Phlebotomy is a procedure that removes blood from the body. Most are more familiar with the procedure that occurs when blood is taken for a medical test, but blood is also taken for blood donation. An individual who performs phlebotomy is a phlebotomist, though nurses, doctors, and medical technicians also perform phlebotomy.
Phlebotomy as a Career
U.S. Bureau of Labor Statistics predicts that employment for phlebotomists will grow 25% through 2024, which is above the average for all occupations. The demand for Phlebotomists in Pennsylvania is high as the healthcare field has expanded and because many healthcare facilities are open all day, seven days a week.
Phlebotomists work in diagnostic laboratories, hospitals, nursing homes, blood donor centers, and any location where blood work is performed. In addition to taking blood, a Phlebotomist is responsible for properly identifying patients and lab specimens. The Phlebotomist also handles paperwork and should know how to effectively communicate with patients. Many patients, children especially, do not like needles and the Phlebotomist should treat them with kindness and compassion. And, the Phlebotomist needs to know specimen safety standards in order to protect themselves, patients, and the public. Start your phlebotomy training today!
Those Test Tube Colors
Anyone who’s ever had blood drawn probably noticed that the Phlebotomist used tubes with different colored tops on them. Such means there are different anticoagulants inside each tube that keep the blood from clotting and are specific for certain tests. A red-topped tube has no anticoagulant and is spun in a centrifuge in order to separate the plasma from the blood cells as certain tests require plasma only.
Phlebotomy in Pennsylvania
Formal training is not necessary and phlebotomists can learn on the job, however, various institutions and colleges offer Phlebotomist Technician Certificates and such will provide an edge to job applicants. While each program differs, all require a high school degree or equivalent, a drug test, and a criminal background check. Most programs are less than twelve months. Common courses for all programs include infection control, laboratory safety, infection control, ethics, basic instrumentation, blood collection (venipuncture), and transport and processing of specimens. If one is considering a Phlebotomy Technician program, they should select one that is approved by the Pennsylvania State Board or another accrediting association and one that offers career placement.
The American Society of Phlebotomy Technicians (ASPT)
While employers do not require phlebotomy certification, ASPT believes practical testing proves a phlebotomy technician has had applicable training and is best suited for the position.
History of Phlebotomy
The roots of phlebotomy began with the archaic practice of bloodletting 2,300 years ago, during Hippocrates time. This might sound a bit strange, considering how Hippocrates is revered as the father of medicine, the opponent of superstition, an innovator of rationality, the source of everlasting wisdom, as well as the first person to believe that illnesses were caused naturally, not by gods and superstition. The doctor’s oath is even named for him.
Understanding Hippocrates time might help one understand what might seem barbaric to the present. 2,300 years ago, around 460 BCE, Hippocrates theorized the four elements, water, air, earth, and fire, represented existence, and that such correlated to the four human senses of humor (body fluids), yellow bile, black bile, blood, and phlegm. Each humor focused on a certain organ, either the lung, gall bladder, brain, or spleen, and was connected to a certain personality: phlegmatic, choleric, melancholic, or sanguine. Because it was believed that an imbalance of one of the four senses of humor caused illness, it was also believed that removing the excess humor would cure the illness. Treatments such as purging, catharsis (both of which induced vomiting, sweating, and diarrhea), diuresis (inducing urination), and bloodletting were carried out. And, because blood was the main humor, every illness could be construed as resulting from its excess, thus bloodletting was used to treat nearly every condition, including, epilepsy, syphilis, fractures, pain, insanity, inflammation, pneumonia, and, amazingly, even hemorrhage.
At around the first century, 129 AD, Galen of Pergamum, a Greek physician, discovered arteries, which the medical community used to believe contained air. At the time, rather than circulating through the body, they thought blood stagnated in the limbs. Galen then created a multifaceted scheme of how much blood should be drained and noted that it should be removed close to the diseased part of the body. Galen had a strong character and greatly influenced the medical community. Bloodletting, therefore, continued through the Middle Ages (5th to 15th Centuries).
The fortunate patients recovered from their illnesses despite their bloodlettings. In reality, they most likely died from blood loss as no one really knew how much to actually remove. President George Washington famously represents how bloodletting may have contributed to death. On a Friday, his upper windpipe was inflamed and he developed a fever along with breathing difficulty. At the time, the medical standard was to perform bloodletting and he actually requested the treatment. His physician’s notes reveal that 12-14 ounces of his blood were removed without improvement. The next day, he was bled “copiously” (profusely) twice, and then another 32 ounces of blood was removed. As well, his physician attempted purging. On Saturday night, the nation’s first president died.
King Charles II underwent bloodletting after a stroke and died soon after. Queen Anne, Lord Byron, Mozart, were also subjected to bloodletting for certain ailments and, they, too, died soon thereafter. Napoleon and King George IV, however, survived their treatments. The late 1800s brought new technologies and treatments that finally ended bloodletting. It is still used today, though, for a few conditions, such as for those with hemochromatosis, which means they have too much iron in their blood, and for those with polycythemia, which means they produce too many red cells.
Recent studies show leeches are beneficial for wound care, especially post surgery and post limb re-attachment. Leeches emit natural anticoagulants that keep blood from clotting. It’s so potent, it’s currently being studied as a possible medication for heart attack and stroke patients.
Who Performed Bloodletting and how was it Carried Out?
Both physicians and barbers performed bloodletting. The red and white striped pole that identifies barbers today was actually made during bloodletting times. The white stripe symbolizes bandages while the red stripe symbolizes blood.The practice was carried out several ways. Venesection was the most severe method. The physician or barber simply cut a vein and place a bowl under it to catch the blood. Such risked losing too much blood, as well as infection. Other methods including cupping, in which a heated glass cup would be put on the skin and left to cool, creating a vacuum. Then, when the cup was removed, the skin would bleed. Scarification was another method. Minor to moderate cuts were made in the skin and then leeches were applied. Such was believed to be useful for treating children and for bloodletting areas where cupping couldn’t be done.
As well, religions influenced the practice. The Talmud (rabbinical teachings) allowed for bloodletting by a skilled individual known as the garage or human, whose status was below a physician. The practice was advised to treat certain ailments and to prevent illnesses as it was viewed as having sanitary value. It was also specified that bloodletting could only be done on certain days of the week and month. Christian writings advised which saints' days were good for bloodletting.Bloodletting was also part of Islamic medicine. The Prophet Mohammed said there were three ways to cure sickness: “a drink of honey, a scratch of Hijamah and cautery.”
Hijamah refers to the aforementioned cupping and cautery refers to the burning of a body part in order to remove or close it off. Arab doctors carried it out during the Middle Ages and Renaissance. They, however, had guidelines regarding how much blood should be drawn and that it should be avoided during full moons and when there was a southern wind. They also believed blood should be drawn from veins far from the unwell part and on the contrasting body side. Bloodletting was primarily used to control the pain of childbirth by bringing about unconsciousness for fractures, childbirth, etc.
Astrology, too, influenced bloodletting. During the Middle Ages, astrology became a part of the medical study as people believed the heavens and moon impacted weather and, thus, impacted the body. Each body part correlated to an astrological sign (e.g., Aries correlated to the head, Pisces the feet). So, if the moon was in Pisces, bloodletting from the feet would be avoided as it was believed excessive bleeding would occur.