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    Cardiovascular System

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    MaggieSam

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    S=|} The Cardiovascular System: Blood ‘The focus of this chapteris blood; the next two chapters will examine the heart and blood vessels, respectively. Blood transports various Substances, helps regulate several life processes, and affords protec tion against disease. For all ofits similarities in origin, composition, {and functions, blood is as unique from one person to another as are skin, bone, and hair. Health-care professionals routinely examine and analyze its differences through various blood tests when trying to etermine the cause of different diseases. Looking Back to Move Ahead... + Blood Tissue (Section 43) + Positive Feedback Systems (Section 1.3) + Phagocytosis (Section 3.3) be] OBJECTIVE Functions of Blood + List and describe the functions of blood. The cardiovascular system (cordio- = heart; vascular = blood oF blood vessels) consists of thee interrelated components: blood, the heart, and blood vessels. The branch of science concerned with the study of blood, blood forming tissues, and the disorders associated With them is hematology (hém-2-TOL6;é; hemo- or hemoto- = blood; logy = study of. ‘Bloods aliquid connective tissue that consists ofcellssurrounded byextracellular matrix. Blood has three general function: ransporta- tion, regulation, and protection, 1. Transportation. Blood transports oxygen from the lungs to cells ; jughout the body and carbon dioxide (a waste product of you ever wonder how and why blood samples are taken? ‘You can find out in Section 14.2, Clinical Connection: Blood ‘Sampling Procedures and Reasons for Sampling. ‘cellular respiration; see Section 20.1) from the cells to the lungs. It also carries nutrients from the gastrointestinal tract to body cells, heat and waste products away from cells, and hormones {rom endocrine glands to other body cells. 2. Regulation, Blood helps regulate the pH of body fluids. The heat- absorbing and coolant properties of the waterin blood plasma (ee ‘ection 2.2) and its variable rate of flow through the skin help ad- just body temperature. Blood osmotic pressure also influences the water content of cells. 3. Protection. Blood clots (becomes gel-like) in response to an in jury, which protects against its excessive loss from the cardio- vascular system. In addition, white bload cells protect against 333 Scanned with CamScanner 34 CHAPTER 14 Tecenaselr tem: Blo disease by carrying on phagocytosis and producing proteins called antibodies. Blood contains additional proteins, called interferons and complement, that also help protect against disease. Checkpoint 4. Name sever substances tanspartesby blood. 2. Howiebloo protective? [2] Components of Whole Blood ossecrive + Discuss the formation, components, and functions of whole blood. Blood is denser and more viscous thicker than water. The temper ‘ature of blood is about 38°C (100.F) ts pH Is slighty alkaline, ‘ranging from 7.35 to 7.45. Blood constitutes about 8% ofthe total body weight. The blood volumes Sto 6 liters (1.5 gal) nan average- sized adult male and 4 to 5 liters (1.2 gal) in an averoge-sized adult female, The difference in volume is due to differences in body size Whole blood is composed of two portions: (1) blood plasma, 8 liquid extracellular matrix that contains dissolved substances, ‘and (2) formed elements, which are cells and cel fragments. fa TERITEEEY components ot tied in anormal adit sample of blood is centituged (spun at high speed) in a small ass tube, the cells (which ae mare dense) sink to the bottom of the tube and the lighter eight blood plasma (whichis ess dense) forme a layer on top (Figure 24.13) Blood is about 45% formed flements and §5% plasma. Normally, more than 99% of the formed elements are red blood cells (RBCs) since they are the most dense, The percentage of total blood volume occupied by fed blood cells is termed the hematocrit (he-MAT-O-kit) Pale, Coloress white blood cells (WAC) and platelets occupy ess than 19 of total blood volume. They form a very thin ayer, called the butt cot, between the packed RBCS and blood plasma in cent fuged blood. Figure 14.18 shows the composition of blood plasma ‘and the numbers of the various types of formed elements in blood. Blood Plasma When the formed elements are removed from blood, 2 straw: colored liquid ealed blood plasma (or simply plasma) remain. Plasma ie about 91.5% wate, 7% proteins, and 1.58 solutes other than proteins, Proteins in the blood, the plosma proteins, are syn thesized mainly bythe liver. The most plentiful plasma proteins are the albumins(a’-U-mins), which account for about 54% ofa plasma proteins, Among other functions, albumin help maintain proper blood osmotic pressure, whichis an important factorin the texchange of lids across capillary walls. Glebulins(GLOB-i-ns), which compose 28% of plasma proteins, include antibodies, defensive proteins produced during certain immune responses. Fibrinogen (-BRIN-&jen) makes up about 7% of plasma proteins {and isa key protein in formation of blood clots. Other solutes in plasma include electrolytes, nutrients, gases, regulatory sub: stances such as enzymes and hormones, vitamins, and waste products. lls, white Blood cel and platelets. ‘Blood is connecive ave tat const flood plasma iqud plus formed elements ed boad Functions of Blood 4. Transports ongen.carbon 4. Prtetsagast bend los oxide, nutrents hormones, throught and aginst heat ond wastes, ‘Seeze trough phagocyte white 1. Regulates body temperature, ‘lead es and proteins such 5 ee eee arto, iets and comolener. <= ‘Blood pasa (35%) Buty cot, ‘we blood cet Reg blood el rapa ) - le) Ansenance of ented ood 4 Scanned with CamScanner BLOOD PLASMA BODY WEIGHT 142 componente cl role Biood 338 sonieant en BLOOD PLASMA weight) FoR agaaa woggomasees |, Qe ornare? “n@ x" @ Ear | WHITE BLOOD CELLS FRED BLOOD CELLS 45-64 malo g eo FORMED ELEMENTS (number pera) (©) Componertso os 'Q Which formed elements of blood are most numerous? Formed Elements ‘The formed elements ofthe blood are the following see Figure 14.2): 1. Red blood eels erythrocytes) 1, White blood cells (leukocytes) ‘A. Granular leukocytes (contain conspicuous granules that are Visible under alight microscope ater staining) 2. Neutrophils 2. Eosinophils 3. Basophits . Agranular leukocytes (no granules are visible under alight mi- cerescope after staining) 1. Tand B lymphocytes and natural killer cells 2, Monocytes tm, Patlers e Scanned with CamScanner Formation of Blood Cells the process by which the formed elements of blood develop is called hemopoiesis (hém-d- poy-E-sis;-poiesis = making), also called hematopoiesis. Before birth, hhemopoiess fist occurs in the yolk sac ofan embryo and later the liver, spleen, thymus, and lymph nodes ofa fetus. In the last three ‘months before birth, red bone marrow becomes the primary site of hemopoiesis and continues as the source of blood cells ater birth and ‘throughout life Red bone marrow is a highly vascularized connective tissue located in the microscopic spaces between trabeculae of spongy ‘bone tissue. Its present chiey in bones of the axial skeleton, pectoral, ‘and pelvic girdles, and the proximal epiphyses ofthe humerus and femur. About 0.05-0.1%4of red bone marrow cells are cells called plur- ‘potent stem ces (loo-Rl-pé-ten;plur: = several). Plripatent stem ‘als are cells that have the capacity o develop into many different ‘ypesofcells (Figure 14.22), 336 CHAPTER 14 Thecarinasclr System: Blood In response to stimulation by specific hormones, pluripotent stem calls generate two other types of stem cells, which have the ca- pacity to develop into fewer types of cells: myelld stem cells and ‘ymphold stem cells (Figure 14.22) Myeloid stem cells begin theie indie ‘numberof RBCS inthe blood, the higher the oxygen delivery to the tissues (Figure 16.4). & person with prolonged hypoxia, may develop alfethreatening condition called cyanosis (s-2-NOsi), characterized by a bluish-purple skin coloration most easly see” inthe nails and mucous membrones. Oxygen delivery may fll due to anemia alower-than-normal numberof RBCs or reduced qua tity of hemoglobin) or czculatory problems that reduce blood flow totiesuer. Clinical Connection Blood Doping Deter of oxigen to muscle i liming factor n muse feats fem ‘weighting to running a marathon. Asa vesu, increasing the ong ‘arying capac ofthe blood enhances thetic pevformance, especialy Inendurance evens. Beause RBCs transport oxygen, thees Nove ed several means of inreasing thelr REC cour, kro 35 blood doping o: artical induced payythena (on abroxally high number oF BCS) to trina compettivo edge Atletes have enhance thelr RC production by injecting epostin alfa [Proc or Epogen') a drug that used to reat “anernaby stimulating the production of RECs by redone marrow. Pro tices that Incense the number of RBCS are dangerous becouse the ase the viscosity ofthe blood ich increases theresitanc to blood How and ‘makes the blood more diffct for he heart to pump. Iceased viscosity ‘Seo cantibutestofigh Dood pressure and creased iskof stroke, During the 1080, at less 5 competitive eels ded from heart attacks or strokestinka to uspecteduse of eoetin ala Athough thelntermtions Clymer Commits ane te ee of epaetin af, norcement ficult bocsvethe di canta t naturally ocuringeythropoitin (0). ‘So-alled natural blood doping is seeing the ky tothe sucess ofmarathon runners rom Kya. Theaverageattude throughout Kenya's highandsie about 00 tet (1629 meters above Sea el ober a035of enya are even higher Atude waning gretly improve fitness, endurance, and pafomance these higher alltvdes, the body increases the production of red bloed cel, whieh means that exercise realy ‘nygeates the Bldod. When these tuners compete in BoRon, for ferampe tan atitude jut above sea lve, ther bodies contain move ‘etvocies than do ue odes of compat who tained in Boston. A rumberaftaningcampehovebeenexablihed in Kenys and now attract ‘rane athletes tom al over the wor Scanned with CamScanner G “a \ EXCIETE nisstve teesosckregutaton of entropies red )) Meodeattermaton ‘The main stimulus for enptropoesls Is hypwia, » decease Inthe ‘oxygen carving capac ofthe blood, “ srmaus s [= "coxtnotien conomion | copper rye (and other tissues) Disupts homeostasis byaecensng| Detect ow onypen eels, Frereasing sohrpoiin ‘reetan taboos ope Renanto omens when rygen aetery drove neeases {ono 1 I / (@ Whats the term for cellular oxygen deficiency? ‘The rate of erythropoiesis is measured by a reticulocyte count. ‘Normally alittle less than 1%of the oldest RBCs are replaced by new= come reticulocytes on any given day. It then takes 1 t02 days forthe teticlocyes to lose the last vestiges of endoplasmic reticulum and RACs. Thus, reticulocytes account for about 0.5-1.59% Scanned with CamScanner 142 Comporertsofle ised 339 ‘ofall RBCs in a normal blood sample. A low “retic” count ina person who is anemic might indicate a shortage of erythropoietin or an ina bility ofthe ed bone marrow to respond to EPO, perhaps because of ‘nutritional deficiency or leukemia. A high “etic” count might ind ‘ate a good red bone marrow respante to previous blood loss or to iron therapy in someone who had been iron-deficient. It could also pointtoillegaluse of epoetin alfa by an athlete White Blood Cells WBC StmuCTURE AND TPES Unlike red blood cells, white Blood cells (WBC) of leukocytes (L00-46-st; leuko- = white) have nuclei ‘and a full complement of other organelies but they 40 not contain hemoglobin, WAC are classified as either granular or agranular, depending on whether they contain chemical filed cytoplasmic gra ules (vesicles) that are made visible by staining when viewed through alight microscope (see Figure 14.28). The gronulorleukocytes include ‘neutrophils (NOO-tr6fis), eosinophils (€-0-SIN-6-is), nd basophils (Gis8-fis). The ogranulor leukocytes include lymphocytes ond ‘monocytes (MON-Sts). (See Table 14.1 forthe sizes and micro- scopic characteristics of WBCS) WBCFUNeTIONS The skin and mucous membranes ofthe body are continuously exposed to microbes (microscopic organisms), such 33 bacteria, some of which are capable of invading deeper tissues and causing disease, Once microbes enter the body, some WECS combat them by phagocytosis, and others produce antibodies. Neutrophils respond first to bacterial invasion, carrying on phagocytosis and releasing enzymes such as lysozyme that destroy certain bacteria. Monocytes take longer to reach the site of infection than neutro phils, but they eventualy arrive in larger numbers. Monocytes that migrate into infected tissues develop into cells called wandering ‘macrophages (macro: = large -phages = eaters), which can phago: cytize many more microbes than neutrophils. They also clean up cellular debris following an infection. Eosinophils leave the capillaries and enter interstitial fluid They release enzymes that combat inflammation in allergic reactions. Eosinophils also phagocytize antigen-antibody complexes ‘and are effective against certain parasitic worms. A high eosinophit count often indicates an allergic condition or a parasitic infection. Basophils are als involved in inflammatory and allergic reac- tions, They leave capillaries, enter tissues, and can liberate heparin, tistamine, and serotonin. Thee substances intensify the inflamma: tory reaction and ae involved in allergic reactions. ‘Three types of lymphocytes—8 cells, T cells, and natural Killer (NK) cels—are the major combatants inimmune responses, which are described in detail in Chapter 17.8 calls develop into plasma cell, which produce antibodies that help destroy bacteria and inactivate their toxins. T cells attack viruses, fungi, transplanted cells, cancer cells, and some bacteria, Natural Killer eels attack a wide variety of infectious microbes and certain spontaneously arising tumor cells. ‘Wiite blood cells and other nucleated body cells have proteins, called major hstocompatiility (MHC) antigens, protruding from theirplasma membrane into the extracellular fluid. These “celiden- tity markers" are unique for each person (except identical twins). Although RBCS (hich do not possess nuclei) passess blood group 40 CHAPTER 16 Thecarsovasclar Systm Blood 14.1 Summary of Formed Elements in Blood “rast Red Blood Cells (RBCS) or 48 millon) inferaes ‘Amillon/t ines 1-84 darter, beancave dss, without nc efor about 120 days Contain emo which tarspons most the angen and some ofthe carbon dice Inthe blond ‘White Blood els wBCs) 5000-100) orLeukoajtes Granular Levkocytes 60-70 of a wacs pale granules asyofaliwecs os-1wofaltwecs @ @ é Torte fra Tew hours toa ew dos) 10-124 dlaeter cleus has 2-Siobescomeced by thin sands ‘of etvomatnsetplasm has very fi 10-124 ameter nucleus usally has 2abes connected by thickstand flebvomai ge re.orengegromles Fite eoplasm 8-10 ym dametr rules has 2 bes; large eoposmi granules appear deep Combat pathogens and eter rear stances hat erat body Propet desraction of bacteria wth yee dlesns, nd strong arts such 2 superonide anion, hydrogen peronide, 208 ypeclose anion ‘combat ne eect ofhtamine i alr reactions, phogooytize antigen-antibody ‘compos, or destoy cen parasite LUberate heparin staring and serotonin ler eacions tht inter the overt ue purple ‘nlammatoy response granular Leskocytes Lymphocytes (Tells, 20-25%ofIVBCs Smal ymohoctes a6 ymin edie immune responses including Beals end nature ameter larg mphoctes are sntigen-artvody reactions Bl develop Ailes) o-i4yminiameterruceussround int plasma cel whichsecreteatbodies, orale indented; gop formsa rim Tels atack invading Wrases, ance cls, Sound the nuceur that looks sy ble the and wanspanted tissue cals. Natural ler lager the ell the more jopiasm sisble cel attack wide vary of nections ‘microbes and certain spontaneously Sraingtumoresis onocytes 2am of allwBcs 12-20,mdameter nucleus shiney Phagocytosis (ater transforing into ‘shapedornoreenoe shape; cnoplasm hed or wandering macrophages) isle gy and nas foamy apoesance 7000-40000 —-aymdareter call Wayman tative Form plate plugin henostasis for 3-3 day contain many vsices bt reas chemicals tat promote ‘salar spasm and bleed cling “cobosap thee seen wen lg ight, {Some ymphye ale amar cl can efor many yeas oncaeid antigens, they lack the MHC antigens. An incompatible tissue trans- plants rejected by the recipient due, in part, to diferences in donor land recipient MHC antigens. The MHC antigens are used to type tissues to identify compatible donors andrecipientsand thus reduce the chance of tissue rejection WBC Lire SPAN Red biood cells outnumber white blood calls about 700 to 1, There are normally about 5000 to 10000 WBCs per wl. of blood. Bacteria have continuous access to the body through the ‘mouth, nase, and pores ofthe skin, Furthermore, many cls espe- lly those of epithelial tissue, age and die daly and their remains ‘must be removed. However, a WAC can phagocyte only a certain amount of material before interferes with the BCs own metabolic _2ctivties. Thus, the lifespan of most WBCS sony afew days. During 2 patod of infection, many WBCS lve only 2 few hours. However, ‘some Band Tcelisremain nthe Body for year, | Scanned with CamScanner aL
  • ' cot;-ss = a condition of The clots called 2 thrombus, may Aissolve spontaneously. it remains intact, however, the thrombus ‘may become dislodged andbe swept away intheblood. blood lt, ‘bubble of air fat from broken bones, ora piece of debris ransported by the blodstream scaled an embolus er-=in-bolus = a mass; plurals emboi). Because emboli ften frm in veins, where blood flow i slower, the most comman site forthe embolus to become lodged is inthe lungs, a condition called pulmonary emboli Mae- sive emboli inthe lungs may result in ight ventricular fallure and death in afew minutes or hours. An embolus that breaks aay from anarterial wall maylodgeinasmaller-dlameter artery downstream. If it blocks blood flow to the brain, kidney, or heart, the embolus can ‘ausea stroke, kidney allure or heart attack, respectively. clinical Connection Aspirin and Thrombolytic Agents Inpatens wit ear and blond vessel ene, the eens of hemostasis may ecur evn witout etal injury to a blood vessel. at ow oes, ‘pln ints vasoconstriction and platelet agrpaion als reduces the chance of thvombus formation. Det these cs, spruces theriekol wari ich atch (TA), toes, myocardial nrction, and backge of perpheralaneries. ‘Trombolyti (ron bé-ITiK) agent ave chemical substances ‘atc ijectd into the body ssl blod clots that hve already foxmed to restore circulation. They either directly or indirect actate plasminogen. The fist thrombolytic agent, approved in 3882 fr ‘dszahingclotsinthe coronary aes he hea, was streptainase, which i produced by septococalbactera A genetical engineered ‘version of human ese plasminogen activator (PA) i now used to treat both heart aachs an ran atacks stokes) that ae caused by ood cts. (Checkpoint 7. Whatishemostass? 1. How do vascular spsem an patel pluglomation cur? 8. whtibrinchsis ny oes blood rarely remain cated side ood veses? M4 Blood Groups and Blood Types ‘OBJECTIVE + Describe the AO and Rh blood groups. The surfaces of red blood cells contain a genetically determines assortment of antigens composed of glycolipids and elycopro teins, These antigen, called egglutinogens(2g'-L00-TIN-6;en2), occur in characteristic combinations. Based on the presence or absence of various antigens, blood is categorized into different blood groups. Within 2 given blood group there may be two or ore diferent blod types. There are at east 24 blocd groups and ‘more than 100 antigens that can be detected on the surface of red blood cals Here we discuss two major blood groups: ABO and Rh, ‘ABO Blood Group ‘The ABO blood groups based on two antigens calledAand BFig- ure 14.6). People whose RBCS display only antigen Ahave type A blood. Those who have only antigen B are type 8 Individuals who have both Aand B antigens ae type AB, and those who have nel ther antigen A nor Bare type O. In about 20% ofthe population, soluble antigens ofthe ABO type appear in salva and other body ids, in which case blood type canbe identified fom a sample of saliva. The incidence of ABO blood types varies among diferent population groups, as indicated in Table 14.2 In addition to antigens on RBCS, blood plasma usually con tains antibodies or agglutinins (a-GLOO-tinins) that react with the Aor antigens ifthe two are mixed, These are the ant-A ant ‘body, which reacts with antigen A, and the anti-B antibody, which reacts with antigen 8. The antibodies resent in each ofthe four ‘N80 blood types are also shown in Figure 14.6. You do not have antibodies that eact with your own antigens, but you do havea tibodies for any antigens that your RBC lack. For example, if you have type A blood, it means that you have A antigens onthe su faces of your RBCS, but ant-8 antibodies in your blood plasma If youthad anti-Aantibodiesin yourblood plasma, they would attack yourR6Cs Scanned with CamScanner G 144 wooden undticed Tye 348 TERETE mreigens and antibodies voted the ABO blood grouping system. ‘Your plasma doesnot contain antboies that could eacwththe artigrson your red Blood ces. Sishey wren ye Tenia. wes lee toe mania ra atom —~& & ra ee eg Which antibodies are found in type 0 blood? Rh Blood Group ‘The Rh blood grup i 40 named because the Rh antigen, called Rh factor, was frst found inthe blood ofthe rhesus monkey. People whose RBCs have the Rh antigen are designated Rh” (Rh postive); those who lack the Rh antigen are designated Rh” (Rh negative). The percentages of Rh” and Rh” individuals in various populations are shown in Table 14.2. Under norma circumstances, plasma does not ‘ontain ant-Rh antibodies. an Rh” person receives an Rh blood ‘vansfusion however, the immune system starts tomake ant-Rha bodies that doremainin the blood. Transfusions Despite the eiflerences in RBC antigens, blood is the most easily shared of human tissues, saving many thousands of ives every year ee TABLE 14.2 Blood Typesin the United States Scanned with CamScanner through transfusions. transfusion (rans-FUzhun) isthe transfer of wiole blood or blood components (red blood cells only of plasma ‘only into the bloodstream. Most often a transfusion i given to allevi> ate anemia or when blood volume is low, for example, ater a severe hemorrhage. In an incompatible blood transfusion, antibodies inthe recipi- ‘ents plasma bind to the antigens on the donated RBCS, When these antigen-antibody complexes form, they cause hemolysis, and release hemoglobin into the plasma. Consider what happens ifaperson with type Ablood receives a transfusion of type 8 blood In this situation, two things can happen. First, the ant-B antibod Jes inthe recipient's plasma can bind to the B antigens on the donor's RBCS, causing hemolysis. Second, the anti-A antibodies in the donor plasma can bind to the A antigens on the recipient's RBCE, The second reaction is usually not serious because the donor's anti antibodies become so diluted in the recipient's plasma that they do not cause any significant hemolysis of the recipient's RECS. People with type AB blood do not have any anti-A or ant-8 anti ‘bodies in their plasma, They are sometimes called “universal recpi- cents” because theoretically they can receive bload from donors ofall four ABO blood types. People with type 0 blood have neither Anor B ‘antigens on their RBCs and are sometimes called “universal donor ‘Theocetically, because there are no antigens on their RBCs for ant- bodies to attack, they can donate blood to all four A80 blood types. “Type 0 persons requitng blood may receive only type O blood, as, ‘they have antibodies to both A and B antigens in ther plasma, In practice, use ofthe terms universal recipient and univers donor is misleading and dangerous. Blood contains antigens and antibodies ‘other than those associated with the ABO system, and they cancause ‘wansfusion problems. Thus, blood should always be carefully ‘matched before transfusion. 46 CHAPTER 14 Thecarvascuar System aed ‘0 blood typing. The bose areas show age (camping of eablood cal. Inthe procedure for ABO blood typing bloods med with atta serum andant-a serum, rim Anti eum encode eit iape Alc ype ance Renedianags @ Which blood type is referred to asthe “universal donor?” Followingisa summary of ABO blood group interactions: Typing and Cross-matching Blood for Transfusion ‘To avoid blood-type mismatches, laboratory technicians type the patients blood and then either crost-match it to potential donor blood or screen forthe presence of antibodies. nthe procedure for 'AB0 blood typing, single drops ofblood are mixed with diferent ont: ‘ser, solutions that contain antibodies (Figure 147). One drop of blood is mined with anti-A serum, which contains ant-A antibodies that wll agelutinate (clam together) red blood cells that possess A antigens, Anether drop is mined with anti-B serum, which contain ‘antB antibodies that will aggutinate red blood cells that possess B antigens. f there blood cls aglutinate only when mixed with ant ‘Aserum, the blood is type AI the red blood calls agglutinate only when mixed with ant serum, the blood s type B. The blood stype ‘ABifboth drops aglutinate;fneither drop agglutinates, the blood is type0. (checkpoint 10, what isthe basis forcsngushngthe various blood soups? 11, nat precautions must be taken before ginga blood teanesion? We will next direct our attention tothe heart, the second major component ofthe cardiovascular system, Common Disorders Anemia ‘Anemia (a-Némé2) is 2 condition in which the oxygen

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