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Principles of MedLab. Sci 2

Week 1: Understanding Phlebotomy & Sections of the Laboratory and Commonly Requested Lab Tests

• Phlebotomy involves collecting blood through veins using incision or puncture methods for analysis and therapeutic purposes.
• A therapeutic measure is performed as part of a person's treatment plan.
• A diagnostic measure is for determining a patient's diagnosis; the physician will order a specific lab test.
• The word "phlebotomy" comes from the Greek words phlebos (vein) and temnein (to cut), or tomos/tome.
• Phlebotomy is also referred to as venesection, derived from the Latin words vena (vein) and sectio (cutting).

Evolution of Phlebotomy

• In the Stone Age, crude tools were used to cut vessels for blood drainage.
• Around 1400 BC, ancient Egyptians practiced phlebotomy via bloodletting and used leeches for blood samples.
• Hippocrates (460-377 BC), a Greek physician and proponent of the Hippocratic Oath, believed health was balanced on four humors: Earth (blood/brain), Air (phlegm/lungs), Fire (black bile/spleen), and Water (yellow bile/gallbladder).
• Bloodletting was essential to keep these humors in balance.
• Through the Middle ages blood letting was performed by barber-surgeons as part of illness treatment.
• In the 17th and 18th centuries, phlebotomy was major therapy.

Other methods

• Cupping: An alternative medicine technique that collects blood samples and causes vasodilation.
• Vasodilation results in widening of blood vessels, which increase blood vessel permeability due to heat.
• Application by using special heated cups on a patients skin by making an incision.
• Incision using a fleam or lancet.
• Leeching is also known as hirudotherapy and uses medicinal leeches for bloodletting.
• Medicinal leeches (scientifically known as hirudo medicinalis) inject a natural vasodilator to encourage blood migration: They contain hirudin, a natural anticoagulant.

Main Goals of Phlebotomy

• Diagnosis and treatment via blood samples
• Transfusion
• Blood removal from a donor

Methods of Phlebotomy

• Venipuncture: Collection of blood from a vein using a needle.
• Capillary puncture: Collection of blood from the sking by puncturing it with a lancet.

Role of Phlebotomists

• Collect blood samples for testing or transfusion
• Label samples correctly with necessary data
• Deliver or transport samples within appropriate time limits
• They also process samples, such as centrifugation and aliquoting
• They may also assist in collecting other specimens (urine, etc.)
• They perform front-office duties, use procedural terminology coding, and handles paperwork
• Phlebotomists promote good relations with patients and hospital staff

Traits forming the Professional Image of Phlebotomists

• Good manual dexterity and communication skills
• Good organizational skills
• Knowledge of laboratory specimen requirements
• Proper training in phlebotomy skills

Credentials

• Certification or license
• Continuing education
• Training and seminars

Patient-Client Interaction

• Reassure and be pleasant
• Communicate well with patients
• Maintain positive relations
• Understand diverse patients

Professionalism (PSICSDE)

• Professional Appearance: conservative clothing and good hygiene.
• Self-confidence: Makes sound decisions and judgements to patients, and know what they are doing.
• Integrity: Personal feeling of "wholeness" derived from honesty and consistency of character
• Compassion: Willing to offer reassurance in a sensitive and caring way.
• Self-motivation: Takes initiative, strive to improve behavior and provide excellent patient care.
• Dependability: Observe work ethic and take responsibility.
• Ethical behavior: Uphold moral principles/standards, and codes of ethics to safeguard welfare of the patient in any way.

Basic Concepts of Communication

• Verbal communication expresses ideas through words.
• Non-verbal includes: facial expressions, kinesics, and proxemics.

The Healthcare Setting

Categories of Healthcare Facilities

• Inpatient (non-ambulatory): Stays longer than 24 hours in a key resource center.
• Offer specialized instruments and technology for complex treatments and diagnoses. Also serves tertiary care.
• Examples are acute care hospitals, nursing homes, extended care facilities, hospices, and rehabilitation centers.
• Outpatient (ambulatory): Goes home after consultation or visit.
• Is main source of healthcare for many people, offering routine to specialized care.
• Serve primary care physicians who are responsible for patient health, and secondary care positions who undergo routine surgery.

Levels of Healthcare

• Primary: rural health units and sub-units.
• Secondary: non-departmentalized hospitals.
• Tertiary: Medical centers/large hospitals with complex technology, such as chemotherapy and surgeries.

Other Healthcare Services

• Ambulatory care: Given to patients requiring medical care or follow-up check-ups.
• Homebound Care: Done in home or long-term facility, provided by special healthcare workers and private nurses
• Public Health Services: Local units run under public oversight (health departments, municipality, barangay health center etc. )

Different Clinical Analysis Areas in a Hospital

• A hospital has permanent inpatient beds, provides 24-hour nursing services and is managed by teams.
• It is divided into a Clinical Analysis Area and Anatomical & Surgical Pathology Area.

Clinical Pathology Examples

• Clinical Chemistry
• Immunohematology
• Medical Microbiology
• Immunology and Serology
• Hematology
• Coagulation
• Clinical Microscopy

Anatomic Pathology

• Focuses diagnosis of diseases through microscopically examining organs and tissues.
• Histopathology determines the different types of diseased tissue.
• Immunohistopathology uses labels like antigens or antibodies to identify those diseases.
• Cytology checks a structure of cells to see whether they are benign or malignant.
• Autopsy & Forensic pathology are also used.

Clinical Chemistry

• Tests blood and fluids to quantify chemicals for disease diagnosis.
• It analyzes serum and plasma and checks if they're in range, indicating if there's a certain disease.

Fasting Blood Sugar (FBS) & Glycosylated Hemoglobin tests

• Test for diabetes mellitus.
• FBS is a screening; done 8-10 hours.
• Glycosylated Hemoglobin (HbA1c) assesses glucose metabolism is throughout the body

Total Cholesterol test

• Lipid profile indicates the amount of lipids in the body.
• It also indicates high and low-density lipoprotein & triglycerides.
• Can determine cardiovascular disease

Blood Uritic Acid test

• Elevated levels indicate kidney disorders or gout.
• Can form uric crystals and develop arthritis.

Additional tests

• Blood Urea Nitrogen: If amounts are high in blood, determines kidney function, an indicator kidney disorders
• Creatinine: This is another indicator of kidney disorders or muscular dystrophy
• Alanine Aminotransferase (ALT): This is also known as Serum Glutamic Pyruvic Transaminase (SGPT)
• Aspartate Aminotransferase (AST): This is known as Serum Glutamic-Oxaloacetate Transaminase (SGOT), and indicate liver disorders.
• Alkaline Phosphatase (ALP): Elevated levels indicate bone or liver disorders
• Bilirubin: Elevated levels indicate liver or hemolytic disorders
• Gamma-Glutamyltransferase (GGT): Indicates early liver disorders, alcoholic tendencies, or alcohol-induced liver
• Lactic Dehydrogenase (LHD)
• Elevated levels indicate myocardial infarction, (heart attack) or from lung and liver disorders.
• Amylase and Lipase - Elevated levels indicate pancreatitis
• Electrolytes (Na, K, Cl, CO2) evaluate body fluid balance
• B type (Beta) natriuretic Peptide (BNP) test - High levels in the blood indicate congestive heart failure
• Drug Analysis - Monitors therapeutic range to avoid toxic levels for drugs.
• Total Protein - Indicates liver and kidney disorders
• Troponin I - Early diagnosis of myocardial infarction, and a cardiac marker.

Microbiology

• Consists of Bacteriology, Mycobacteriology, Mycology, and Virology
• It identifies bacteria and fungi on received specimens.
• Samples are obtained from several bodily fluids, such as wounds, blood, urine, and cerebrospinal fluid.
• Culture detects and determines microbial infection, and determines antibiotic treatment

Blood Culture

• Detects bacteria and fungi
• PINK BACTEC detects bacterial infections in pediatrics.
• BLUE BACTEC detects infections in adults (aerobic culture).
• ORANGE/BROWN BACTEC detects infections in anaerobic culture.
• Fungal & Gram Stains also detects presence and helps in identifying certain fungi & bacterias.
• Gram positive (with purple color), and Gram negative (pink).

Hematology and Coagulation Studies

• Hematology enumerates cells in the blood and other body fluids.
• Coagulation Studies focus on blood testing to determine coagulation factors.
• Whole Blood (using tubes with lavender stopper) is a common sample, where acid (EDTA) is inverted 8 times .
• Plasma comes from an anticoagulated sample where protein fibrinogens.
• Serum is liquid portion of the clotted liquid sample.
• Complete Blood Count (CBC) is the most common in the Hematology section.

Complete Blood Count

• Differential Count:
  • This test determines the percentage of specific white blood type which evaluates platelets & blood morphology.
  • Basophil is defined as cells with intense granules, which indicate an allegric reaction.
  • Lymphocyte can indicate viral infections.
  • Monocytes indicate kidney or irregular level infections.
  • Eosinophil indicates allergy and parasitic infection.
  • Band Cell means immature.
  • Neutrophil indicates presence of lobules and segmentation.
• Hematocrit (Hct): Determine volume of RBC packed by centrifugation.
• Hemoglobin (HgB): Determines the oxygen carrying capacity of RBC
• Mean Corpuscular Hemoglobin (MCH): Expressed in picrograms. Determines the amount of hemoglobin.
• Man Hemoglobin (HCHC): Determinds the weight of hemoglobin in RBC and compares with cell size.
• Mean Corpuscular Volume (MCV): Determines RBC
• Platelets - determining numbers of platelets to aid blood circulation, stopping one's bleeding.
• Red Blood Cell (RBC): determines number of RBC to help blood circulation.
• RBC Distribution Width: to see difference of size enumarating different types of cells in the body.
• body analysis - for fluid in a human body.
• Bone Marrow- for type of cells in bones
• Erythrocyte Sedimentation Rate (ESR): helps determine rate of sedimentation
• Reticulocytes- evaluate blood cell production of red blood cells
• For diagnosis of sick cell disease.

Coagulation

• Evaluate Hemostasis which is the stoppages in the vessels.
• Sample is often in light blue stopper containg sodium Citrate.

Clinical Microscopy

• Tests bodily fluids and examine stool/routine fecalysis
• Urine is used for routine to detect disorders of the kidney and used to check for diseases

Urinalysis Performace

• Macroscopic examination- looking and evaluating colors, transparency and other tests.
• Chemical Examination- using other material for testing.
• Microscopic Examination- using microscopes.
• It looks for red blood cells and other structures like crystals.

Parameters

• color- to look for the color of the red.
• Detects cellular and crystalline elements
• Can be clear, slightly cloudy,cloudy or turbid
• Specific concentration- measures urine level
• PH determined the acids
• Protein to be at a level for kidney disorders
• Glucose levels can be seen.
• blood
• helps detect hemoglobia.
• Elevated levels indicate liver disorders
• Elevated is not there, one has normal level of urine.
• To test UTI infection
• Detects bacteria of UTI Lymphatic

Blood Bank and Immunohematology

• Consists of testing to include compatibility and typing the components for transfusion
• All Commercial bodies to test for the the presence of the antibody in the cell
• Tests ABO to type test

Some of the Tests done

• Group type: ABO and RH.
• Screeners help detect antibodies in serum for testing.
• Globulin test; detects RBC in the serum.

Other tests

• To help the body function through blood
• detect hepatitis cells to perform the cells.
• screening for vdrl.
• Screenings for aids.