PMLS 2 Reviewer PDF

KIDAPAWAN DOCTORS COLLEGE, INC. Ninoy Aquino Avenue, Lanao, Kidapawan City www.kdci.edu.ph VANESSA SUNGCAD BMLS 1A PMLS 2 Main Goals of Phlebotomy Practice...

KIDAPAWAN DOCTORS COLLEGE, INC. Ninoy Aquino Avenue, Lanao, Kidapawan City www.kdci.edu.ph VANESSA SUNGCAD BMLS 1A PMLS 2 Main Goals of Phlebotomy Practice 1. for diagnosis and treatment using blood The Evolution of Phlebotomy samples Phlebotomy - the process of collecting blood 2. for transfusion, to remove blood form the through the vein by using incision or puncture donor methods to draw blood for analysis or as part of 3. for removal of blood for polycythemia or therapeutic or diagnostic measures under the therapeuticpurposes. physician’s request. There are two main methods in phlebotomy: - Can be traced back to the Stone Age *Venipuncture – method of blood collection - Humans used crude stools to cut vessels and using a needle inserted in a vein drain blood from the body *Capillary Puncture – done by puncturing the - Ancient Egyptians also practiced phlebotomy as skin. a form of “blood letting” as early as 1400 BC - Hippocrates (460-377 BC), believed that a Role of the Phlebotomists person’s health was dependent on the balance - They collect blood samples for laboratory of the Four Humors. The removal of excess testing or for transfusion humor through bloodletting must be performed - They properly label collected blood samples to keep the balance. with the necessary data to identify the patient - Middle Ages – Barber-Surgeons performed - They are responsible in delivering or bloodletting as part of the treatment for some transporting collected samples within the illness appropriate prescribed time limits - 17th and 18th Centuries when phlebotomy was - They also process collected blood samples such treated as a major therapy as centrifuging and aliquoting samples ready for Cupping – an alternative medicine that helps laboratory testing. ease pain, inflammation or other health-related - They are the main players in blood-letting concerns. It involves the application of special activities such as drawing of blood units from heated suction cups on the patient’s skin and the donors for transfusion. incision that is made using a fleam (lancet). Traits that Form the Professional Image of the Phlebotomists Leeching – also known as hirudotherapy, a method that uses leeches for blood letting and is Good phlebotomists possess the following skills currently used for microsurgical replantation. and knowledge: The process involves placing a drop of milk or 1. Good Manual Dexterity blood on the patient’s skin and introducing Hirudo medicinalis (medical leech) to the site,. 2. Special Communication Skills allowing to engorge and fall off. 3. Good Organizational Skills It is believed that the leeches inject local vasodilator, anesthetic and hirudin, which is an 4. Thorough Knowledge of Laboratory anticoagulant. Specimen Requirements 5. Training in Phlebotomy skills coupled with Standard Practice  KIDAPAWAN DOCTORS COLLEGE, INC. Ninoy Aquino Avenue, Lanao, Kidapawan City www.kdci.edu.ph VANESSA SUNGCAD BMLS 1A CREDENTIALS 4. They must show compassion, sensitivity to the needs of others, and the ability to - Phlebotomists should have certification or stay calm and maintain a helpful license and demeanor towards those in need. continuing education. 5. Phlebotomists are self-motivated, - They have the official recognition and are having the positive attitude and the certified to have initiative to follow through tasks and continuously look for areas of completed the training by an accredited body improvement. as required by 6. They are dependable, observe proper the healthcare institution. work ethic, and take personal responsibility for their actions. - They should have passed a certifying or licensure examination 7. They display good ethical behavior, conforming with standards so as to avoid - They should also have continuing education exposing patients to harm. and should attend Basic Concepts of Communication in the trainings and seminars Healthcare Setting PATIENT – CLIENT INTERACTION  VERBAL COMMUNICATION - Phlebotomists should be reassuring and - Involves expressing ideas through words pleasant when dealing with patients - To have an effective communication, it - They should be able to communicate well is important that the sender and receiver despite cultural and social differences. are able to accurately exchange ideas by - They should maintain positive customer using feedback relations - Uses words that can be easily They must understand the diversity of the understood by the patient patients and be able to adjust accordingly. VERBAL BARRIERS Qualities of Professionalism - Hearing Impairment 1. Professional appearance should be - Emotional Level maintained. Phlebotomists should wear conservative clothing and observe - Patient-education Level proper personal hygiene always. - Age 2. Phlebotomists must have self- confidence because they would be - Language Barriers directly expressing their decisions and - Health status judgments to patients and fellow co- workers.  NON-VERBAL COMMUNICATION 3. They must be persons of integrity, - Includes kinesics (body motion and exhibiting honesty and consistency in language), proxemics (individual's their actions, values and beliefs. concept and use of space), appearance  KIDAPAWAN DOCTORS COLLEGE, INC. Ninoy Aquino Avenue, Lanao, Kidapawan City www.kdci.edu.ph VANESSA SUNGCAD BMLS 1A (attire), and touch (thoughtful  CULTURAL DIVERSITY expression). Customs Positive Body Language Beliefs - Smiling Religion - Eye contact - Display confidence Values Negative Body Language Cultural Diversity Guidelines - Shuffling - Smile and use friendly tone of voice - No eye contact - -Acting distracted - Be alert to patient’s reactions - Zone of Comfort - Be mindful of personal space ZONE OF COMFORT - Take time to explain procedures ZONE AMOUNT OF DISTANCE - Show respect for diversity 1. INTIMATE 2 FEET 2. PERSONAL 2 TO 4 FT THE HEALTHCARE SETTING 3. SOCIAL 4 TO 12 FT Categories of Healthcare Facilities: 4. PUBLIC GREATER THAN 12 FT Inpatient (non-ambulatory) – requires patients to stay in the hospital for at  ACTIVE LISTENING least one night to be serviced by health - Listening – major part of communication care practitioners - Leads to better understanding of Outpatient – patients are served by situations and instructions secondary care specialists on the same day - Phlebotomists build rapport Levels of Healthcare Facilities: Active listening involves: Primary Level - refers to health units in 1. Looking directly and attentively to the the rural areas and sub-units which are patients operated by the Department of Health 2. Encouraging the patients to express Secondary Level – refers to non- feelings, anxieties and concerns departmentalized hospitals that attend to patients during the symptomatic 3. Allowing the patient time to describe stages of an ailment why he or she is concerned Tertiary Level – refers to medical 4. Providing feedback to the patient centers and large hospitals where through appropriate responses services are sophisticated coupled with 5. Encouraging patient communication by highly technical facilities that can asking questions address serious diseases.  KIDAPAWAN DOCTORS COLLEGE, INC. Ninoy Aquino Avenue, Lanao, Kidapawan City www.kdci.edu.ph VANESSA SUNGCAD BMLS 1A Other Healthcare Services: Red Blood Cell (RBC) Count – erythropoietic activity Ambulatory care - medical care given to outpatients or patients requiring care White Blood Cell (WBC) Count – or follow-up check-ups after their leukocyte response discharge from the hospital Platelet Count – chemotherapy and - can be in the freestanding medical care radiation conditions setting and hospital-owned clinics, or in the outpatient departments and urgent care Differential White Blood Cell Count facilities – changes in the appearance or quantity of specific cell types Homebound services – refer to procedures, tests and services provided Indices – show the changes in RBC to a patient which are done in a patient’s size, weight and Hgb content home or in a long-term facility Mean Corpuscular Hemoglobin Public Health Services – belong to the unit (MCH) – weigh of the hemoglobin in at the local level but are still under the the cell jurisdiction of the health department of the Mean Corpuscular Volume (MCV) – government. size of the cell The Different Clinical Analysis Areas of the Mean Corpuscular Hemoglobin Laboratory and the Types of Laboratory Concentration (MCHC) – Procedures Performed concentration of the hemoglobin Hospital - an institution that has permanent per unit volume of RBCs inpatient beds with 24-hr nursing Red Blood Cell Distribution Width service along with therapeutic and (RDW) – size differences of the RBCs diagnostic services - It houses the Clinical Laboratory Services 2. COAGULATION – ability of blood to form Major Divisions of a Clinical Laboratory and dissolve clots 1. Anatomical and Surgical Pathology Area Activated Partial Thromboplastin Time (APTT) – adequacy of heparin o Histology therapy o Cytology D-dimer – thrombin and plasmin o Cytogenetics activity 2. Clinical Analysis Area Fibrin Split Products (FSP) – amount of fibrin degradation products 1. HEMATOLOGY - blood and blood- (FDPs) in the blood forming tissues Fibrinogen Test – fibrinogen levels Hematocrit (Hct) – hemoglobin level in the blood and red cell count Prothrombin Time (PT) or Hemoglobin (Hgb) – value that rule International Normalized Ratio out anemia  KIDAPAWAN DOCTORS COLLEGE, INC. Ninoy Aquino Avenue, Lanao, Kidapawan City www.kdci.edu.ph VANESSA SUNGCAD BMLS 1A (INR) – liver diseases or deficiency in Blood Calcium – which could help Vitamin K determine or monitor the effects of renal failure 3. CLINICAL CHEMISTRY – amounts of certain chemicals in a blood sample Total Cholesterol – indicates risk of cardiovascular diseases Alanine Aminotransferase Test (ALT) – liver damage Cortisol – shows adrenal hypofunction and hyperfunction Alpha-fetoprotein (AFP) – AFP levels in pregnant women during the Creatine Kinase – used to check second trimester of pregnancy muscle damage Alkaline Phosphatase (AP) Test – Creatinine – checks for cases that amount of AP enzyme in the blood indicate renal impairment or stream muscular dystrophy Ammonia – measures the level that Drug Analysis – monitors could indicate cirrhosis or hepatitis therapeutic range to avoid toxic levels for drugs Amylase – checks the enzyme level that could indicate liver disease, Electrolytes (Sodium, Potassium, cholesystitis, etc. Chloride) –shows sodium values that determine disorder of the Aspartate Aminotransferase Test kidney and adrenals (AST) – enzyme that may indicate liver damage Glucose – used to check diabetes, liver disease or malnutrition Bilirubin Test – could indicate red blood cell destruction Gamma-Glutamyl Transferase (GGT) – used for diagnosis of liver, Arterial Blood Gases (ABG) – acid- specifically hepatobiliary problems base balance by measuring the pH, partial pressure of the carbon Hemoglobin A1C (HBA1c) – dioxide and oxygen determines glycosylated hemoglobin level Blood Urea Nitrogen (BUN) - could determine impaired renal function Lactate dehydrogenase – checks lung, kidney and liver dysfunction B-type Natriuretic Peptide (BNP) Test – levels of BNP hormone in the Lipase – shows the level that could blood which could indicate lead to either pancreatitis or congestive heart failure pancreatic carcinoma C-reactive Protein High Sensitivity Prostate Specific Antigen (PSA) – (hs-CRP) test that screens patients for the presence of prostate cancer Carcinoembryonic Antigen (CEA) Test –may help diagnose and Total Protein – used to check liver manage certain types of cancers and kidney disorders  KIDAPAWAN DOCTORS COLLEGE, INC. Ninoy Aquino Avenue, Lanao, Kidapawan City www.kdci.edu.ph VANESSA SUNGCAD BMLS 1A Triglycerides – serve as index in the Epstein-Barr Virus – checks for the evaluation of atherosclerosis and presence of heterophil antibody, which lipid metabolism disorder indicates infectious mononucleosis Troponin I – used for early diagnosis Hepatitis B Surface Antigen (HbsAg) – of small myocardial infarcts checks for the presence of hepatitis antigen on the surface of the red cells Uric Acid Test – used to check levels that indicate gout and renal 3. General studies problems C-Reactive Protein (CRP) – indicates Vitamin B12 and Folate tests – used inflammation when levels are increased to check for anemia and diseases of the small intestine Human Chorionic Gonadotropin (HCG) Test – the hormone is present when patient is pregnant 4. SEROLOGY/IMMUNOLOGY – serum and autoimmune reactions in the blood 5. URINALYSIS (CLINICAL MICROSCOPY) – 1. Bacterial Studies tests urine specimen Antinuclear Antibody (ANA) – 1. Physical Evaluation shows autoimmune disorders such Color – indicates the presence of as systematic lupus erythematosus blood melanin, bilirubin or urobilin Antistreptolysin-O (ASO) Titer – in the urine specimens (Colorless- indicates streptococcal infection Dark Yellow) Cold Agglutinins – checks cases of Clarity/Transparency – shows the atypical pneumonia presence of fat, chyle or bacteria which affect the turbidity (Clear- Febrile Agglutination Test – shows Milky) the presence of antibodies to specific organisms Specific Gravity – shows the renal tubular involvement or ADH FTA.ABS – confirms syphilis deficiency Rapid Plasma Reagin (RPR) – when 2.Chemical Evaluation positive, it is indicative of syphilis but it still needs confirmation Blood – hematuria could be due to hemorrhage infection, or trauma Rheumatoid Factor (RF) – indicates rheumatoid arthritis Bilirubin – helps differentiate between obstructive jaundice and hemolytic 2. Viral Studies jaundice Anti-HIV – screens human Glucose – glucosuria may be a result of immunodeficiency virus diabetes mellitus or renal impairments Cytomegalovirus Antibody (CMV) – a Ketones – uncontrolled diabetes confirmatory test for CMV antibody mellitus or starvation  KIDAPAWAN DOCTORS COLLEGE, INC. Ninoy Aquino Avenue, Lanao, Kidapawan City www.kdci.edu.ph VANESSA SUNGCAD BMLS 1A Leukocyte – indicates urinary tract Blood Culture – checks for the presence infection if there is a lot of neutrophils of bacteria indicative of bacteremia or septicemia pH – indicates the acid-base balance Campylobacter-like Organism (CLO) Protein – proteinuria is an indicator or Test – shows the presence of renal dysfunction or disorder Helicobacter pylori Nitrite – positive results could mean Culture and Sensitivity (C&S) – indicates bacterial infection infection if there is growth in the Urobilinogen – increases in amount pathogenic microorganism when the patient suffers form hepatic Fungus Culture and Identification – issues used to determine the type of fungi if 3. Microscopic Evaluation – shows the status of present the urinary tract, hematuria, pyuria, etc. Gram Stain – it is done to allow Blood – hematuria could be due to antimicrobial therapy while waiting for hemorrhage infection, or trauma culture results Bilirubin – helps differentiate between Occult Blood – checks for blood in the obstructive jaundice and hemolytic stool which could result from jaundice gastrointestinal bleeding Glucose – glucosuria may be a result of Ova and Parasites (O&P) Exam – solves diabetes mellitus or renal impairments the “etiology unknown” intestinal disorders Ketones – uncontrolled diabetes mellitus or starvation Gram POSITIVE Bacteria – VIOLET coloured Leukocyte – indicates urinary tract Gram NEGATIVE Bacteria – PINK coloured infection if there is a lot of neutrophils 7. Blood bank/Immunohematology– pH – indicates the acid-base balance blood for transfusion Protein – proteinuria is an indicator or Antibody (Ab) Screen – agglutination renal dysfunction or disorder means presence of abnormal antibodies in the blood Nitrite – positive results could mean bacterial infection Direct Antihuman-globulin Test (DAT) – determines transfusion incompatibility Urobilinogen – increases in amount when the patient suffers form hepatic ABO and Rh Type – shows the ABO and issues Rh Blood Groups 6. MICROBIOLOGY – microorganisms in Type and Crossmatching – shows the body fluids or tissues blood group and screens for antibodies in the recepient’s blood Acid-Fast Bacilli (AFB) – used to monitor the treatment for TB Compatibilty Testing – detects antibodies and antigen in both recipients and donor’s blood  KIDAPAWAN DOCTORS COLLEGE, INC. Ninoy Aquino Avenue, Lanao, Kidapawan City www.kdci.edu.ph VANESSA SUNGCAD BMLS 1A STAT LABS A laboratory facility that is usually located near the emergency room of some tertiary-care facilities so that procedures and tests can be done immediately when needed. REFRENCE LABORATORY A large and independent laboratory that provides specialized and confirmatory laboratory tests for blood, urine, and tissues and offers as well faster turnaround or processing time. 1. National Kidney and Transplant Institute (NKTI) – Hematology and Coagulation 2. Research Institute for Tropical Medicine (RITM) – Microbiology (identification and antibiotic susceptibility testing) and Parasitology (identification of ova and quantitation of malaria) 3. Lung Center of the Philippines (LCP) – Chemical Chemistry (for testing 10 analytes – glucose, creatinine, total protein, albumin, blood urea nitrogen, uric acid, cholesterol, sodium, potassium, and chloride) 4. East Avenue Medical Center (EAMC) – Drugs of abuse (methamphetamine and cannabinoids) 5. San Lazaro Hospital STD-AIDS Cooperative Center Laboratory (SACCL) – Infectious immunology hepatitis B surface Antigen (HBsAg), Human Immunodeficiency Virus (HIV), Hepatitis C Virus (HCV)