MODULE 5: CIRCULATORY SYSTEM 1.

The exchange of materials occurs through the

Phlebotomy – extraction of blood
a. Venipuncture
 more often than not, blood that is collected for
analyses is extracted from the veins
(deoxygenated blood)
b. Arterial puncture
 blood that is collected for analyses is extracted
from the arteries (oxygenated blood)
CIRCULATORY SYSTEM
 cardiovascular system or vascular system
 network of organs that allow the movement of
blood throughout the body
 works separately but together <3
 vital function is to transport blood to all parts of the
body
 extremely important because it carries
nutrients, oxygen, carbon dioxide, hormones,
and blood cells which are required for the
nourishment and growth the cells of every
organ
 a closed network consisting of five major
components:
a. heart
b. blood
c. blood vessels
d. lymph
e. lymphatic vessels
single-celled endothelial walls of capillaries.
Deoxygenated blood (CO2) from various tissues
then returns to the right atrium of the heart
through two major veins – the superior and
inferior vena cava.
2. Once deoxygenated blood reaches the right
ventricle through the tricuspid valve, it is
pumped to the lungs during ventricular systole
through the pulmonary artery.
3. In the lungs, gas exchange (blood expels CO2
and receive O2) occurs within the alveoli.
Oxygenated blood (O2) from the lungs arrives
through the pulmonary vein to the left atrium.
4. It passes into the left ventricle through the
mitral valve during atrial systole or contraction.
5. During ventricular systole, this blood is pumped
into the aorta to be circulated in the body
through arteries, arterioles, and capillaries.
6. Blood containing oxygen passes it to the cells
because the body needs O2 for its metabolic
activities, and again the blood will be receiving
CO2 and wastes.

2 Division of the Vascular System

1. Lymphatic System
 drains excess fluid from the tissue spaces and
transport nutrients and waste products back to
the blood stream
 provides a defence mechanism against disease
by storing lymphocytes and monocytes that
protect the body from foreign substances
through phagocytosis and the immune response
BLOOD VESSELS
(helper T-cells & D-cells)
 lymphocytes – converted into phagocytes
or those that produce antibodies like B-
cells; killer T-cells
 monocytes – known as the large
phagocytes

2. Cardiovascular System
 the transport system of the body
 three main components: heart, blood vessel
and blood
 best specimen in detecting the cause of disease
is blood because it travels throughout the body,
thus containing bits and pieces of information
on what is going on inside the body a. Vein
- carries unoxygenated blood (CO2) except
pulmonary vein; or
THE HEART - carries blood towards the heart
 has four chambers: two atria and two ventricles
- venous blood – darker and more blue/purple
a. atria – receiving chambers (receive blood from
- less pressure because it has a wider lumen but
veins)
thinner endothelium
b. ventricles – efficient pumps (sending blood into
 in extracting blood from vein, we need to
arteries)
apply tourniquet to increase pressure/
temporarily block the blood from exiting in
How blood circulates in the Heart?
order to visualize the vein
 - due to the less pressure, it contains valves in
order to stop backflow of blood
b. Artery
- carries oxygenated blood (O2) except
pulmonary artery; or
- carries blood away from the heart toward
other tissues and organs
- arterial blood – usually bright red in color
because of the large amount of oxygen it carries
- great pressure that is why it requires a thicker
endothelium
- doesn’t have valves because there is no danger
of blood back-flowing because of the great
pressure coming from the heart
Why capillaries doesn’t have external covering?
to allow nutrients to easily diffuse (transfer) or pass
through them
 Blue represents deoxygenated blood, while the red
represents oxygenated blood (a real color
phenomenon seen in blood)
 Arteries and veins undergo repeated branching to
produce arterioles and venules.
 Capillaries – thinnest blood vessels made of a single
layer of squamous epithelial cells
 These thin tubular structures are the primary site
for the exchange of materials between the
circulatory system and tissue
 Arteries and veins are connected through
capillaries.
*Review
Cells → Tissues → Organs → System → Organism
Cells
a. Squamous - surfaces
b. Cuboidal – glands
c. Columnar – deeper tissues
Tissues
a. Muscle
b. Nerve
c. Connective
d. Epithelial
In blood vessels
 epithelium – outer surface (covers)
 endothelium – inner surface (lines)
 both are lined up with epithelial tissues
 The blood drawn for routine tests is often from the
veins.
 thin layer, thus easier to pierce
 less painful because superficial – making it more
accessible
 lower blood pressure so that the bleeding can
be stopped more quickly and easily
 Arteries of the systemic circulation contain
oxygenated blood, while the veins bring
deoxygenated blood containing high amounts of
carbon dioxide towards the heart.
 The reverse is true for pulmonary circulation since
the blood receives oxygen in the lungs, then makes
its way back to the heart to be pumped out to the
body.
LYMPHATIC CIRCULATION
 functions of the Lymphatic System overlap with the
circulatory system
Interstitial fluid
 A colorless solution that bathes all the cells of
the body and forms a major component of the
extracellular fluid
 formed due to the hydrostatic force of
blood in capillaries which causes water,
ions, and small solutes from the circulatory
system to escape
 Interstitial fluid is similar to blood plasma in
many ways (structure and composition)
 Some of this fluid starts to flow into the
extended open-ended network of tubular
structures forming the lymphatic circulation
 this fluid is now called lymph and passes
through lymph nodes, where pathogens,
damaged cells, or cancerous cells can be
trapped and destroyed
 Metabolic wastes and cell remnants are then
moved towards the bloodstream and processed
before being expelled or excreted as body
waste
 Edema (swelling) accumulates in tissues during
inflammation or when lymph drainage is
impaired
 It absorbs and transports fatty acids and
fats as chylomicrons from the digestive
system
MAJOR ARM VEINS FOR VENIPUNCTURE
Best Sites for Venipuncture Superficial veins of the
upper limb:
1. Median cubital vein
 most commonly used for venipuncture
 it lies over the cubital fossa and serves as an
anastomosis between the cephalic and basilic
veins
2. Cephalic Vein
 it can be followed proximally where it empties
into the axillary vein
3. Basilic Vein
 it divides to join the brachial vein

Other sites:
1. Dorsal metacarpal veins
 not exactly a common choice (eg. in cases for
bloated/obese patients)
 these are found in the middle of the hand, and
is commonly used for intravenous infusion
 in the event that the antecubital vein is
inaccessible, the dorsal metacarpal veins
provide a viable alternative
For newborns, the physicians can also collect in the vein
that is located at the ankle region
Inappropriate Sites for Venipuncture
 Arm on side of mastectomy
 mastectomy – the process where the breast
or both breast are removed for certain
condition
 because there will be an increase of certain
substances that may lead to false increase
in analytes, especially clinical chemistry
examination
 Edematous areas
 edema – there is an accumulation of
extracellular fluid
 thus, instead of collecting blood, it will be
diluted already with extracellular fluid/
interstitial fluid
 Hematomas
 hematoma – your blood vessels has already
had enough punctures or it could mean that
your blood vessels is injured
 Arm in which blood is being transfused
 because transfusion would mean that
another person’s blood is entering the
recipients bloodstream, thus, it might give
us a wrong impression on analytes that may
be present
 we might be collecting the blood from the
donor instead of the blood of the recipient
 Scarred areas
 give us a hard time penetrating the area
because it is already calloused
 Arms with fistulas or vascular grafts
 fistula – cut-downs or result of an injury or
surgery
 Sites above an IV cannula
 site of infusion (like dextrose)
 because it will be diluted by the infusion
BLOOD
 a fluid that is also a type of connective tissue
 connective tissues are made up of 2
components: cells and extracellular matrix
 composed of blood cells (RBC, WBC, platelets) and
an aqueous fluid known as plasma (extracellular
matrix)
 two major functions: transporting substances to
and from our cells, and providing immunity and
protection against infectious agents such as bacteria
and viruses
 other function is thermoregulation
Blood Components
Amorphous:
1. Plasma
 major constituent of blood comprises about 55
percent of blood volume
 consists of water with several different
substances dissolved within
 contains salts, proteins, and some blood
cells
 also transports nutrients, sugars, fats,
hormones, gases, and waste material contained
within blood
Formed Elements
2. Red Blood Cells (Erythrocytes)
 determine blood type and are the most
abundant cell type in the blood
 have what is known as a biconcave shape
 both sides of the cell's surface curve inward
like the interior of a sphere
 this flexible disc shape helps to increase the
surface area-to-volume ratio of these
extremely small cells
 do not have a nucleus, but they do contain
millions of hemoglobin molecules
 younger cells are nucleated, and as RBC
mature they lose their nucleus
 in hematology, when you found nucleated
RBC, it means cancer or there is something
wrong in your blood production
 hemoglobin are iron-containing proteins bind
oxygen molecules obtained in the lungs and
transport them to various parts of the body
 after depositing oxygen to tissue and organ
cells, red blood cells pick up carbon dioxide
(CO2) for transportation to the lungs where
the CO2 is expelled from the body
3. White Blood Cells (Leukocytes)
 play an important role in the immune system
and lymphatic system by defending the body
against infection
  locate, destroy, and remove pathogens and
foreign matter from the body
 have several different types of white blood
cells, each with different functions:
A. Granular
a. Basophils – during intoxication (eg.
poison)
b. Eosinophils – during allergic reactions
c. Neutrophils – phagocytosis
B. Agranular
a. Monocytes – largest; phagocytes; can
be found in different parts of the body
(lungs = dust cells, bones = osteoclast,
skin = Langerhans cells, etc.)
b. Lymphocytes
i. B-cells – produce antibodies
ii. T-cells – killer T-cells (phagocytes),
helper T-cells(trigger the B-cells),
suppressor
4. Platelets (Thrombocytes)
 are formed from pieces of cells found in the
bone marrow called megakaryocytes
 fragments of the megakaryocytes circulate
through the bloodstream and play a major role
in clotting
 when platelets encounter an injured blood
vessel, they clump together to block the
opening in the vessel
The illustration below shows the classification of the
components of blood with its corresponding percent
composition.
This illustrates the composition of blood spun in a
centrifuge. Normally RBC is about 55%, plasma or serum
is about 45% and WBCs and platelets less than 1%.
COAGULATION OF BLOOD
Hemostasis
 ability of the body to control the flow of blood
following vascular injury is paramount to
continued survival
 in phlebotomy, the best thing to do after
extracting blood from patient is to apply
pressure and cover it with cotton
 involves clotting and then the subsequent
dissolution of the clot, following repair of the
injured tissue
 microorganism will be prevented from
entering
 blood will be prevented from escaping
 comprises four major events that occur in a set
order following the loss of vascular integrity:
1. Vascular constriction
 initial phase of the process
 limits the flow of blood to the area of injury =
tissues will constrict
2. Platelets activation
 by thrombin and aggregate at the site of injury,
forming a temporary, loose platelet plug
 fibrinogen is primarily responsible for
stimulating platelet clumping
 when fibrinogen (already present in the
bloodstream) is triggered, it will convert to
fibrin because of the presence of thrombin
 platelets clump by binding to collagen that
becomes exposed following rupture of the
endothelial lining of vessels
 Upon activation, platelets release the
nucleotide, ADP and the eicosanoid, TXA2
(both of which activate additional platelets),
serotonin, phospholipids, lipoproteins, and
other proteins important for the
coagulation cascade
 in addition to induced secretion, activated
platelets change their shape to accommodate
the formation of the plug
 most important chemical that triggers clot
formation is the tissue (body fluid)
3. Clot formation
 fibrin mesh and entraps the plug
 to insure stability of the initially loose platelet
plug
 white thrombus
 If the plug contains only platelets
 red thrombus
 if red blood cells are present
4. Dissolution of the clot
 for normal blood flow to resume following
tissue repair
 occurs through the action of plasmin
 every wound will always produce a scar
INTRINSIC AND EXTRINSIC PATHWAY
 Two pathways lead to the formation of a fibrin clot:
the intrinsic and extrinsic pathway.
 Although they are initiated by distinct mechanisms,
the two converge on a common pathway that leads
to clot formation.
 Both pathways are complex and involve numerous
different proteins termed clotting factors.
Extrinsic Pathway
 Fibrin clot formation in response to tissue
injury is the most clinically relevant event of
 hemostasis under normal physiological
conditions.
 This process is the result of the activation of
the extrinsic pathway.

Intrinsic Pathway
 The formation of a red thrombus or a clot in
response to an abnormal vessel wall in the
absence of tissue injury is the result of the
intrinsic pathway.
 has low significance under normal physiological
conditions
 most significant clinically is the activation of the
intrinsic pathway by contact of the vessel wall
with lipoprotein particles, VLDLs and
chylomicrons
 this process clearly demonstrates the role of
hyperlipidemia in the generation of
atherosclerosis
 the intrinsic pathway can also be activated by
vessel wall contact with bacteria