blood destruction
8.Blood Gases (ABG) evaluates acid-base balance by
measuring the pH, partial pressure of the carbon dioxide
and oxygen.
9.Blood Urea Nitrogen (BUN) checks elevated levels which
leads to impaired renal function.
10.B-type natriuretic peptide (BNP) is a cardiac marker for
congestive heart failure.
11.C-reactive protein High sensitivity (hs-CRP) detects low
level of CRP
12.Carcinoembryonic antigen (CEA) is used for early
detection of malignancy in colorectal cancer.
13.Calcium is used for monitoring effects of the renal
failure.
14.Cholesterol (total) indicates risk of cardiovascular
diseases.
Chemistry continuation...
16.Creatine Kinase (CK) used to check muscle damage.
17.Creatinine checks for cases that indicate renal
impairment or muscular dystrophy.
18.Drug Analysis monitors therapeutic range to avoid toxic
levels for drugs.
19.Electrolytes (sodium, potassium, chloride, CO2) shows the
sodium values that determines disorder of the kidney and
adrenals.
20.Glucose is used to check diabetic problems, liver disease
or malnutrition.
21. Gamma-glutamyl transferase (GGT) is used for diagnosis
of liver specifically hepatobiliary problems.
22.Hemoglobin A1C determines the Glycohemoglobin level that
shows the diabetic control over the past months.
23.Lactate dehydrogenase checks lung, kidney and liver
dysfunction.
24.Lipase shows the level that could lead to pancreatitis,
pancreatic carcinoma
25.Prostate specific antigen is a test that screens patients
for presence of prostate cancer.
26.Total Protein used to check liver and kidney disorders.
27.Triglycerides serves as index to evaluation of
atherosclerosis and lipid metabolism disorder.
28.Troponin-I used for early diagnosis of small myocardial
infarcts.
29.Uric Acid tests are used to check levels that indicates
gout and renal problems.
30.Vitamin B12 and folate tests are done to check for anemia
and diseases of the small intestine.
Serology/Immunology - serum and autoimmune reactions.
NAME OF TEST AND PROCEDURES
1.Bacterial Studies
●Antinuclear antibody (ANA) shows autoimmune disorders
such as systematic lupus erythematosus
●Antistreptolysin O (ASO) titer indicates streptococcal
infection
●Cold agglutinins checks cases of atypical pneumonia
●Febrile agglutinins shows presence of antibodies to
specific organisms
●FTA-ABS confirms syphilis
●Rapid plasma reagin (RPR) when positive it is indicative
of syphilis but it needs confirmation
●Rheumatoid factor (RF) indicates rheumatoid arthritis
2.Viral Studies
●Anti-HIV screens Human immunodeficiency virus
●Cytomegalovirus antibody (CMV) is a confirmation test
●Epstein-Barr Virus checks for presence of heterophil
antibody which indicates infectious mononucleisis
●Hepatitis B surface antigen checks for presence of
hepatitis entigen in the surface of the red cells.
3.General Studies
●C-reactive protein (CRP) indicates inflammation when
levels are increased.
●Human chorionic gonadotropin (HCG) tests are present
when patient is pregnant.
Urinalysis- tests urine specimens.
NAME OF TEST AND PROCEDURES
1.Physical Evaluation
●Color indicates presence of blood melanin, bilirubin or
urobilin in the urine specimen
●Clarity shows presence of fat, chyle bacteria which affects
the turbidity
●Specific Gravity suggests renal tubular involvement or ADH
deficiency
2.Chemical Evaluation
●Blood - Hematuria could be due to hemorrhage, infection or
trauma
●Bilirubin - helps differentiate between obstructive and
hemolytic jaundice
●Glucose - Glucosuria maybe a result of diabetis melitus,
renal impairments
●Ketones - uncontrolled diabetes mellitus or starvation
●Leukocyte - indicates urinary tract infection if there is a
lot of neutrophils
●pH - indicates in acid-base balance
●Protein - Proteinura is an indicateor of renal dysfunction
or disorder
●Nitrite - positive results could mean bacterial infection
●Urolibinogen - increases in amount when patient suffers
from hepatitic issues
3.Microscopic Evaluation
●shows the status of the urinary tract, hematuria, pyuria,
etc.
Microbiology - microorganisms in body fluid or tissues
NAME OF TEST AND PROCEDURES
1.Acid-fast bacili (AFB) is used to monitor treatment for
TB
2.Blood culture checks presence of bacteria which indicates
bacteremia or septicemia
3.CLO test shows presence of Helicobacter pylori
4.Culture & Sensitivity (C&S) indicates infection if there
is growth in the pathogenic microorganism
5.Fungus culture and identification - used to determine the
type fungi if present
6.Gram stain - done to allow antimicrobial therapy while
waiting for culture results
7.Occult blood - checks for blood in the stool which could
result from gastrointestinal bleeding
8.Ova and parasites - solves "etiology unknown" intestinal
disorders
Blood bank/ Immunology - blood transfusion
NAME OF TEST AND PROCEDURES
1.Antibody (Ab) screen - agglutination means presence of
abnormal antibodies in the blood
2.Direct antihuman globulin test (DAT) determines
transfusion incompatibility
3.Type and RH - shows the blood group (ABO) and type (Rh)
4.Type and crossmatch shows the blood group and screens
for antibodies in the recipient's blood
5.Compatibility testing - detects antibodies and antigen
in both recipient's and donor's blood
Stat Labs
- located near emergency room of
some tertiary-care facilities so
that procedures and tests can be
done immediately when needed.
Reference Laboratory
- a large and independent
laboratory that provide
specialized and confirmatory
laboratory tests for blood,
urine, and tissues, and offers as
well faster turnaround or
processing time.
INFECTION CONTROL
INFECTION CONTROL (lesson 2)
- when a microorganism invades the body, multiplies and
causes injuryor disease.
- communicable and nosocomial and healthcare-associated
infections (HAIs).
Pathogen
- microbe that can cause diseases, and microbes that
could be bacteria, fungi, protozoa or viruses.
COMPONENTS OF THE CHAIN OF INFECTION
Infectious (causative) agent
- Pathogenic microbe such as virus, bacteria, fungus,
protozoa, rickettsia
Reservoir
- Source of infection agent or place where the microbe
could grow, survive and multiply which could be in humans,
animals, food, water, soil or equipment
Exit pathway
- A way or manner where an infectious agent can leave the
reservoir host which could be through secretions and
exudates, tissue specimens, blood, feces or urine.
Means of transmission

- Airborne, direct (touching or kissing) or indirect contact

(contaminated objects), droplets (coughing or sneezing), vector
(insect, anthropod or animal) and vehicle (food, water or
drugs)

Entry pathway

- Refers to the way an infectious agent enters a host that is

susceptible to infection which includes body orifices, mucous
membranes, and breaks in skin

Susceptible host

- Someone who is prone to infection due to age, health or

immune status. They usually include the elderly, newborn,
patients who are immune suppressed, unvaccinated, and those
suffering from acute or chronic illness.

Infection Control Measures

● Effective hand hygiene procedure

● Good nutrition
● Immunization against common pathogens
● Insect and pest control
● Isolation and decontamination procedures
● Use of proper safety devices
● Use of PPE when needed
● Proper disposal of sharps

Four functions of Infection-control program

1.protect patients, employees, and visitors from infection

2.screen employees for infectious diseases and require

immunization when needed

3.provide evaluation and treatment to health workers who were

exposed to infections while performing their duty

4.monitor employees and patients who are at risk of infection DONNING REMOVING
and collect data from patients and health worker who were
exposed to such

PROPER PROCEDURES FOR HAND HYGIENE, PUTTING ON AND

REMOVING PROTECTIVE CLOTHING, AND ENTERING THE OR AND
ICUS Note: Wash hands immediately after removal of the PPE.
Steps in wearing gloves
- Includes hand hygiene using alcohol-based
antiseptic and Personal Protective Equipment 1.The wrist of one hand is grasped by the opposite hand.
(PPE) 2.The glove is pulled inside out and off the hand.
3.Place the recently removed glove in the gloved hand. The
fingers of the non-gloved hand are slipped under the wrist
Hand Hygiene of the remaining glove but make sure not to touch the the
exterior surfaces.
•include hand washing or use of alcohol-based 4.The second glove is pulled inside out.
antiseptic hand cleaners 5.Drop the gloves in the proper receptacle.
•Hand washing could be routine hand washing which uses
plain soap and water.
•Hand antisepsis uses antimicrobial soap to remove
transient microorganisms NURSERY AND NEONATAL ICU INFECTION CONTROL TECHNIQUE

1.Do the proper hand washing procedure before putting on

Steps in performing the routine the PPE.
hand-washing technique: 2.The phlebotomist should only bring items necessary for
the specimen collection.
1.Stand a few inches from the sink to avoid contamination 3.Blood collection tray should be left outside the
2.Turn on the faucet and place hands under the running water. nursery, preferably the anteroom.
3.Use soap and work up lather to ensure that surfaces are 4.Remove gloves, wash hands, and use a new pair of gloves
reached. between patients.
4.Scrubbing for at least 15 seconds is necessary. Make sure to
scrub all surfaces especially between the fingers and the
knuckles.
STANDARD
STANDARD AND
AND TRANSMISSION-BASED
TRANSMISSION-BASED PRECAUTION
PRECAUTION
Steps in performing the routine hand-washing technique (Continuation): FOR
FOR BLOOD-BORNE
BLOOD-BORNE PATHOGEN
PATHOGEN
BLOOD-BORNE PATHOGENS (BBP)
1.Apply a little friction and rub hands together for at
least 15 seconds. -Microorganisms in the human blood
2.Rinse the hands from the wrist to fingertips using a -most common pathogens include, hepatitis B (HBV),
downward motion. hepatitis C (HCV) and Human Immunodeficiency Virus (HIV)
3.Dry hands using a clean paper towel.
4.Use the paper towel to close the faucet except when
it is foot or motion activated.
DEFENSE,
DEFENSE, HAZARDS
HAZARDS AND
AND SYMPTOMS
SYMPTOMS OF
OF BLOOD-BORNE
BLOOD-BORNE PATHOGEN
PATHOGEN 3. Non-intact skin - contamination through breaks or
cuts in the skin;
a. Cover with non-permeable bandages

ELECTRIC SHOCK

•potential hazard in the workplace when dealing with

electrical equipment.
•actions should be taken if electric shock occurs:
1.remove the source of electricity using non-conductive
object or simply turn off the source of electricity,
2.ask for medical assistance, start cardiopulmonary
resuscitation (CPR) if necessary, and keep the victim warm.

FIRE

•another potential work hazard.

•regular fire drills should be conducted
•The location of fire extinguishers and heavy blankets
should be known, and the staff should know how to use it.

Exposure control plan

Exposure occurs when the following happens:

a)When a contaminated needle or sharp object pierces the

skin of the health worker.
b)Body fluid or blood splashes in the eyes, nose or mouth
c)Cut, scratch or abrasion has made contact with blood or
body fluid
d)Human bite cuts the skin

When there is BBP exposure either by needle stick or

sharp object injury or mucous membrane exposure, the
following procedure should be followed:

Needle stick or other sharp injury:

1.Carefully remove the shards or foreign object.

2.Wash the site thoroughly with soap and water for at
least 30 seconds.

Mucous membrane exposure:

1.Flush with water or saline for at least 10 minutes.

2.For the eyes, use eyewash station for flushing if
available. Remember to remove the contact lenses (if
there are any) and make sure to disinfect them.
3.Report the incident to the immediate supervisor and the
provider so that evaluation, treatment and counseling can
be provided.
HAZARDS, WARNING SYMBOLS, ACTIONS TO TAKE IF
INCIDENTS OCCUR, AND RULES TO FOLLOW FOR
BIOLOGICAL, ELECTRICAL, FIRE, RADIATION, AND
CHEMISTRY SAFETY
RADIATION
•exposure depends on distance, shielding and time.
•protection worn at the time would also have a bearing on the
intensity of exposure.
•radiation symbol should be posted in areas where radioactive
materials are present and storage areas where these are kept.
•can be encountered when collecting specimen from patients
injected with radioactive dyes or collecting specimen from the
nuclear medicine department
SHOCK

•condition when there is not enough blood that circulates

BIOHAZARD
Biosafety is used to prevent and protect
clinical laboratories from harmful incidents
caused by laboratory specimen that are potentially
biohazard. Biohazard refers to any material that
could be harmful to health.
back to the heart which results to inadequate supply of
oxygen in the body. never store chemicals in unlabeled
containers;
•result of hemorrhage, heart attack, trauma and drug
reactions;
•common symptoms are: pale, cold & clammy skin; rapid and
weak pulse; increased and shallow breathing and
expressionless face with staring eyes.

A health worker could be exposed to biohazard in variety
of manners, also called the biohazard exposure routes:
1. Airborne - from splashes and aerosols during
centrifuge and aliquot; patients with airborne diseases;
a. Proper handling practices
b. Wearing PPE properly
c. Use safety shield and guards
These should never be done:
•never store chemicals above eye level;
•never add water to acid, do not mix chemicals
indiscriminately;
•never store chemicals in unlabeled containers;
•never pour chemicals into used or dirty containers;
•never use chemicals in ways other than their intended use.

2. Ingestion - did not sanitize hands before handling food;

a. Frequent hand washing
b. Avoid hand-to-mouth activities
c. Stop placing items in the mouth
 First Aid procedures
When the patient is in shock, perform the following steps
as first aid:
(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
Cardiopulmonary Resuscitation (CPR)
- a procedure done during emergency cases such as when a
person is in cardiac arrest.
Steps on how to do CPR:
1.While the patient is lying on his back on a steady surface.
Kneel beside him and place your hands in the middle of his
chest.
2.Cover the first hand with the heel of the other hand,
interlocking the fingers. The fingers should be raised so
they do not touch the ribcage.
3.Lean forward (shoulders directly over the patient's chest)
and press down on the chest for about two inches. Release the
pressure to allow the chest to come back up. Do not release
your hands. Repeat. Give 30 compressions at a rate of 100
compressions per minute.
4.Tilt the patient's head and lift his chin to open the
airway allowing the mouth fall open slightly.
5.Using your hands, the pinch the nostrils and support the
chin with the other hand. Take a normal breath, place your
mouth over the patient's, and blow until you see the chest
rise.
6.Remove your mouth and watch the chest fall. Repeat steps
five and six once.
7.Replicate the cycle of 30 chest compressions, to be
followed by two rescue breaths. Continue this cycle.
PERSONAL HYGIENE, PROPER NUTRITION, REST,
EXERCISE, BACK PROTECTION, AND STRESS
MANAGEMENT IN PERSONAL WELLNESS
•Personal wellness begins with personal hygiene which
includes bathing regularly and using deodorant, brushing
your teeth regularly, keeping your hair neat and clean,
trimming and cleaning fingernails, and avoiding the use of
heavy lotions and colognes.
•Proper nutrition and balanced diet consist of vegetables,
fruits & legumes.
•Have enough sleep and to stay fit by having a regular
exercise routine.
•Maintain proper posture and keep your back safe from any
injury by using proper techniques when lifting objects.
•Work-life balance and find time to relax to relieve
yourself of stress from work.
THE CIRCULATORY SYSTEM
-transports the oxygenated blood from the heart and lungs all
throughout the body thru the arteries, and then the oxygen depleted
blood is returned to its origin thru the help of the veins.
-helps in the coagulation process, regulates the body temperature
and assists the body in fighting diseases.
-t wo main components: the Cardiovascular system and the
Lymphatic system.
THE LAYERS, STRUCTURES OF THE HEART AND THEIR FUNCTION
-hollow muscular organ
-four chambers (left atrium, right atrium, left ventricles,
and right ventricles)
-surrounded by pericardium (thin, fluid-filled sac)
-about the same size as of a man's clenched fist
Layers of the heart
1.Epicardium - thin, watery membrane in the outer layer of the
heart.
Function: covers the heart and attached to the pericardium.
2.Myocardium - thick layer of cardiac muscles in the middle layer
of the heart.
Function: pumps blood to the arteries by contracting.
3.Endocardium - thin layer of epithelial cells in the inner layer of
the heart.
Function: lines the valves and interior chambers.
Chambers of the heart
1.Right Atrium - upper right chamber
Function: Receives deoxygenated blood from the body.
2.Right Ventricle - lower right chamber
Function: Receives the blood from the right atrium and pumps into
pulmonary artery.
3. Left Atrium - upper left chamber
Function: Receives oxygenated blood from the lungs and pumps it into
the left ventricle.
4. Left Ventricle - lower left chamber
Function: Receives blood from the left atrium and pumps it into the
aorta.
Valves of the heart
1.Right AV valve - tricuspid valve which is located bet ween the right
atrium and right ventricle.
Function: Closes as the right ventricles contracts preventing blood
from flowing back to the right atrium.
2.Left AV valve - bicuspid or mitral valve which is located bet ween the
left atrium and left ventricle.
Function: Closes as the left ventricles contracts preventing blood from
flowing back to the left atrium.
3. Right semilunar valve - pulmonary or pulmonic valve located at the
entrance of the pulmonary artery.
Function: Closes when the right ventricle relaxes preventing blood from
flowing back to the right ventricle.
4. Left semilunar valve - aortic valve located at the entrance of the
aorta.
Function: Closes when the left ventricle relaxes preventing blood from
flowing back to the left ventricle.
NICOLE REBANAL
Septa DISORDERS AND DIAGNOSTICS TESTS OF THE CIRCULATORY SYSTEM

1.Interatrial septum - partition that separates the right from the left The human heart may have disorders which can be detected and
atria. addressed using the proper diagnostic tests:
2.Interventicular septum - separates the right and the left ventricles. 1.Angina pectoris
2.Aortic stenosis
3.Bacterial endocarditis
Coronary Circulation 4.Congestive heart failure
5.Myocardial infarction
- receives blood supply thru the left and right coronary arteries, and 6.Pericarditis
coronary veins return the oxygen depleted blood from the heart
muscle back to the heart.
List of diagnostic tests for heart disorders:

Heart function > Arterial Blood Gases (ABG)

> Aspartate aminotransferase (AST) or Serum glutamic-oxaloacetic
-the Coronary circulation supplies the blood and also provides transaminase (SGOT)
drainage from the tissues. > Cholesterol
> Creatine kinase (CK)
-composed of the left and right coronary arteries and coronary > Creatine Kinase (CK)-MB
veins.
> Electrocardiogram (ECG or EKG)
> Lactate dehydrogenase (LD) isoenzymes
> Microbial cultures
> Myoglobin
> Potassium (K)
> Triglycerides
> Troponin T (TnT)

TWO MAIN DIVISIONS AND FUNCTIONS OF THE VASCULAR SYSTEM

Vascular System - the loop which consists of a system of blood vessels

through which blood is circulated to the rest of the body.

•t wo divisions:
(1) pulmonary circulation and
(2) systemic circulation

FUNCTIONS OF THE HUMAN HEART

Structure of the Vascular System

a)Arteries

b)Arterioles

c)Veins

d)Venules

e)Capillaries

Venous System

Arterial System
 TYPES, STRUCTURES AND FUNCTIONS OF BLOOD VESSELS Disorders of the vascular system

Blood vessel structure 1.Aneurysm

A.Layers
•tunica adventitia (outer connective tissue), 2.Arteriosclerosis
•tunica media (middle, muscle and elastic fiber), and
3.Atherosclerosis
•tunica intima (inner, endothelial cells)
4.Embolism
B.Lumen
5.Embolus
C.Valves
6.Hemorrhoids

7.Phlebitis
THE FLOW OF BLOOD
8.Thrombophlebitis
•Oxygen-poor blood is returned to the heart thru the superior and
inferior venae cavae and it enters the right atrium of the heart. 9.Thrombus

•The right atrium contracts, pushing blood through the tricuspid 10.Varicose veins
valve, and into the right ventricle.

•The contraction on the right ventricle forces the blood to the Diagnostic Test of the vascular system
pulmonary semilunar valve into the pulmonary artery.
- D-Dimer
•It flows through the pulmonary artery to the capillaries of the lungs. - Fibrin degradation products (FDP)
•Oxygen-rich blood flows back to the heart thru the pulmonary veins - Lipoproteins
and enters the left atrium. - Prothombin time (PT)
- Partial thromboplastin time (PTT/APTT)
•The left atrium contracts forcing the blood in the bicuspid valve into - Triglycerides
the left ventricle.

MAJOR CONSTITUENTS AND FUNCTIONS OF BLOOD CELLS

•The contraction of the left ventricle forces the blood through the
aortic semilunar valve to the aorta. The blood is the red fluid that is transported throughout
the body through the circulatory system.
•The blood travels through the body by the way of the arteries. They
branch into smaller arteries and the smallest of which are the There are t wo functions:
arterioles. 1.Arterial blood
2.Venous blood
•The arterioles connect with the capillaries. Oxygen, water, and
nutrients from the blood are diffused through the capillary walls to
the cells and carbon dioxide and other end product enters the
bloodstream.

•The capillaries connect with the venules.

•The venules merge into larger veins until the blood returns to the
heart by thru the superior or inferior vena cava.

HUMAN BLOOD

•Composed of plasma and other formed elements.

•Contains gases (02, CO2, N), minerals (Na, K, Ca, Mg), carbs &
lipids, proteins, etc.

Plasma - a clear, straw-colored liquid portion of the blood which is

90% water.

Three components:
1.Erythrocytes (red blood cells)
2.Leukocytes (white blood cells)
3.Thrombocytes (platele
Blood type Blood disorders
•The human blood type is inherited and determined by the antigens 1.Anemia
on the surface of the red blood cells.
2.Leukemia
•The blood contains or can develop antibodies directed at the
opposite blood type. 3.Leukocytes
•Blood type match is important especially during blood transfusion 4.Leukocytosis
because the wrong type could agglutinate the red blood cells. When a
doctor mentions blood type, he is referring to your or ABO system or 5.Leukopenia
Rhesus (RH) factor.
6.Polycythemia
ABO blood group system 7.Thrombocytosis
•System of classifying human blood by the presence of antigens 8.Thrombocytopenia
A and B and based on the antigenic components found on the
surface of the red blood cells.

•Patient's blood could be classified as A, B, O, or AB (universal

patients).

STRUCTURE AND FUNCTION OF THE LYMPHATIC SYSTEM

The lymphatic system of the human body is a net work of tissues and
organs that is responsible for the removal of toxins and waste in the
body.

RH blood-group system Primary function:

The main function is to transport the white blood cells to and from the
lymph nodes throughout the body.
•system of classification of primary importance in obstetrics
because of the hemolytic disease of the newborn (HDN). Structure of the Lymphatic System
o The Lymphatic System is composed of fluids or lymph which is similar
•based on the "D" antigen or the Rh factor. Rh positive (Rh+) have to plasma but is composed of 95% water.
red blood cells that have the D antigen while the Rh negative (Rh -)
does not have the D antigen. o The lymph is transported throughout the system thru the lymphatic
vessels, ducts and masses of lymph tissue called nodes.
•Compatibility and cross-match is necessary to determine the
compatibility of the donor and recipient's blood because an
individual who do not produce the D antigen will produce anti-D
which could be fatal if they encounter the D antigen.

WHOLE BLOOD, SERUM AND PLASMA

There are three blood specimen that are collected

for testing purposes:

1.Serum
2.Plasma
3.The whole blood
 Functions of the Lymphatic System
Coagulation factors and pathways
Aside from the transporting the white blood cells to and from the
lymph nodes, the Lymphatic System has other functions: Coagulation or clotting is the process where the blood changes
from a liquid form into a gel that forms the blood clot.
(1)transport back the tissue fluids to the bloodstream,
(2)removes impurities, There are three types:
(3)processes lymphocytes and
(4)transport the fats absorbed from the small intestine into the 1.Enzyme precursors,
bloodstream. 2.Cofactors, and
3.Substrates
The Lymph, an excess tissue fluid that filters into lymphatic
capillaries. The Capillaries are joined and forms the larger vessels which Pathways of the clotting cascade:
empties into the right lymphatic duct and thoracic duct which empties 4.Extrinsic pathway
into the larger veins of the upper body. 5.Intrinsic pathway

Phases of cell-based coagulation:

6.Initiation
Disorders of the Lymphatic System 7.Amplification, and
8.Propagation
1.Lymphangitis

2.Lymphadenitis Role of the thrombin

3.Lymphadenopathy •Thrombin is an enzyme that plays an important role in coagulation.
•It amplifies coagulation and converts fibrinogen to soluble fibrin.
4.Splenomegaly •This supports the platelet plug formation by activating factor XIII to
cross-link fibrin and also controls the formation & coagulation process
5.Hodgkin's disease by activating protein C.
6.Lymphosarcoma
Fibrinolysis
7.Lymphoma
Fibrinolysis is the process where the fibrin is dissolved. It has
t wo main activities:
Diagnostic Test for the Lymphatic System disorder
(1)the intact vessels are reopened by dissolving the clots, and
hBone marrow biopsy (2)removing hemostatic clots from the tissue as part of the
healing process.
hComplete Blood Count
The role of the liver in hemostasis
hCulture & Sensitivity
•The liver’s role in the hemostasis is to synthesize coagulation
hLymph node biopsy factors such as V, VIII, prothrombin, & fibrogen.
•This organ produces heparin and bile salts needed for synthesis.
hMononucleosis test
•It is also responsible for the production of bile salts needed for
vitamin K absorption.
HEMOSTASIS, BASIC COAGULATION AND FIBRINOLYSIS PROCESSES

Hemostasis is the stoppage of bleeding as a response to an Hemostatic Disorders

injury whether it be normal vasoconstriction where the vessel
walls close temporarily, abnormal obstruction like plaque or by 1.Deep venous thrombosis (DVT)
coagulation such as litigation. 2.Disseminated intravascular coagulation
3.Hemophilia
There are four interrelated responses: 4.Thrombocytopenia

1.Vasoconstriction
Diagnostic Test for Hemostatic disorders
2.Formation of the primary platelet plug
hBleeding time
3.Progression to the stable blood clot
hD-dimer
4.Fibrinolysis or dissolving of clot
hFactor assays

hFibrin degradation products (FDP)

hPlatelet function assay (PFA)

hProthrombin time (PT)

hPartial thromboplastin time (PTT or APTT)

MAJOR ARM AND LEG VEINS IN VENIPUNCTURE A.Other arm and hand veins - used only if the antecubital veins
are not accessible. The veins at the back of the hand which can be
A.Antecubital fossa used are smaller, so it may be very painful. Take note that the
•also called the elbow pit is a triangular area on the anterior of underside of the wrist is never used as a venipuncture site.
the elbow.
•the first-choice for venipuncture site because there are several
major arm veins called antecubital veins which are close to the
surface which makes it easy to locate and penetrate.

Arteries - not used for routine blood collection and limited to

collection of arterial blood gas. Special training is needed and it is
H-Shaped antecubital veins - a vein arrangement that occurs in more risky for the patient.
about 70% of the population.

•Median cubital vein

EQUIPMENT AND SUPPLIES USED IN VENIPUNCTURE (lesson 3)
•Cephalic Vein
•Basilic vein
Selecting the correct tools and using them properly during the testing
procedure ensures not only safe collection, but also guarantees an
accurate result.

1.General Blood Collection

2.Venipuncture Equipment

General Blood collection equipment and supplies

- Blood - Drawing Station

- Phlebotomy Chair
- Equipment carrier
- A new pair of gloves and glove liners
- Antiseptics
- Disinfectants
- Hand sanitizer& wall-mounted hand sanitizer dispenser
- Gauze Pads
- Bandages
- 1x3 inches glass microscope slides
- Pen with non smear ink
- Watch with timer
- Needle and sharps disposal containers
- Biohazard bags
H-Shaped antecubital veins - a vein arrangement that occurs in
about 70% of the population.

•Median cubital vein Venipuncture equipment

•Cephalic Vein
•Basilic vein 1.Vein-Locating Devices
2.Tourniquet
3.Needles
4.Needle gauge
5.Evacuated Tube System (ETS)

ANTISEPTICS AND DISINFECTANTS USED IN VENIPUNCTURE

Disinfectants

•EPA -registered sodium hypochlorite

•1:100 dilution and 1-10 dilution for spills prior to clean-up procedures
•contact time required is 10 minutes.
Antiseptics CATEGORIES OF ADDITIVES USED IN BLOOD COLLECTION

•70% ethyl alcohol, - anticoagulants

•70% isopropyl alcohol, - special-use anticoagulants
•Benzalkonium chloride, - antiglycolytic agents
•chlorhexidine gluconate, - clot aviators
•hydrogen peroxide, - thrixotropic gel separator
•povidine-iodine and tincture iodine. - trace element-free tubes

COLOR CODING IN IDENTIFYING ADDITIVES IN BLOOD COLLECTION TUBES

PHLEBOTOMY NEEDLES
An additive is any substance that is placed within the tube and
they can be used in ETS tubes to prevent clotting and preser ving the
Types of phlebotomy needles that are used in evacuated tube
components.
systems or syringe systems:

1.multi-sample needles
2.hypodermic needles
3.winged infusion

EVACUATED TUBE SYSTEM (ETS) AND SYRINGE SYSTEM

COMPONENTS

Syringe System

•used for patients as an alternative method when drawing blood

from patients with small or difficult veins.
ORDER OF DRAW refers to the specific order that must be followed
•traditional collection procedure that uses a syringe to draw by a phlebotomist when collecting blood samples to prevent any
blood from the patient and the collected specimen is transferred cross-contamination especially when dealing with multiple
into tubes. collection tubes. Not following the prescribed sequence affects
the test results due to cross contamination.
•The components of this system include:
(1) syringe needle that has a resheating feature, and
(2) a syringe which is divided into graduated barrel and plunger
 VENIPUNCTURE
- a process of collecting or "drawing" blood from a vein of the
patient for laboratory testing purposes.
- a phlebotomist should acquire the knowledge and skill to
perform venipuncture since he will perform this procedure
frequently as part of his duties and responsibilities in the
healthcare institution.
THE REQUEST PROCESS
- the first step of the pre-examination phase is the test
request that came from a physician.
- a request form includes information on the type of test
ordered and any special instructions or conditions that
should be considered during the pre-examination and
examination phase.
- test requisition could be manual, computerized or bar-coded.
Required Requisition information are as follows:
Name of the physician who ordered the test
Patient's full name including the middle initial
The medical record number for inpatients
Birthday and age of the patient
Room number and bed number if inpatient
Type of test ordered
Date when the test is to be performed
Billing information with ICD-9 codes for outpatient
Test status
Special precaution
Accessioning the test request helps improve the documentation,
handling and reporting of test results.
This means that the specimen to be collected is assigned a special
number that will ser ve as the reference number for all associated
processes and paper work.
Step 2: Approach, Identify, & Prepare Patient
Proper "bedside manner" and handling special situations
associated with patient contact
-organize the test request according to priority, and prepare all the
necessary equipment and supplies needed to complete his collection
round.
-check for phlebotomy-related signs and warnings regarding the
condition of the patient such as "No BP or venipuncture right arm",
Do not Resuscitate (DNR) or Do Not Attempt to Resuscitate (DNAR),
etc.
The Bedside Manner is the behavior of a healthcare worker as
perceived by the patient which is applicable to both in- and out-
patient settings. The following should be followed when doing
collection:
- Knock on the door gently before entering the room.
- Make a good impression by greeting the patient warmly.
- Stay organized and have all supplies available and approach the
patient in a professional manner that goes well with having a
neat appearance.
- Most patients are afraid of blood collection, so maintain a calm
expression.
- Introduce yourself and explain the procedure. Obtain the verbal
or expressed consent of the patient before proceeding with the
test.
- Remain compassionate and professional during the procedure.
- Thank the patient for their cooperation before leaving.
- If there is a physician or clergy in the room, interrupt only if the ordered
test is stat or timed.
- Family members or visitors can stay in the room, but it would be better
if they could step out of the room until you are finished.
Importance of proper patient identification
-Obtaining a specimen from the wrong person can have serious
consequences and can even be fatal in cases that involve blood
transfusion.
-Misidentifying patients can be a ground for dismissal or lawsuit on
the grounds of malpractice.
-When identifying patients, confirm the name and date of birth of the
patient.
-If the patient is fast asleep, the phlebotomist should wake him up
gently for proper identification.
- If the patient is young, mentally incapacitated or there is language
barrier:
(1) the phlebotomist should ask a relative, attendant, or the nurse to
identify the patient and
(2) the information provided should match those on record and the
information on the ID bracelet.
Patient preparation for testing
•The phlebotomist should explain the test procedure to the
patient and confirm that the patient understood what was
discussed.
•It is best to direct inquiries on the purpose or result of the
test to the patient's nurse or physician to avoid any
miscommunication.
•The phlebotomist must remain calm and professional even
if the patient is being difficult or have needle-phobia.
 Step 3: Verify Diet Restrictions & Latex Sensitivity

Verifying fasting and other diet requirements

•The phlebotomist should verify if there are special instructions

on the diet of the patient that needs to be followed such as
fasting for about 8 to 10 hours.

•A patient with allergic reaction to latex can have life-

threatening reactions upon exposure, so it is important to check
that all equipment used on him is latex-free, and there are no
latex items in the room.

Step 4: Sanitize Hands

Proper hand hygiene should be obser ved to avoid spreading infection.

Step 5: Position Patient, Apply Torniquet, and Ask Patient to Make a fist

•Be sure that the hand or arm for venipuncture procedure is well
supported.

•The phlebotomist can then proceed to the tourniquet application and

fist clenching. The tourniquet should be placed 3 to 4 inches from the
intended site.