Phlebotomy



Definition

Phlebotomy is the act of drawing or removing blood from the circulatory system through a cut (incision) or puncture in order to obtain a sample for analysis and diagnosis. Phlebotomy is also done as part of the patient's treatment for certain blood disorders.


Purpose

Phlebotomy that is part of treatment (therapeutic phlebotomy) is performed to treat polycythemia vera, a condition that causes an elevated red blood cell volume ( hematocrit ). Phlebotomy is also prescribed for patients with disorders that increase the amount of iron in their blood to dangerous levels, such as hemochromatosis, hepatitis B, and hepatitis C. Patients with pulmonary edema may undergo phlebotomy procedures to decrease their total blood volume.

Phlebotomy is also used to remove blood from the body during blood donation and for analysis of the substances contained within it.


Description

Phlebotomy is performed by a nurse or a technician known as a phlebotomist. Blood is usually taken from a vein on the back of the hand or just below the elbow. Some blood tests, however, may require blood from an artery. The skin over the area is wiped with an antiseptic, and an elastic band is tied around the arm. The band acts as a tourniquet, retaining blood within the arm and making the veins more visible. The phlebotomy technician feels the veins in order to select an appropriate one. When a vein is selected, the technician inserts a needle into the vein and releases the elastic band. The appropriate amount of blood is drawn and the needle is withdrawn from the vein. The patient's pulse and blood pressure may be monitored during the procedure.

For some tests requiring very small amounts of blood for analysis, the technician uses a finger stick. A lance, or small needle, makes a small cut in the surface of the fingertip, and a small amount of blood is collected in a narrow glass tube. The fingertip may be squeezed to get additional blood to surface.

The amount of blood drawn depends on the purpose of the phlebotomy. Blood donors usually contribute a unit of blood (500 mL) in a session. The volume of blood needed for laboratory analysis varies widely with the type of test being conducted. Typically one or several small (5–10 mL) tubes are drawn. Therapeutic phlebotomy removes a larger amount of blood than donation and blood analysis require. Phlebotomy for treatment of hemochromatosis typically involves removing a unit of blood—250 mg of iron—once a week. Phlebotomy sessions are required until iron levels return to a consistently normal level, which may take several months to several years. Phlebotomy for polycythemia vera removes enough blood to keep the patient's hematocrit (proportion of red blood cells) below 45%. The frequency and duration of sessions depends on the patient's individual needs.

Diagnosis/Preparation

Patients having their blood drawn for analysis may be asked to discontinue medications or to avoid food (to fast) for a period of time before the blood test. Patients donating blood will be asked for a brief medical history, have their blood pressure taken, and have their hematocrit checked with a finger stick test prior to donation.


Aftercare

After blood is drawn and the needle is removed, pressure is placed on the puncture site with a cotton ball to stop bleeding, and a bandage is applied. It is not uncommon for a patient to feel dizzy or nauseated during or after phlebotomy. The patient may be encouraged to rest for a short period once the procedure is completed. Patients are also instructed to drink plenty of fluids and eat regularly over the next 24 hours to replace lost blood volume. Patients who experience swelling of the puncture site or continued bleeding after phlebotomy should seek immediate medical treatment.


Risks

Most patients will have a small bruise or mild soreness at the puncture site for several days. Therapeutic phlebotomy may cause thrombocytosis and chronic iron deficiency (anemia) in some patients. As with any invasive procedure, infection is also a risk. This risk is minimized by the use of prepackaged sterilized equipment and careful attention to proper technique. There is no risk of HIV infection from phlebotomy, since all needles are disposed of after a single use. Arterial blood collection carries a higher risk than venous collection, and is performed by a physician or other specially trained professional. Patients who are anemic or have a history of cardiovascular disease may not be good candidates for phlebotomy.


Normal results

Normal results include obtaining the needed amount of blood with the minimum of discomfort to the patient.

Morbidity and mortality rates

Properly performed, phlebotomy does not carry the risk of mortality. It may cause temporary pain and bleeding, but these are usually easily managed.


Alternatives

Phlebotomy is a necessary medical procedure, and is required for a wide variety of other procedures.


Resources

periodicals

Messinezy, Maria and T. C. Pearson. "Polycythaemia, Primary (Essential) Thrombocythaemia and Myelofibrosis (ABC of Clinical Haematology)." British Medical Journal 314 (22 February 1997): 587–90.

Wolfe, Yun Lee. "Case of the Ceaseless Fatigue." Prevention Magazine (July 1997): 88–94.


Paula Anne Ford-Martin Richard Robinson

QUESTIONS TO ASK THE DOCTOR



WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?



Phlebotomy is usually performed by a phlebotomy technician. Arterial collection may be performed by a physician. Collection occurs in the hospital or outpatient clinic.

Also read article about Phlebotomy from Wikipedia

User Contributions:

1
Nancy
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Sep 18, 2008 @ 12:00 am
I have a question about obtaining a blood specimen post theraptic phlebotomy. If an MD orders a post Phlebotomy CBC or Iron levels for example, may that blood specimen be taken from the phlebotomy bag or must it be obtained from the patient himself post phlebotomy? Thank you.
2
fredrick
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Mar 3, 2009 @ 5:17 pm
what kind of advise would you give those who wants to be a phlebotomist and have no skills and wants to persue a carerr in helping people
3
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Feb 24, 2010 @ 1:13 pm
I have completed training and am doing an externship at a local doctors office. What I didn't learn in school is: On average, how many tests can be performed from on serum tube? I hate to draw more than I need.

Please advise.

Thanks
4
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Mar 18, 2010 @ 12:12 pm
The last 2 times I have donated blood, my vein continues to bleed. The cotton pad is taken off and it looks like it has stopped, then it starts again. The last time the blood bank put pressure on the site and applied an ice pak. I have donated over 74 gallons and would like to make it to 100, but wonder if they vein is scarred and that is why the bleeding continues. What can I do to prevent the continued bleeding, if anything?
5
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Apr 22, 2010 @ 1:01 am
I am in a phlebotomy program and every day we draw blood from each other. I think I am anemic and I was wondering if getting my blood drawn every day in class would make it worse or make me anemic if im not.

Thanks,
Raquel
6
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May 7, 2010 @ 9:09 am
if you are anemic DONT GIVE BLOOD i am anemic, only slightly, and yet i was near death in my phlebotomy class. refuse to give it because your health depends on it
7
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May 31, 2010 @ 8:08 am
You need at least 2ml for each SST tube test...





good luck
8
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Jun 16, 2010 @ 2:14 pm
who is extenship...now i am in phlebetomy class...but i like talk another people for this point.thank u.
9
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Feb 12, 2011 @ 5:17 pm
can a phlebotomist refuse to draw blood on a patient with hiv or hepatitis?
10
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Mar 11, 2011 @ 3:15 pm
If you are a Phlebotomist, please give me advise is that a good job to do?
I do not want to take a long term in cours. Is that job easier to get sick from other?
example: HIV or AID
Thanks
11
Sam
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Mar 27, 2011 @ 1:13 pm
Therapeutic Phlebotomy hemochmotosis? What is the volume of a unit that is withdrawn?
12
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Aug 9, 2011 @ 10:10 am
Is phlebotomy useful in smokers polycythemia? Are there any guidelines?
13
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Aug 19, 2011 @ 11:11 am
HOW DO I KNOW WHAT TUBE TO USE FOR EACH TEST? AND WHERE CAN I GET A HELP GUIDE FOR THIS?
14
Manish
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May 17, 2012 @ 3:03 am
I am a patient of Polycithemia vera. i get phlebotomy done every 3 months since last 5 years. i am 43 years old. i came to know that there is a HH Kit to remove excessive iron content in blood. my question is that can such a treatment remove RBC from my blood to increase the time to do a process. Can that Kit be used for me.
15
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Oct 1, 2012 @ 5:17 pm
My husband has polycythemia and been blood letting with saline for 6 months. He had a egd and colonoscopy two weeks before his next phlebotomy. They gave him saline drip while he was under. Would that make his numbers seem good? So he had saline twice in 4 weeks.
16
jasmine
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Mar 15, 2013 @ 4:16 pm
hi im phlebotomist i had a 8 year old client who was refusing blood draw she was crying and shouting from top of the lung for 30 min and she was forced by her mom to do blood test when i asked mom may be they can wait in waiting room until client cool down she pushed the child back into the chair saying no ive hadent enough we gonne do this blood test any way after 30 40 min argue and child shouting i refuse the client i said im not gonne draw the blood she opened huge complain agains me on the top of that she lied on my behalf that i disrespacted them ive been mean and other other things what should i do in this kind of situations how many min maximum i have to spend on the client in this kind of situation if the child is forced by parent what should i do thank u waiting for your answer.
17
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Jun 15, 2013 @ 5:05 am
Kindly anyone answer my question.
After blood is drawn and the needle is removed, pressure is placed on the puncture site with a Dry cotton or with spirit cotton to stop bleeding?
18
Harry
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Jul 2, 2013 @ 2:14 pm
I have haemochromatotis, I usually give blood weekly. I am presently on antibiotics for a month with prostasitus will I still be able to give blood if not how long before i can continue
19
shovit thapa
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Oct 9, 2013 @ 9:09 am
sir/s, i am MD internal medicine resident in nepal. Is there latest update or research on use of phlebotomised blood for transfusion to other patients if the procedure is done for secondary polycythemia in patients with Chronic Obstructive Airway Disease? i would be very thankful if you could provide me with explanation and link if possible.
20
kathy
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Dec 2, 2014 @ 3:15 pm
Whenever I attempt to get my blood drawn the phlebotomist tells me the tissue swells immediately, making it difficult to retrieve blood. It takes many attempts, usually comes out very slowly, and afterwards my arms are bruised, last time the pain in my arms and shoulders lasted for months. Also having bizarre reactions to vaccines (swelling flu shot) and ppd test (negative but swelling that lasts for months) Even mosquito bites can last months. I am in health care so I need these tests and vaccines. (BTW I get the flu multiple times despite the shot.) any advice where to look for help is welcomed.
21
vera
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Feb 28, 2015 @ 3:15 pm
My iron level at the last check was 304 , Am I in a category that may need phlebotomy treatment . I have thalassemia minor.
22
Bona Condon
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Mar 8, 2015 @ 4:04 am
I will be having therapeutic phlebotomy for polycythemia. I am very fearful. Does it hurt. Where is it done. How long does a session last.
23
gerald dom
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Apr 1, 2015 @ 5:17 pm
Hi, i have stress polycythemia and my 1st phlebotomy treatment this coming monday!! After the treatment how it affect my daily routine or my work?and how long the life span this kind of disease?hope you can help me or give some idea!!thanks you sir/ ma'm!! God bless
24
Contessa
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Sep 23, 2015 @ 9:21 pm
What are all the body systems that Phlebotomist use to draw blood? its important because i need it for a case study in my Phlebotomy class. Thank you for your time.
25
Kemo Fredah Tshukudu
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Feb 11, 2016 @ 10:10 am
Thank for the information since i'm about to start my coarse in phlebotomy i will always visit here.
26
AJ Kennedy
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Aug 25, 2016 @ 10:10 am
For a person without a spleen, how much blood is safely removed in one session?
27
Carmen P Cedeno
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Jan 27, 2017 @ 6:18 pm
How do you bill for a phlebotomy visit when you attempted to do the phlebotomy and couldn't do it ... pooked the patient about 5 times and nothing

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