Breaking Through -- Phlebotomy
Lesson 2
Reading Activities based on The Clinical Laboratory
The clinical laboratory is divided into two areas – anatomical and clinical. The
anatomical area is responsible for the analysis of surgical specimens, frozen sections,
biopsies, cytological specimens, and autopsies. Sections of the anatomical area include
cytology, histology, and cytogenetics.
In the cytology section, cytologists process and examine tissue and body fluids for the
presence of abnormal cells, such as cancer cells. The Papanicolaou (Pap) smear is one of
the most common tests performed in cytology. In the histology section, histology
technicians process and stain tissue obtained from biopsies, surgery, autopsies, and frozen
sections. A pathologist then examines the tissue. Cytogenetics is the section in which
chromosome studies are performed to detect genetic disorders. Blood, amniotic fluid,
tissue, and bone marrow specimens are analyzed.
In the clinical laboratory, the specialized sections include: hematology, chemistry, blood
bank, serology(immunology), microbiology, urinalysis, and phlebotomy.
Clinical Laboratory Personnel
In the laboratory, there are many types of personnel who work in that section. The
laboratory director is usually a pathologist who has a doctorate degree. A pathologist is a
physician who has completed a 4 to 5 year residence in pathology. The laboratory
manager is the administrator who deals with overall technical and administrative
management of the laboratory, including personnel and budgets. This type of job usually
requires a master’s degree and 5 or more years of laboratory experience. The section
supervisor is a medical technologist with experience and expertise related to the
laboratory sections. The medical technologist, or clinical laboratory scientists, has a
bachelor’s degree in medical technology or biological science. The technologist
performs laboratory procedures that require independent judgment and responsibility
with minimal technical supervision. The technologist also can perform complex
laboratory procedures and tests. The medical laboratory technician usually has a two
year associate degree from an accredited college medical laboratory program This
technician performs routine laboratory procedures including collecting and processing
biologic specimens for analysis, and recognizing and reporting abnormal testing. The
phlebotomist collects blood from patients for laboratory analysis. The phlebotomist must
have a high school diploma and usually has completed a structured phlebotomy training
program. The phlebotomist is trained to properly collect and prepare specimens for
analysis. He or she must also pass a national certification exam.
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Some Highlights from Hematology
Hematology is the study of the formed (cellular) elements of the blood. In this section,
the cellular elements, red blood cells, white blood cells, and platelets are enumerated and
classified in all body fluids and in the bone marrow. These cells, which are formed in the
bone marrow, are released into the blood stream as needed to carry oxygen, provide
immunity against infection, and aid in blood clotting.
The most common body fluid analyzed in the hematology section is whole blood (a
mixture of cells and plasma). A whole blood specimen is obtained by using a collection
tube with an anticoagulant to prevent clotting of the specimen. Most tests performed in
the hematology section require blood that has been collected in tubes with a lavender
stopper that contain the anticoagulant ethylenediaminetetraacetic acid (EDTC).
Immediate inversion of this tube eight times is critical to prevent clotting and ensure
accurate blood counts.
Blood is analyzed in the form of either whole blood, plasma, or serum. The liquid
portion of blood is called plasma if it is obtained from a specimen that has not been
allowed to clot. If the specimen is allowed to clot, the liquid portion is called serum. The
major difference between plasma and serum is that plasma contains the protein fibrinogen
and serum does not. It is important to differentiate between plasma and serum because
many laboratory tests are designed to be performed specifically on either plasma or
serum.
A complete blood count (CBC) is the primary analysis performed in the hematology
section. Very often it is ordered on a stat basis (immediately). Many of the tests in
hematology and coagulation are performed on automated instruments.
Clinical chemistry tests are performed primarily on serum collected in serum separator
tubes, but the serum may also be collected in tubes with red, green, gray, or royal blue
stoppers. Tests are also performed on plasma, urine, and other body fluids. Serum and
plasma are obtained by centrifugation, which should be performed within one to two
hours of collection. Because many tests are performed on tests that take photometric
readings, differences in the appearance, or color of a specimen may adversely affect the
test results. In addition, fasting specimens drawn from patients who have not eaten for 8
to 12 hours are preferred.
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Reading Activities
Lesson 2
A phlebotomist with a high school diploma has completed the community college
training to become a certified phlebotomist. He has just received national
certification and is now working full time at the local hospital laboratory. He is
meeting with his supervisor to ask her how he can continue on with his clinical
laboratory career.
1. What could be the next step in education and training for this phlebotomist?
2. If the phlebotomist returns to school and obtains a master’s degree, what type of
job could he do, especially if he likes working with budgets and personnel
decisions?
3. If the phlebotomist wants to be able to independently make judgments on
laboratory tests and likes to perform complex tests, what type of educational
degree would be required?
Place the sections in the appropriate area for the clinical laboratory. Put them in
either the Anatomical Section OR the Clinical Section.
hematology
blood bank
cytogenetics
microbiology
cytology
phlebotomy
serology
urinalysis
chemistry
histology
immunology
CLINICAL
LABORATORY
ANATOMICAL
CLINICAL
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True / False questions:
_____ 1. The Pap smear is not a very common laboratory test.
_____ 2. Amniotic fluid is analyzed in the cytogenetics section.
_____ 3. Another word for serology is histology.
_____ 4. A medical laboratory technician would be able to supervise a laboratory
pathologist.
_____ 5. Hematology is the study of blood cells.
_____ 6. Blood collected in a lavender stopper has an anticoagulant in the tube.
_____ 7. It is okay to invert blood tubes only three times as long as the blood starts
turning a lighter color after inversion.
_____ 8. The major difference between plasma and serum is that serum contains the
fibrinogen and plasma does not.
_____ 9. Phlebotomists never have contact with the patients.
_____ 10. It is preferred to draw specimens from patients who have not eaten within
eight to twelve hours.
Fill in the blanks:
Use these words:
histology adversely
CBC cytology
urine
clinical laboratory scientist
clinical
1. Clinical laboratory tests can be performed on plasma, ________, and other body
fluids.
2. Differences in the appearance or color of a specimen may ____________ affect
the test results.
3. The __________ is the primary analysis performed in the hematology section.
4. The medical technologist or, ____________________, has a bachelor’s degree in
medical technology or in a biologic science.
5. Frozen specimens are analyzed in the _____________ section.
6. Pap smears and cancer cell studies are performed in the ___________ section.
7. Microbiology tests are performed in the _____________ section.
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ANSWER KEY – LESSON 2
A phlebotomist with a high school diploma has completed the community college
training to become a certified phlebotomist. He has just received national
certification and is now working full time at the local hospital laboratory. He is
meeting with his supervisor to ask her how he can continue on with his clinical
laboratory career.
1.
What could be the next step in education and training for this phlebotomist?
He could go on for his associate degree and then complete a four year
degree at a university or college.
2.
If the phlebotomist returns to school and obtains a master’s degree, what type of
job could he do, especially if he likes working with budgets and personnel
decisions? He could then become a laboratory administrative manager.
3. If the phlebotomist wants to be able to independently make judgments on
laboratory tests and likes to perform complex tests, what type of educational
degree would be required? A four degree (bachelor’s degree) would be
required to be a medical laboratory technologist or clinical laboratory
scientist.
Place the sections in the appropriate area for the clinical laboratory:
hematology
blood bank
cytogenetics
microbiology
cytology
phlebotomy
serology
urinalysis
chemistry
histology
immunology
CLINICAL
LABORATORY
ANATOMICAL
Cytology histology
cytogenetics
CLINICAL
Hematology chemistry blood bank
Serology immunology
Microbiology urinalysis phlebotomy
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True / False questions:
___F__ 1. The Pap smear is not a very common laboratory test.
___T__ 2. Amniotic fluid is analyzed in the cytogenetics section.
___F__ 3. Another word for serology is histology.
___F__ 4. A medical laboratory technician would be able to supervise a laboratory
pathologist.
___T__ 5. Hematology is the study of blood cells.
____T_ 6. Blood collected in a lavender stopper has an anticoagulant in the tube.
__F___ 7. It is okay to invert blood tubes only three times as long as the blood starts
turning a lighter color after inversion.
___F__ 8. The major difference between plasma and serum is that serum contains the
fibrinogen and plasma does not.
___F__ 9. Phlebotomists never have contact with the patients.
___T__ 10. It is preferred to draw specimens from patients who have not eaten within
eight to twelve hours.
Fill in the blanks:
Use these words:
histology adversely
CBC cytology
1.
2.
3.
4.
5.
6.
7.
urine
clinical laboratory scientist
clinical
Clinical laboratory tests can be performed on plasma, __urine______, and other
body fluids.
Differences in the appearance or color of a specimen may __adversely_____
affect the test results.
The ___CBC_______ is the primary analysis performed in the hematology
section.
The medical technologist or, __clinical laboratory scientist_____, has a
bachelor’s degree in medical technology or in a biologic science.
Frozen specimens are analyzed in the ___cytology__________ section.
Pap smears and cancer cell studies are performed in the ___histology____
section.
Microbiology tests are performed in the ____clinical______ section.
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