Phlebotomy is the process of collecting blood through the vein by using incision or puncture methods to draw blood for

analysis or as part of therapeutic or diagnostic measures under the physician’s request. The word is derived from two
Greek words: phlebos, which means vein, and temnein, which means to cut. It is also called venesection.

Evolution of Phlebotomy

The practice of phlebotomy can be traced back to the Stone Age. Back then, humans used crude tools to cut vessels and
drain blood from the body. The ancient Egyptians also practiced phlebotomy as a form of “bloodletting” as early as 1400
BC.

During the Middle Ages, barber-surgeons performed bloodletting as part of the treatment for some illnesses. It was only
during the 17th and 18th centuries when phlebotomy was treated as a major therapy. Cupping and leeching were
performed by phlebotomists using lancets and fleams.

Cupping is an alternative medicine that helps ease pain, inflammation, or other health-related concerns. It involves the
application of special heated suction cups on the patient’s skin and the incision that is made using a fleam (lancet) which
is previously wiped with a rag.

Leeching, also known as hirudotherapy, is a method that uses leeches for bloodletting and is currently used for
microsurgical replantation. The process involves placing a drop of milk or blood on the patient’s skin and introducing
Hirudo medicinalis (medicinal leech) to the site, allowing it to engorge and fall off. It is believed that the leeches inject
local vasolidator, anesthetic, and hirudin, which is an anticoagulant.

Phlebotomy has evolved from simple bloodletting in the ancient times into a fundamental diagnostic tool in the
healthcare industry today. The main goals of the phlebotomy practice are: (1) for diagnostic and treatment using blood
samples, (2) for transfusion, to remove blood from the donor, and (3) for removal of blood for polycythemia or
therapeutic purposes.

There are two main methods used in phlebotomy, namely the venipuncture and the capillary puncture. Venipuncture is
the methods of blood collection using a needle inserted in a vein while capillary puncture is done by puncturing the skin.

Role of the Phlebotomists

The main role of phlebotomists assigned in the clinical laboratory is to collect blood samples for laboratory testing or for
transfusion. They properly label collected blood samples with the necessary data to identify the patient. They are also
responsible in delivering or transporting collected samples within appropriate prescribed time limits. In other
institutions, phlebotomists also process collected blood samples such as centrifuging and aliquoting samples ready for
laboratory testing. Sometimes, they are asked to assist in collecting other specimens such as urine and other non-blood
samples from patients.

Phlebotomists are also the main layers in blood-letting activities such as drawing of blood units from donors for
transfusion to a patient requiring whole blood or blood components.

Traits that From the Professional Image of the Phlebotomists

Good phlebotomists possess the following skills and knowledge: good manual dexterity, special communication skills,
good organizational skills, through knowledge of laboratory specimen requirements, and the training in phlebotomy
skills coupled with standard practice.

Credentials

Phlebotomists need to maintain certain credentials in the continuous practice of their profession. They should have the
following: certification or license and continuing education.

Patient – Client Interaction

Phlebotomists should be reassuring and pleasant when dealing with patients. They should maintain positive customer
relations especially since they are the only contact of the patients from the clinical laboratory; and their attitude may
affects how the patient views the hospital services in general. Moreover, they must understand the diversity of the
patients and be able to adjust accordingly. Patients come from various backgrounds and have different customs and
traditions, beliefs various backgrounds and have different customs and traditions, beliefs and values, attitudes, and
needs based on their environment and culture.

Basic Concepts of Communication in the Healthcare Setting

Phlebotomists need to have good communication skills which are essentials to ensure the patient feels at ease during
the venipuncture procedure. Communication is important in the healthcare setting because of valuable information that
needs to be transmitted properly from one person to another. The components of good communication are as follows:

Verbal communication

To be able to have effective communication to a healthcare setting, it is important that the sender (speaker) and
receiver (listener) are able to accurately exchange ideas by using feedback wherein they are able to clarify and confirm
ideas hampered by vagueness, confusion, and issues. Good phlebotomists use words that can be easily understood by
the patient

Non-verbal Communication

Phlebotomists should be keen in observing the patient’s facial expressions and other non-verbal communication clues
that can tell something about how the patient feels.

Active Listening

Listening is a major part of communication. It leads to better understanding of situations and instructions.
Phlebotomists build rapport by listening to their patients. They should ensure that they have interpreted the message
correctly by giving feedback.

The Different Clinical Analysis Areas of the Laboratory and the Types of Laboratory Procedures Performed

A hospital is an institution that has permanent inpatient beds with 24-hour nursing service along with therapeutic and
diagnostic services managed by organized medical staff or permanent. It houses the clinical laboratory services (clinical
lab) where tests requested by physicians are performed.

Examples of Tests and Procedures in Clinical Analysis Areas

Clinical Areas
Hematology – blood and blood
forming tissues
Coagulation – ability of blood to
form and dissolve clots
Chemistry – amount of certain
chemicals in a blood sample
Examples of Tests and Procedures and What They Determine
1. Hematocrit (Hct) – hemoglobin level and red cell count
2. Hemoglobin (Hgb) – values that rule out anemia
3. Red blood cell (RBC) Count – erythropoietic activity
4. White Blood cell (WBC) Count – leukocyte response
5. Platelet Count – chemotherapy and radiation conditions
6. Differential White Blood Cell Count – changes in the appearance or quantity of
specific cell types
7. Indices – show the changes in RBC size, weight, and Hgb content
8. Mass Corpuscular Hemoglobin (MCH) – weight of the hemoglobin in the cell
9. Mean Corpuscular Volume (MCV) – size of the cell
10. Mean Corpuscular Hemoglobin Concentration (MCHC) – concentration of the
hemoglobin per unit volume of RBCs
11. Red Blood Cell Distribution Width (RDW) – size differences of the RBCs
1. Activated Partial Thromboplastin Time (APTT) – adequacy of heparin therapy.
2. D-dimer – thrombin and plasmin activity
3. Fibrin Split Products (FSP) – amount of fibrin degradation products (FDPs) in the
blood.
4. Fibrinogen Test – fibrinogen levels in the blood
5. Prothrombin Time (PT) or International Normalized Ration (INR) - liver diseases
or deficiency in Vitamin K
1. Alanine Aminotransferase Test (ALT) - liver damage
2. Alpha-fetoprotein (AFP) –levels increase in pregnant women during second
trimester of pregnancy
3. Alkaline phosphatase – amount of alkaline phosphatase enzyme in the blood
stream
4. Ammonia- measures the level that indicates cirrhosis and hepatitis
5. Amylase – indicates liver disease, cholesystitis, etc.

Serology/Immunology – Serum
and autoimmune reactants in the
blood
Urinalysis – tests urine specimen
6. Aspartate Aminotransferase Test (AST) – liver damage
7. Bilirubin Test – indicates RBC destruction
8. Arterial Blood Gas (ABG) – Acid-base balance by measuring the pH, partial
pressure of the CO2 and O2
9. Blood Urea Nitrogen (BUN) - can determine impaired renal function
10. B-Type Natrieuretic Peptide – indicative of congestive heart failure
11. Carcinoembryonic Antigen (CEA) – help diagnose and manage certain types of
cancer.
12. Calcium - help determine determines or monitor the effects of renal failure
13. Creatine Kinase – used to check muscle damage
14. Total Cholesterol – indicates one of cardiovascular diseases
15. Cortisol – shows adrenal hypofunction and hyperfunction
16. Creatinine – indicative for renal impairment or muscular dystrophy
17. Drug Analysis – monitors therapeutic range to avoid toxic levels for drugs
18. Electrolytes – shows Sodium, Potassium, and Chloride levels that determine
disorder of the kidney and adrenals
19. Glucose – used to check diabetes, liver disease, or malnutrition
20.GGT – Gamma-glutamyl trasferase – used for diagnosis af liver specifically
hepatobiliary problems
21. Hemoglobin A1C – determines glycosylated hemoglobin level
22. Lactate Dehydrogenase – checks lung, kidney, and liver dysfunction
23. Lipase – shows the level that could lead to either pancreatitis or pancreatitic
carcinoma
24. Prostate Specific Antigen (PSA) – test that screens patients for the presence of
prostatic cancer
25. Total Protein – used to check liver and kidney disorders
26. Triglycerides – lipid metabolism disorder
27. Troponin I – used for early detection of acute myocardial infarction
28. Uric Acid test – indicates gout and renal problems
29. Vitamin B-12 and Folate test – used to check for anemia and diseases of the
small intestine .
1. Bacterial Studies
- Antinuclear Antibody (ANA) – shows autoimmune disorders such as SLE
- Anti Streptolysin-O – ASO Test – indicates streptococcal infection
- Cold Agglutinins – checks causes of a typical pneumonia
- Febrile Agglutination test – show presence of antibodies to specific organisms
- FTA-ABS – confirms syphilis
- Rapid Plasma Reagin (RPR) – when positive it is indicative of syphilis that needs
confirmation
- Rheumatoid Factor – indicates rheumatoid arthritis
2. Viral Studies
- Anti HIV – screens Human Immunodeficiency Virus
- Cytomegalovirus Antibody (CMV) – confirmatory test for CMV antibody
- Epstein-barr Virus (EBV) – checks the presence of heterophile antibody which
indicates infectious mononucleosis
- Hepatitis B Surface Antigen (HBSAg) – checks for the presence of Hepatitis
Antigen on the surface of the cell
3. General Studies
- C-Reactive Protein (CRP) – indicates inflammation when levels are increased
- Human Chorionic Gonadotropin (HCG) Test – the hormone is present when
patient is pregnant
1. Physical Evaluation
- Color indicates the presence of blood metabolites, bilirubin or urobilin in the
urine specimen.
- Clarity/transparency shows the presence of fat, chile, or bacteria which affects
the turbidity
- Specific gravity suggests renal tubular evolvement of ADH deficiency
2. Chemical Evaluation
- Blood - hematuria could be due to hemorrhage, infection, or trauma
- Bilirubin – helps differentiate between obstructive jaundice and hemolytic
jaundice
- Glucose – glucosuria may be a result of diabetes mellitus, renal impairments.
- Ketones - uncontrolled diabetes mellitus or starvation
- Leukocyte – indicates UTI if there is a lot neutrophils

Microbiology – microorganisms in
body fluids or
Blood bank/Immunohematology
–blood for transfusion
- pH – indicates the acid-base balance
- Protein – proteinuria is an indicator of renal dysfunction or disorder
- Nitrite – positive results could mean bacterial infection
- Bilinogen – increases in amount when the patient suffers from hepatitis tissues
3. Microscopic – shows the status of the urinary tract
1. Acid Fast Bacilli (AFB) – used to monitor treatment for Tuberculosis
2. Blood Culture – checks for the presence of bacteria indicative of bacteremia or
septicemia
3. Campilobacter-like Organism (CLO) Test– shows the presence of Helicobacter
pylori
4. Culture and Sensitivity - indicates infection if there is growth in the pathogenic
microorganism
5. Fungus Culture and Identification – used to determine the type of fungi if
present
6. Gram Stain – it is done to allow antimicrobial therapy while waiting for culture
results
7. Occult Blood – checks for blood in the stool which bound result from
gastrointestinal bleeding
8. Ova and Parasites (O&P) Exam – solves “etiology unknown” intestinal disorders
1. Antibody (Ab) Screen – agglutination means presence of abnormal antibodies in
the blood
2. Direct Antihuman-globulin Test (DAT) – determines transfusion incompatibility
3. ABO and Rh Type – shows the ABO and Rh blood groups
4. Type and Crossmatch – shows the blood group and screens for antibodies in the
recipient’s blood.
5. Compatibility Testing - detects antibodies and antigen in both recipient’s and
donor’s blood.