PHBLecture3Th CirculatorySystem

Phlebotomy Handbook
Blood Collection Essentials

Seventh Edition
Diana Garza
Kathleen Becan-McBride
Chapter Four
The Cardiovascular System
Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Copyright 2005 Diana Garza Kathleen Becan-McBride
Introduction
Circulatorysystemisatransportsystem.
Contributestobodydefensesandthe
coagulationprocessandcontrolsbody
temperature.
Thelymphaticsystemisconsideredtobepart
ofthecirculatorysystem,theprimarypurpose
ofwhichistocirculatelymphfluid

The Blood
Box 4.1: Functions of the blood

Blood
Allbloodcellsdevelopfromundifferentiated
stemcells
Stemcellsareconsideredimmaturecells
Astheymature,theydifferentiateintoerythrocytes
(redbloodcellsorRBCs),leukocytes(whiteblood
cellsorWBCs)andthrombocytes(platelets).
undergochangesinthenucleusandcytoplasmso
thatwhentheyreachthecirculatingblood,they
becomefullymatureandfunctional
The Blood
Table 4.1: Blood Cells

Erythrocytes
Red blood cells measure about 7 mm in

diameter with a thickness of 2 mm
During maturation in the bone marrow the RBCs
lose their nucleus
Unique and flexible shape (biconcave
disc) enables them to pass through very
narrow capillaries and provides for
maximum surface area to transfer
oxygen and carbon dioxide.
Normal blood has approximately 4.5 to 5 million
cells per cubic milliliter.
The life-span of RBCs is approximately
120 days in the circulating bloodstream.
Erythrocytes
ThemaincomponentoftheRBCishemoglobin
whichbindstooxygenfortransporttothetissues,
thenbindstoCO2tobedeliveredtothelungsasa
wasteproduct.
Hemoglobingivesblooditsredcolor.
MillionsofRBCsarecontinuallybeingformedand
destroydaily
Deficienciesmayresultinanemia.
ThesurfacemembraneofRBCscontainstructures
calledantigensthatdesignatetheindividualsblood
type
The Blood
Figure 4.5 Human Blood Types

Leukocytes
WBCsnumberabout5,000to10,000andare
classifiedintocelllineswhichdifferincolor
size,shape,nuclearformationandfunction.
Whitecellsarefurtherdividedintocelllines,
oneofwhichisthegranulocyteswhich
containcytoplasmicgranules.
Segmentedneutrophils
Eosinophils
Basophils
Leukocytes
Monocytesandlymphocytesareagranularcells.
Monocytes
Lymphocytes
Acommonlyperformedlaboratorytestisthe
"differential
AhighWBCcountwithanincreaseingranulocytes
indicatesabacterialinfection
AhighWBCcountwithpredominantlyimmatureWBCs
presentindicatesleukemia
AlowWBCcountwithanincreaseinthelymphocytes
indicatesaviralinfection.
The Blood
Figure 4.6 Human Blood Cells

Platelets
Thrombocytes,commonlycalledplatelets,aremuchsmaller
thanotherbloodcellsandareactuallyfragmentsof
megakaryocytes.
Normallythereare250,000to450,000platelets/mm3.
Lifespanis912days.
Thrombocytesparticipateinbloodclotting.
Whenvesselsaredamaged,theplateletsreleasefactorsthatare
neededfortheclottingreaction
Bloodclotting,orcoagulation,isthefinalstepinhemostasis,
thepreventionofbloodloss.
Lowplateletsmaycauseapatienttohaveexcessivebleeding
oruncontrolledbleedingafteraninjury.
Plasma
Plasma
Ifachemicalagentoranticoagulantisaddedto
preventclotting,abloodsamplecanbeseparated
bycentrifugationintothecellsandplasma.
Plasmacannotclotduetoinactivationofcertain
vitalnecessaryelementsandwillcontainall
coagulationfactors.
Anticoagulatedwholebloodisrequiredforalltests
performedinthehematologydepartment
Plasmaisrequiredforallcoagulationtests
Serum
Serumisproducedwhenbloodisdrawninto
anonadditivetubeandallowedtoclot.
Thebloodcellsbecomemeshedinafibrinclot.
Serumcontainsessentiallythesamechemical
constituentsasplasmaexceptthatclottingfactors
havebeenuseduptoformtheclotsowillhaveNO
coagulationfactors.

The Blood
Figure 4.7 Centrifuged Blood Specimens With and Without Anticoagulant, Respectively

The Blood
Figure 4.8 Blood is slightly basic with a pH of 7.35

The Heart
Figure 4.1 Superficial Anatomy of

the Heart

The Heart
The human heart is a muscular organ about the

size of a mans closed fist.
The heart contains four chambers and is located
slightly left of the midline in the thoracic cavity.
The two atria are separated by the interatrial
septum (wall), and the interventricular septum
divides the two ventricles.
Heart valves are positioned between each atrium
and ventricle so that blood can flow in one
direction only, thereby preventing backflow.
Blood flow through the heart
TheHeart
Theheartisamuscularorganresponsiblefor
thecontinuouspumpingofbloodthroughthe
vascularsystem
Itisaboutthesizeofaman'sclosedfist.
Itcontainsfourchambers:therightandleft
atrium,andtherightandleftventricle

TheHeart
Bloodenterstheheartthroughtherightatrium
andleftatriumandleavesbywayoftheright
andleftventricles.
Rightatriumreceivesbloodfromsuperiorvena
cavaandinferiorvenacava.
Bloodexitsthroughtherightventricletobegin
pulmonarycircuit.

The Heart
Figure 4.2 Sectional

Anatomy of the Heart

TheHeart
Therightsideoftheheartisresponsiblefor
pumpingoxygenpoorbloodtothelungsto
pickupoxygen.
Theleftsideoftheheartisresponsiblefor
pumpingtheoxygenrichbloodtoallpartsof
thebody.
Amuscularwallcalledtheseptumdividesthe
rightandleftsidesoftheheart.
The Heart
Figure 4.3 The Pulmonary Circuit

TheHeart
Thepulmonaryveinsbringoxygenrichblood
andthevenacavabringsoxygenpoorblood
Valvesintheheartcontroltheflow,ifavalve
malfunctions,bloodflowsbackwardscausing
aheartmurmur.
Theheartbeatsabout60to80timesper
minuteandismeasuredbyfeelingthepulse.

The Heart: Conduction System
Intrinsic conduction system

(nodal system)
Heart muscle cells contract, without nerve
impulses, in a regular, continuous way
Copyright2003PearsonEducation,Inc.publishingasBenjaminCummings Slide
The Heart: Conduction System
Special tissue sets the pace

Sinoatrial node (right atrium)
Pacemaker
Atrioventricular node (junction of r&l atria
and ventricles)
Atrioventricular bundle (Bundle of His)
Bundle branches (right and left)
Purkinje fibers
Heart Contractions
Figure 11.5
The Heart: Cardiac Cycle
Atria contract simultaneously

Atria relax, then ventricles contract
Systole = contraction
Diastole = relaxation
Filling of Heart Chambers
the Cardiac Cycle
Figure 11.6
The Heart: Cardiac Output
Cardiac output (CO)

Amount of blood pumped by each side of
the heart in one minute
CO = (heart rate [HR]) x (stroke volume
[SV])
Stroke volume
Volume of blood pumped by each ventricle
in one contraction
Cardiac output, cont.
CO = HR x SV
5250 ml/min = 75 beats/min x 70 mls/beat
Norm = 5000 ml/min
Entire blood supply passes through body
once per minute.
CO varies with demands of the body.
Cardiac Output Regulation
Figure 11.7
The Heart: Regulation of Heart
Rate
Stroke volume usually remains relatively
constant
Starlings law of the heart the more that
the cardiac muscle is stretched, the
stronger the contraction
Changing heart rate is the most
common way to change cardiac output
Regulation of Heart Rate
Increased heart rate
Sympathetic nervous system
Crisis
Low blood pressure
Hormones
Epinephrine
Thyroxine
Exercise
Decreased blood volume
The Heart: Regulation of Heart
Rate
Decreased heart rate

Parasympathetic nervous system
High blood pressure or blood volume
Dereased venous return
In Congestive Heart Failure the heart is
worn out and pumps weakly. Digitalis
works to provide a slow, steady, but
stronger beat.
TheVesselsandCirculation
Bloodcirculatesthroughoutthebodywithina
closedsystemthroughbloodvessels.
Bloodvesselsaretubelikestructurescapable
ofexpandingandcontractingandconsistof
threetypes:arteries,veinsandcapillaries.

Arteries
Arteriescarryhighlyoxygenatedbloodaway
fromtheheart.
Arteriesbranchintosmallervesselscalled
arterioles.
Arterieshavethickwallscomposedofthreelayers
becausethebloodisunderpressure
Theonlyarterythatisnotoxygenatedisthe
pulmonaryartery,whichcarrybloodfromthe
rightsideofthehearttothelungsforoxygenation.
The Vessels and Circulation
Figure 4.9 The Arterial System

Arteries
Theonlyarterythatisnotoxygenatedisthe
pulmonaryartery,whichcarrybloodfromthe
rightsideofthehearttothelungsfor
oxygenation.
Fullofoxygen,normalarterialbloodisbright,
cherryredincolor.
Thelargestarteryinthebodyistheaorta.
Arterieshaveapulse.
Figure 4.11 Comparison of

Arteries, Veins, and Capillaries

Capillaries
Bloodflowsfromthearterialsystemintothe
smallestofthebloodvessels,thecapillaries.
Capillariesaremicroscopicvesselscomposedofa
singlelayerofendothelialcells
oxygenisreleasedandcarbondioxideisabsorbed
bytheblood.
Capillariesreturntheoxygenpoorbloodtothe
smallestoftheveins,venules
Bloodinthecapillariesisamixtureofbothvenous
andarterialblood.
The Blood
Figure 4.4 Exchange of gases in Systemic

and Pulmonary Capillaries

Figure 4.17 Capillary Bed

Capillaries
Capillary bleeding is occurs slowly and evenly

because of the smaller size of the vessels and
the low pressure within the vessels.
Capillary bleeding is usually considered minor
and is easily controlled with slight pressure or
sometimes bleeding stops without intervention.

Capillary Beds
Capillary beds
consist of two
types of vessels
Vascular shunt
directly connects an
arteriole to a venule
Copyright2003PearsonEducation,Inc.publishingasBenjaminCummings Figure 11.10 Slide

Capillary Beds
True capillaries
exchange vessels
Oxygen and
nutrients cross to
cells
Carbon dioxide
and metabolic
waste products
cross into blood
Copyright2003PearsonEducation,Inc.publishingasBenjaminCummings Figure 11.10 Slide

Diffusion at Capillary Beds
Figure 11.20
Click on the image above to see an animation showing capillary pressure.

Figure 4.10 Venous System

Veins
Veinsareresponsibleforreturningbloodto
theheart.
Veinscarrydeoxygenatedblood
Theonlyveinthatcarriesoxygenatedbloodisthe
pulmonaryvein,whichcarriesoxygenatedblood
fromthelungsbacktotheheart.
Thewallscomposedofthreelayersbutarethinner
thanarteriesbecausethebloodisunderless
pressure.
Veins
Becausevenousbloodisoxygenpoor,itis
muchdarkerincolorthannormalarterial
blood.
Thelargestveininthebodyisthevenacava.
Thelongestveininthebodyisthegreat
saphenousveinintheleg.

Figure 4.13 Venous System of

the Upper Torso and Arm

Figure 4.14 Major Arm Veins

Figure 4.15 Variations in Venous Patterns

Figure 4.16 Major Leg Veins

Figure 4.12 Plaque Build-Up Causing Partial Blockage of the Artery

Summary
Insummary,bloodisoxygenatedinthelungs,
thearteriescarrytheoxygenrichblood
througharteriolesthentothesmallestbranches
calledcapillaries.Bloodgoesfromthe
capillariesintothevenulestotheveinstobe
returnedbacktotheheart.

Hemostasis and Coagulation
Hemostasis
Hemostasis is the maintenance of circulating
blood in the liquid state and retention of blood in
the vascular system by preventing blood loss.

Hemostasisistheprocessbywhichthebody
stopstheleakageofbloodfromthevascular
systemafteraninjury.
Itincludestheprocessthatleadstoclotformation
aswellasclotdissolution.
Ifaninjuryoccurstoabloodvessel,the
hemostaticprocessissetinmotiontorepairthe
injury.

Thishemostaticprocess,alsocalled
coagulation,proceedsinfoursteps
MEMORIZE.
Vasoconstriction
Plateletplugformation
Fibrinclotformation
Fibrinolysis

Figure 4.18 Steps in the clotting

response

Coagulation Issues that Impact Phlebotomy

Divided into two systems: intrinsic and extrinsic.
When a phlebotomist discovers or anticipates
bleeding, it is important to use standard
precautions, including gloves, to avoid exposure
of the skin and mucous membranes.
Drugs such as heparin and Coumadin (warfarin),
suppress clotting factors.
Clotting factors are not produced by the body.
Disseminated intravascular coagulation (DIC),
emboli, thrombi, etc.

Laboratory Tests of the
Cardiovascular System
The number of RBCs, their morphological traits,

and their hemoglobin content can be determined
from an anticoagulated blood specimen in the
clinical hematology laboratory.
Platelets and WBCs can be assessed on the
basis of number and morphological features.
Platelet function, as well as each coagulation
factor, can be measured from anticoagulated
blood specimens in the coagulation section of
the clinical hematology laboratory.

DiagnosticAssessmentofthe
CirculatorySystem
Blood
CBCincludingindices(MCV,MCH,MCHC)lavender
Hemoglobinand/orHematocrit(H&H)lavender
differentiallavender
eosinophilcountlavender
ESRlavenderorblack
Ferritinred
Ironandtotalironbindingcapacity(TIBC)red
bonemarrow

CirculatorySystem
Heart
ABG
AST
CKandCKisoenzymes
ElectrolytesNa,K,CO2andCl
LDH
Triglycerides
cholesterol

CirculatorySystem
BloodVessels
Cholesterol
Triglycerides
coagulationtests(seenext)

CirculatorySystem
Coagulation
Prothrombintime(PT)
Partialthromboplastintime(PTT)
Fibrinogen
Fibrindegradationproducts(FDP)
Plateletcount
Factorassays
Bleedingtime

Table 4.3 Common Blood Chemistries

and Examples of Disorders Associated
with Abnormal Results

Bone marrow can be stained and studied

microscopically in the hematology laboratory for
the detection of abnormal numbers and
morphological characteristics of blood cells.
Tests for blood types and cross-matches for
donor blood are done in an immunohematology,
a transfusion, or a blood banking laboratory


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Phlebotomy Handbook

Blood Collection Essentials

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Box 4.1: Functions of the blood

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Table 4.1: Blood Cells

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Red blood cells measure about 7 mm in

Figure 4.5 Human Blood Types

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Figure 4.6 Human Blood Cells

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Figure 4.8 Blood is slightly basic with a pH of 7.35

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Figure 4.1 Superficial Anatomy of

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

The human heart is a muscular organ about the

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Figure 4.2 Sectional

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Figure 4.3 The Pulmonary Circuit

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Intrinsic conduction system

Special tissue sets the pace

Atria contract simultaneously

Cardiac output (CO)

Decreased heart rate

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Figure 4.9 The Arterial System

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Figure 4.11 Comparison of

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Figure 4.4 Exchange of gases in Systemic

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Figure 4.17 Capillary Bed

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Capillary bleeding is occurs slowly and evenly

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Copyright2003PearsonEducation,Inc.publishingasBenjaminCummings Figure 11.10 Slide

Copyright2003PearsonEducation,Inc.publishingasBenjaminCummings Figure 11.10 Slide

Click on the image above to see an animation showing capillary pressure.

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Figure 4.10 Venous System

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Figure 4.13 Venous System of

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Figure 4.14 Major Arm Veins

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Figure 4.15 Variations in Venous Patterns

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Figure 4.16 Major Leg Veins

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Figure 4.12 Plaque Build-Up Causing Partial Blockage of the Artery

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition