Ancient Beginnings

Phlebotomy finds its roots in ancient civilizations where blood was believed to hold mystical and healing properties. For the ancient Greeks, Hippocrates theorized the humoral theory, which posited that the body’s health depended on the balance of four bodily fluids – blood, phlegm, yellow bile, and black bile. Being ill during this time meant that there was a disruption of equilibrium between these four humors. So, treatment meant draining one of those four in order to get back to balance. [1]

Additionally, the dominant medical voice of Rome around 2-300 AD, Galen of Pergamum shifted this idea that humoral imbalances come from specific organs, as well as in the body overall. Along with this, he proclaimed that blood was the most important humor. Coupled with him discovering that arteries carried blood rather than air, as was taught for over 400 years, bloodletting became bigger within medical care, as well as Galenic physiology, for the next 1400 years [2]. Galen advocated for leeching – the practice of using leeches to draw blood as a method for healing. This practice soon spread across Europe and Asia. [3].

Middle Ages to the Renaissance

The Middle Ages marked a transition in medical practices, where the boundaries between surgery, pharmacy, and healing arts were often blurred. During this era, the role of barber-surgeons emerged prominently, encompassing a range of duties from simple haircuts to surgical procedures and bloodletting. First recognized around 1000 A.D., barber-surgeons were the grooming and surgery experts during the middle ages. They first began in monasteries, where due to health and sanitary reasons, monks needed to keep a clean shaven head. Barber-surgeons were hired by monks, and even then taught the practice of blood-letting performed regularly by the monks, as barbers had a knack for handling sharp objects and tools [4]. As Jennie Cohen from History.com says, “the modern striped barber’s pole harkens back to the bloodstained towels that would hang outside the offices of these “barber-surgeons.”” And after Pope Alexander III prohibited clergymen from performing bloodletting in 1163, barber-surgeons took over the practice as a whole.

The most common method of bloodletting at this time was cutting into a vein, at the forearm or the neck, to drain the blood. Another method was cupping – where the barber-surgeon would scrap the skin and placing a cup over the skin. They would then apply heat or suction to create a vacuum so that the blood would be drawn out. Leeching was still common to use in these medical practices as well. [3].

18^th and 19^th Century

The 18th and 19th centuries witnessed significant advancements in phlebotomy techniques, blood transfusion, and the understanding of circulatory physiology, marking a pivotal period in the history of medicine. During the 18th century, phlebotomy tools underwent notable advancements. Lancets evolved to include spring-loaded mechanisms for quicker and more precise incisions. William Harvey, known for being the person to recognize blood circulation all over the human body, lauded bloodletting for being beneficial to remedying many diseases [3]. His theories laid the foundation for understanding the dynamics of blood flow and the role of the heart in circulation. This newfound knowledge influenced phlebotomy practices, emphasizing the importance of vein selection, and avoiding arteries during blood collection.

The late 18th and early 19th centuries witnessed the experimental use of blood transfusion as a medical intervention. Dr. James Blundell, a British obstetrician, conducted pioneering work in blood transfusion, particularly in cases of postpartum hemorrhage. His first was donating blood from a husband to his post-partum wife – ending in success. He performed 10 transfusions between 1825 – 1830, 5 of which were successful. He created several devices to perform these transfusions while publishing papers on the practice within that time. [5]

20^th Century

The 20th century witnessed a revolution in phlebotomy practices, marked by technological innovations, standardization of procedures, and advancements in transfusion medicine. Bloodletting started becoming denounced as a viable practice of medicine as physicians began to recognize that losing large amounts of blood at a time hurt rather than helped patients. As explained by Brittanica, “the extraction of large volumes of blood… could lead to low blood pressure, difficulty breathing, loss of consciousness, and, in some cases, death. Bloodletting also carried a risk of infection from the implements used to create the incisions for bleeding.” This began to turn the tide of bloodletting turning into what we know now as modern phlebotomy.

Modern Phlebotomy

In the contemporary healthcare landscape, phlebotomy has evolved into a specialized discipline characterized by precision, safety protocols, and a patient-centered approach. Modern phlebotomy practices encompass a range of innovations and standards that ensure efficient blood collection, accurate testing, and optimal patient outcomes. And though it’s possible that the history of bloodletting has lead to a lot of fear and myths, modern phlebotomy continues to be a major push for diagnostic care. Click here to read more about modern phlebotomy and how it is not like many stereotypes.

Famous Cases of Bloodletting

With such a vast history of medical uses, bloodletting has plenty of famous names you will recognize that utilized such practices. Here are three major historical figures who were known to use the practice:

• George Washington: The famous first United States president utilized bloodletting after falling ill from a throat infection. However, it is also the reason why the inaugural leader died after nine pints of blood were drained from him. With our modern eyes, we can see now that losing that much blood was most likely the reason for his death as opposed to the throat infection he wanted to treat [6].
• King Charles II: After suffering a seizure, King Charles II lost a total of 24 ounces of blood from both an arm venipuncture and cupping [1]. He later died between this and a combination of other treatments his physicians tried to give him.
• Marie Antoinette: The infamous French queen had her blood released by her physician after she fainted during the birth of her first child. However, we know now that didn’t end her life, not until the guillotine over a decade later [7].

The journey through the history and evolution of phlebotomy unveils a narrative of constant innovation, precision, and patient-centered care that defines modern healthcare practices. From ancient rituals of bloodletting to the techniques of contemporary phlebotomy, the practice has gone from blood draining for equilibrium to precision drawing for diagnostic care. In essence, modern phlebotomy stands as a testament to human ingenuity, scientific progress, and compassionate healthcare delivery, embodying the timeless commitment to advancing medical science for the benefit of individuals and communities worldwide. To learn how you can join a career in phlebotomy, go to virginia.an.edu.

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Sources:

1. Greenstone, G. (2010). A history of bloodletting. BC Medical Journal Premise, 52(1), 12-14. Retrieved from https://bcmj.org/premise/history-bloodletting.
2. Nutton, V. (1998, July 20). Galen. Encyclopedia Britannica. Retrieved from https://www.britannica.com/biography/Galen (Last updated March 6, 2024).
3. Raikar, S. P. (2023, September 29). Bloodletting. Encyclopedia Britannica. Retrieved from https://www.britannica.com/science/bloodletting (Last updated March 15, 2024)
4. Hue, D. L. (2017, November 6). History of the Barber-Surgeon. Barbers Surgeons Guild Magazine. Retrieved from https://barbersurgeonsguild.com/magazine/history-barber-surgeon/.
5. Association for the Advancement of Blood and Biotherapies (AABB). (n.d.). Highlights of transfusion medicine history. Highlights of Transfusion Medicine History. Retrieved from https://www.aabb.org/news-resources/resources/transfusion-medicine/highlights-of-transfusion-medicine-history.
6. Phlebotomy Coach. (2015, September 9). History of phlebotomy. Phlebotomy Coach. Retrieved from https://phlebotomycoach.com/resources/history-of-phlebotomy.
7. Cohen, J. (2012, May 30). A brief history of bloodletting. com. Retrieved from https://www.history.com/news/a-brief-history-of-bloodletting (Updated: March 28, 2023).

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Myth One: Getting Your Blood Drawn is Painful

While the initial prick of the needle may have a pinch, actual blood collection should not be painful while in the care of a trained phlebotomist. Factors such as individual pain tolerance, anxiety levels, and previous experiences with blood draws can influence how a person perceives the sensation during phlebotomy. While some individuals may feel mild discomfort or a brief pinch from the needle, others may hardly notice the procedure at all. The actual blood collection is painless.

Phlebotomists undergo specialized training to master venipuncture techniques and prioritize patient comfort during blood collection. They are skilled in selecting appropriate veins, using gentle and precise movements, and communicating effectively with patients to alleviate anxiety and minimize discomfort. And in today’s modern healthcare setting, all care is patient centered. This is so every patient can have a positive experience for each procedure.

According to the National Library of Medicine, there are several things, though not an exhaustive list, that phlebotomists should do in a procedure to ensure the comfort of the patient:

• The provider should introduce themselves to the patient and give a brief description of their role in the patient’s care.
• Identify the purpose of the procedure.
• Gain informed consent to the procedure without patient resistance.
• Answer any questions the patient may have about the procedure.
• Ask the patient about convenient collection sites to be prioritized.
• Those patients who have had a history of panic attacks or fear of blood testing should have specific attention paid to them so that both provider and patient can be prepared should anything go wrong.

Myth Two: Phlebotomists Are Not Healthcare Professionals

Contrary to this myth, phlebotomists are highly trained healthcare professionals who undergo specialized education and certification in blood collection techniques. Whether they are nurses, medical assistants, or phlebotomists, they each have all had the training required for blood collection in every healthcare setting. Phlebotomists undergo specialized education and training programs to acquire the knowledge and skills necessary for blood collection procedures. These programs cover topics such as:

• Anatomy and physiology of the circulatory system.
• Venipuncture techniques and best practices.
• Infection control measures and safety protocols.
• Handling and processing blood specimens.
• Communication and patient interaction skills.

Not only that, but like every other healthcare professional, those working in phlebotomy must obtain certification or education in order to perform blood collection. At American National University, our phlebotomy students prepare to sit for the Certified Phlebotomy Technician (CPT) exam as part of their curriculum. Upon completing their education and training, many phlebotomists often obtain certification from accredited organizations, such as the National Healthcareer Association (NHA), American Society for Clinical Pathology (ASCP), or the National Phlebotomy Association (NPA).

Myth Three: Phlebotomists Only Work in Hospitals

For many, we only think of phlebotomists working in a hospital. However, the reality is that phlebotomists are in demand across a wide range of healthcare settings, each with its unique requirements and challenges. And the need for phlebotomists is only going to grow as our healthcare system grows as well.

1. Clinics or Outpatient facilities – Clinics like an urgent care, an oncology clinic, primary care facilities, and among many others employ phlebotomists to collect blood specimens from patients. Phlebotomists in these settings work closely with healthcare providers to facilitate diagnostic testing, monitor treatment progress, and ensure accurate laboratory results.
2. Laboratories – Diagnostic laboratories rely on phlebotomists to collect blood samples and process them for various tests. Phlebotomists in laboratory settings follow strict protocols for specimen handling, quality control, and result reporting, contributing to accurate diagnoses and patient care.
3. Blood Banks and Donation Centers – One of the most central places for a phlebotomist to be found would be at a facility built for blood collection. Blood banks and donation centers heavily rely on phlebotomists to collect blood donations from voluntary donors. Phlebotomists ensure the safety, quality, and proper labeling of donated blood products, which are used for transfusions, surgeries, and medical treatments. Their expertise in blood collection is critical for maintaining a stable blood supply and supporting patient needs.
4. Nursing or Long-Term Care Facilities – Phlebotomists may work in nursing homes, assisted living facilities, and long-term care centers to provide blood collection services for elderly residents and patients with chronic conditions. They collaborate with healthcare teams to monitor residents’ health status, conduct routine blood tests, and facilitate timely interventions when necessary.

Phlebotomists play a crucial role in various settings, including clinics, laboratories, blood banks, long-term care facilities, community health programs, and research institutions. Their expertise in blood collection and specimen handling is essential for accurate diagnoses, patient care, and public health initiatives.

By challenging misconceptions about pain, recognizing phlebotomists as healthcare professionals, and showcasing their diverse roles beyond hospitals, we empower patients with knowledge and foster respect for phlebotomy professionals. If you’re interested in becoming a phlebotomist, American National University has the programs for you whether you have existing degrees or not. Go to virginia.an.edu to learn more.

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American National University has recently been re-approved for the Workforce Innovation and Opportunity Act (WIOA) Title I program. The WIOA program provides government funds for laid-off workers to enroll in approved programs for additional education that will give them greater opportunities. By helping them learn and develop new skills, we prepare unemployed workers for careers in the evolving global economy.

WIOA program approval extends to the following courses:

• Pharmacy Technician (Diploma and Associate’s)
• Paralegal (Diploma and Associate’s)
• Phlebotomy & ECG Diploma
• Network Support Associate’s
• Business Administration Associate’s
• Business Administration – Accounting (Diploma and Associate’s)
• Medical Coding & Billing Diploma
• Medical Assisting (Certificate and Associate’s)
• Health Information Management Associate’s
• Administrative Medical Assisting Associate’s

The application was approved by the Western Virginia Workforce Development Board (WVWDB) and Chief Local Elected Officials (CLEO) in Local Workforce Development Area 3 (LWDA3).

For more information on how you may qualify, call 833.388.1100, click, or Zoom an admissions representative today!

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