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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

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
The Blood

Box 4.1: Functions of the blood

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
Blood

Allbloodcellsdevelopfromundifferentiated
stemcells
Stemcellsareconsideredimmaturecells
Astheymature,theydifferentiateintoerythrocytes
(redbloodcellsorRBCs),leukocytes(whiteblood
cellsorWBCs)andthrombocytes(platelets).
undergochangesinthenucleusandcytoplasmso
thatwhentheyreachthecirculatingblood,they
becomefullymatureandfunctional
Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition
Copyright 2005 Diana Garza Kathleen Becan-McBride
The Blood

Table 4.1: Blood Cells

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Copyright 2005 Diana Garza Kathleen Becan-McBride
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.
Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition
Copyright 2005 Diana Garza Kathleen Becan-McBride
Erythrocytes
ThemaincomponentoftheRBCishemoglobin
whichbindstooxygenfortransporttothetissues,
thenbindstoCO2tobedeliveredtothelungsasa
wasteproduct.
Hemoglobingivesblooditsredcolor.
MillionsofRBCsarecontinuallybeingformedand
destroydaily
Deficienciesmayresultinanemia.
ThesurfacemembraneofRBCscontainstructures
calledantigensthatdesignatetheindividualsblood
type
Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition
Copyright 2005 Diana Garza Kathleen Becan-McBride
The Blood

Figure 4.5 Human Blood Types

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
Leukocytes

WBCsnumberabout5,000to10,000andare
classifiedintocelllineswhichdifferincolor
size,shape,nuclearformationandfunction.
Whitecellsarefurtherdividedintocelllines,
oneofwhichisthegranulocyteswhich
containcytoplasmicgranules.
Segmentedneutrophils
Eosinophils
Basophils
Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition
Copyright 2005 Diana Garza Kathleen Becan-McBride
Leukocytes

Monocytesandlymphocytesareagranularcells.
Monocytes
Lymphocytes
Acommonlyperformedlaboratorytestisthe
"differential
AhighWBCcountwithanincreaseingranulocytes
indicatesabacterialinfection
AhighWBCcountwithpredominantlyimmatureWBCs
presentindicatesleukemia
AlowWBCcountwithanincreaseinthelymphocytes
indicatesaviralinfection.
Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition
Copyright 2005 Diana Garza Kathleen Becan-McBride
The Blood

Figure 4.6 Human Blood Cells

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
Platelets
Thrombocytes,commonlycalledplatelets,aremuchsmaller
thanotherbloodcellsandareactuallyfragmentsof
megakaryocytes.
Normallythereare250,000to450,000platelets/mm3.
Lifespanis912days.
Thrombocytesparticipateinbloodclotting.
Whenvesselsaredamaged,theplateletsreleasefactorsthatare
neededfortheclottingreaction
Bloodclotting,orcoagulation,isthefinalstepinhemostasis,
thepreventionofbloodloss.
Lowplateletsmaycauseapatienttohaveexcessivebleeding
oruncontrolledbleedingafteraninjury.
Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition
Copyright 2005 Diana Garza Kathleen Becan-McBride
Plasma

Plasma
Ifachemicalagentoranticoagulantisaddedto
preventclotting,abloodsamplecanbeseparated
bycentrifugationintothecellsandplasma.
Plasmacannotclotduetoinactivationofcertain
vitalnecessaryelementsandwillcontainall
coagulationfactors.
Anticoagulatedwholebloodisrequiredforalltests
performedinthehematologydepartment
Plasmaisrequiredforallcoagulationtests
Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition
Copyright 2005 Diana Garza Kathleen Becan-McBride
Serum

Serumisproducedwhenbloodisdrawninto
anonadditivetubeandallowedtoclot.
Thebloodcellsbecomemeshedinafibrinclot.
Serumcontainsessentiallythesamechemical
constituentsasplasmaexceptthatclottingfactors
havebeenuseduptoformtheclotsowillhaveNO
coagulationfactors.

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
The Blood

Figure 4.7 Centrifuged Blood Specimens With and Without Anticoagulant, Respectively

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
The Blood

Figure 4.8 Blood is slightly basic with a pH of 7.35

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
The Heart

Figure 4.1 Superficial Anatomy of


the Heart

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
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
Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition
Copyright 2005 Diana Garza Kathleen Becan-McBride
TheHeart

Theheartisamuscularorganresponsiblefor
thecontinuouspumpingofbloodthroughthe
vascularsystem
Itisaboutthesizeofaman'sclosedfist.
Itcontainsfourchambers:therightandleft
atrium,andtherightandleftventricle

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
TheHeart

Bloodenterstheheartthroughtherightatrium
andleftatriumandleavesbywayoftheright
andleftventricles.
Rightatriumreceivesbloodfromsuperiorvena
cavaandinferiorvenacava.
Bloodexitsthroughtherightventricletobegin
pulmonarycircuit.

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
The Heart

Figure 4.2 Sectional


Anatomy of the Heart

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
TheHeart

Therightsideoftheheartisresponsiblefor
pumpingoxygenpoorbloodtothelungsto
pickupoxygen.
Theleftsideoftheheartisresponsiblefor
pumpingtheoxygenrichbloodtoallpartsof
thebody.
Amuscularwallcalledtheseptumdividesthe
rightandleftsidesoftheheart.
Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition
Copyright 2005 Diana Garza Kathleen Becan-McBride
The Heart

Figure 4.3 The Pulmonary Circuit

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
TheHeart

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

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
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
Copyright2003PearsonEducation,Inc.publishingasBenjaminCummings Slide
Heart Contractions

Figure 11.5

Copyright2003PearsonEducation,Inc.publishingasBenjaminCummings Slide
The Heart: Cardiac Cycle

Atria contract simultaneously


Atria relax, then ventricles contract
Systole = contraction
Diastole = relaxation

Copyright2003PearsonEducation,Inc.publishingasBenjaminCummings Slide
Filling of Heart Chambers
the Cardiac Cycle

Figure 11.6

Copyright2003PearsonEducation,Inc.publishingasBenjaminCummings Slide
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
Copyright2003PearsonEducation,Inc.publishingasBenjaminCummings Slide
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

Copyright2003PearsonEducation,Inc.publishingasBenjaminCummings Slide
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

Copyright2003PearsonEducation,Inc.publishingasBenjaminCummings Slide
Regulation of Heart Rate
Increased heart rate
Sympathetic nervous system
Crisis
Low blood pressure
Hormones
Epinephrine
Thyroxine
Exercise
Decreased blood volume
Copyright2003PearsonEducation,Inc.publishingasBenjaminCummings Slide
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.
Copyright2003PearsonEducation,Inc.publishingasBenjaminCummings Slide
TheVesselsandCirculation

Bloodcirculatesthroughoutthebodywithina
closedsystemthroughbloodvessels.
Bloodvesselsaretubelikestructurescapable
ofexpandingandcontractingandconsistof
threetypes:arteries,veinsandcapillaries.

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
Arteries

Arteriescarryhighlyoxygenatedbloodaway
fromtheheart.
Arteriesbranchintosmallervesselscalled
arterioles.
Arterieshavethickwallscomposedofthreelayers
becausethebloodisunderpressure
Theonlyarterythatisnotoxygenatedisthe
pulmonaryartery,whichcarrybloodfromthe
rightsideofthehearttothelungsforoxygenation.
Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition
Copyright 2005 Diana Garza Kathleen Becan-McBride
The Vessels and Circulation

Figure 4.9 The Arterial System

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
Arteries

Theonlyarterythatisnotoxygenatedisthe
pulmonaryartery,whichcarrybloodfromthe
rightsideofthehearttothelungsfor
oxygenation.
Fullofoxygen,normalarterialbloodisbright,
cherryredincolor.
Thelargestarteryinthebodyistheaorta.
Arterieshaveapulse.
Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition
Copyright 2005 Diana Garza Kathleen Becan-McBride
The Vessels and Circulation

Figure 4.11 Comparison of


Arteries, Veins, and Capillaries

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
Capillaries

Bloodflowsfromthearterialsystemintothe
smallestofthebloodvessels,thecapillaries.
Capillariesaremicroscopicvesselscomposedofa
singlelayerofendothelialcells
oxygenisreleasedandcarbondioxideisabsorbed
bytheblood.
Capillariesreturntheoxygenpoorbloodtothe
smallestoftheveins,venules
Bloodinthecapillariesisamixtureofbothvenous
andarterialblood.
Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition
Copyright 2005 Diana Garza Kathleen Becan-McBride
The Blood

Figure 4.4 Exchange of gases in Systemic


and Pulmonary Capillaries

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
The Vessels and Circulation

Figure 4.17 Capillary Bed

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
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.

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
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

Copyright2003PearsonEducation,Inc.publishingasBenjaminCummings Slide
The Vessels and Circulation

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

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
The Vessels and Circulation

Figure 4.10 Venous System

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
Veins

Veinsareresponsibleforreturningbloodto
theheart.
Veinscarrydeoxygenatedblood
Theonlyveinthatcarriesoxygenatedbloodisthe
pulmonaryvein,whichcarriesoxygenatedblood
fromthelungsbacktotheheart.
Thewallscomposedofthreelayersbutarethinner
thanarteriesbecausethebloodisunderless
pressure.
Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition
Copyright 2005 Diana Garza Kathleen Becan-McBride
Veins

Becausevenousbloodisoxygenpoor,itis
muchdarkerincolorthannormalarterial
blood.
Thelargestveininthebodyisthevenacava.
Thelongestveininthebodyisthegreat
saphenousveinintheleg.

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
The Vessels and Circulation

Figure 4.13 Venous System of


the Upper Torso and Arm

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


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The Vessels and Circulation

Figure 4.14 Major Arm Veins

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


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The Vessels and Circulation

Figure 4.15 Variations in Venous Patterns

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


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The Vessels and Circulation

Figure 4.16 Major Leg Veins

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


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The Vessels and Circulation

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

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
Summary

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

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
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.

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
Hemostasis and Coagulation

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

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
Hemostasis and Coagulation

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

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
Hemostasis and Coagulation

Figure 4.18 Steps in the clotting


response

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
Hemostasis and Coagulation

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.

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
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.

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
DiagnosticAssessmentofthe
CirculatorySystem
Blood
CBCincludingindices(MCV,MCH,MCHC)lavender
Hemoglobinand/orHematocrit(H&H)lavender
differentiallavender
eosinophilcountlavender
ESRlavenderorblack
Ferritinred
Ironandtotalironbindingcapacity(TIBC)red
bonemarrow

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
DiagnosticAssessmentofthe
CirculatorySystem
Heart
ABG
AST
CKandCKisoenzymes
ElectrolytesNa,K,CO2andCl
LDH
Triglycerides
cholesterol

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
DiagnosticAssessmentofthe
CirculatorySystem
BloodVessels
Cholesterol
Triglycerides
coagulationtests(seenext)

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
DiagnosticAssessmentofthe
CirculatorySystem
Coagulation
Prothrombintime(PT)
Partialthromboplastintime(PTT)
Fibrinogen
Fibrindegradationproducts(FDP)
Plateletcount
Factorassays
Bleedingtime

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
Laboratory Tests of the
Cardiovascular System

Table 4.3 Common Blood Chemistries


and Examples of Disorders Associated
with Abnormal Results

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride
Laboratory Tests of the
Cardiovascular System

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

Pearson Education Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition


Copyright 2005 Diana Garza Kathleen Becan-McBride