CIRCULATORY SYSTEM

PRINCIPLES OF MEDICAL LABORATORY SCIENCE (Lecture)

MEDICAL LABORATORY SCIENCE - LYCEUM OF THE PHILIPPINES BATANGAS

Functions:
 Deliver oxygen & nutrients.
 Removes wastes products.
 Helps in the coagulation process.
 Regulates body temperature.
 Important in body defenses (WBCs in
the blood)
Two main components:
 Cardiovascular System
o Heart OXYGENATED BLOOD
DEOXYGENATED BLOOD
o Blood vessels
o Blood
 Lymphatic System
o Lymph
o Lymph nodes (neck - surgical
lymph node)
o Lymph vessels
 
CARDIOVASCULAR SYSTEM
HEART
 Hollow muscular organ that has four
chambers and is surrounded by a thin,
fluid- filled sac called pericardium
 Its size is about that of a person’s
clenched fist
Pericardium / Pericardial Sac
 a sac that anchors and protects heart
 Functions
o Keeps the heart contained in the
chest cavity
LAYERS OF THE HEART WALL
o Prevents the heart from
1. Epicardium (Outer)- covers the heart
overexpanding when blood and is attached to the pericardium.
volume increases.
o Limits heart motion.
 consists of fibrous and serous pericardia
o Fibrous pericardium - tough,
fibrous connective tissue outer
layer
o Serous pericardium - the inner
layer of flat epithelial cells, with a
thin layer of connective tissue
 Parietal pericardium -
portion of the serous
pericardium lining the
fibrous pericardium.
 Visceral pericardium / 2. Myocardium (Middle)- pumps blood into
Epicardium - the portion the arteries
covering the heart surface.
 3. Endocardium (Inner)- lines the valves 1. Cardiac Cycle- Systole (contraction)
and interior chambers and diastole (relaxation) lasts about 0.8
seconds
2. Electrical Conduction System- sends
impulses which is initiated by the
sinoatrial (SA) node pacemaker
3. ECG- graphical representation of the
cardiac cycle
4. Heart sound- “Lubb” and “Dupp”
- Lubb - has a lower pitch than the
second; occurs at the beginning of
ventricular systole and results from
closure of the AV valves
- Dupp - occurs at the beginning of
ventricular diastole and results from
CHAMBERS OF THE HEART closure of the semilunar valves
1. Right Atrium (Upper right)- receives 5. Heart Rate and Cardiac Output-
deoxygenated blood from the body average heart rate is 72 bpm and
2. Right Ventricle (Lower right)- receives
cardiac output refers to the volume of
blood from the right atrium and pumps it
blood pumped per minute (slightly more
to the pulmonary artery
3. Left Atrium (Upper left)- receives than 5 L/min.) (avg heartrate/heartbeat –
oxygenated blood from the lungs and 60-100 bpm)
pumps it into the left ventricle a. TACHYCARDIA – ABOVE 72
4. Left Ventricle (Lower left)- receives BPM
blood from the left atrium and pumps it b. BRADYCARDIA – BELOW 66
into the aorta BPM
VALVES OF THE HEART 6. Pulse- rhythmic throbbing from the
1. Right AV valve- tricuspid valve expansion of the artery
Location: between RA and RV 7. Blood Pressure- force exerted by the
Function: closes as RV contracts preventing blood on the walls of the blood vessel
blood from flowing back to the RA (120/80 mmHg)
2. Left AV valve- bicuspid or mitral
valve DISORDERS OF THE HEART
Location: between LA and LV
Function: closes as LV contracts preventing ANGINA PECTORIS
blood from coming back to the LA - Sharp chest pain caused by decrease
3. Right semilunar valve- pulmonary blood flow to the heart usually because
valve of an obstruction in the coronary
Location: entrance of the pulmonary artery arteries.
Function: closes when the RV relaxes
preventing blood from flowing back to the RV
4. Left semilunar valve- aortic valve
Location: entrance of the aorta
Function: closes when the LV relaxes
preventing blood from flowing back to the LV
AORTIC STENOSIS
SEPTA - A murmuring sound produced when the
1. Interatrial septum- separates the right aortic leaflets fail to fully open during
from the left atria systole
2. Interventricular septum- separates the
BACTERIAL ENDOCARDITIS
right and the left ventricles
- Inflammation of the inner lining of the
heart caused by a bacterial infection
(Staphylococcus epidermidis)
CONGESTIVE HEART FAILURE
- Impairs the ability of the heart to pump
blood efficiently,
FUNCTIONS OF THE HUMAN HEART
 causing fluid accumulation in the lungs cholesterol levels, eat a diet low in cholesterol
and tissues. and saturated fat.
3. Control high blood pressure. More
than 50 million people in the U.S. have
hypertension, or high blood pressure,
MYOCARDIAL INFARCTION (di na makadaan ang blood making it the most common heart
dahil barado)
disease risk factor. Exercise and healthy
- Death (necrosis) of the heart muscle eating help. Some people may need
caused by lack of oxygen to the medicine to control their blood pressure,
myocardium because of an occluded too.
artery. 4. Get active. People who don't exercise
- Commonly known as heart attack are more likely to get heart disease, and
die from it, than people who are active.
Check with your doctor before starting a
new exercise program, especially if you
aren't active now. She can tell you what
you can do.
5. Follow a heart-healthy diet. Eat foods
that are low in fat and cholesterol. Just
- Inflammation of the pericardium of the about everyone should eat more fruits,
heart caused by bacteria, viruses, vegetables, whole grains, beans, nuts,
trauma or malignancy legumes, and other plant-based foods.
The fiber is good for your cholesterol,
RHEUMATIC HEART FEVER and you'll get vitamins the natural way,
- Autoimmune disorder affecting heart from foods.
tissue following a streptococcal infection
DIAGNOSTIC TESTS FOR HEART
DISORDERS You can still eat fish (especially salmon or tuna,
which are high in good-for-you omega-3 fatty
1. ABG 8. LDH
acids), poultry, and meat, but make it lean and
2. AST/ SGOT 9. Microbial cultures keep the portions modest. Also limit salt and
3. Cholesterol 10. Myoglobin sugar. Most people get too much of both.
4. CK/ CK- MB 11. Potassium 6. Get to a healthy weight. Losing extra
5. Digoxin 12. TAG (triglyceride) weight is good for your heart. It can also
6. ECG 13. Troponin help you lower high blood pressure and
manage diabetes.
7. Control diabetes. Diabetes makes
You can do a lot to lower your odds of getting
heart disease more likely. Many people
heart disease. Taking action will improve your
who have diabetes don't know it. Get
health -- and, possibly, save your life. Get
tested and get treated.
going on these 8 ways to get on track.
8. Manage stress and anger. Everyone
1. Quit smoking. If you smoke, you are has stress, and it's normal to get angry
more than twice as likely to have a heart now and then. When stress and anger
attack as nonsmokers, and you’re much flare up, especially if it happens a lot,
more likely to die if you do have a heart that's a problem. Managing your stress
attack. and handling your anger in healthy ways
2. Improve cholesterol levels. You're puts you back in charge.
more likely to get heart disease if you
CARDIOVASCULAR SYSTEM
have:
BLOOD VESSELS
- Total cholesterol level over 200
Two main divisions:
- HDL ("good") cholesterol level under 40
- Pulmonary circulation- RV to the lungs
- LDL ("bad") cholesterol level over 160
- Systemic circulation- LV to the rest of
Cholesterol isn't the only thing that matters. the body
Your doctor will consider the big picture,
Structures of the Vascular System
including all your potential risks. To help lower
 -Arteries- carry oxygen- rich blood
(bright red in color)
- Arterioles – small diameter blood
vessels that branch out from the arteries
and transport blood from small arteries
to capillaries
- Veins- carry deoxygenated blood (dark
red in color)
- Venules - have a diameter slightly larger
than that of capillaries, very small veins
that collect blood from the capillaries
- Capillaries-(pinakamaliit)fine hair-like blood
vessels that connect arterioles and veins From upper extremities

HACV – BLOOD CIRCULATION IN THE

HEART
- FROM THE HEART TO ARTERY TO
CAPILLARY TO VEIN THEN CYCLE
AGAIN TO HEART
CIRCULATION OF BLOOD

Blood vessel structure

1. Layers Oxygenated blood
- Tunica externa / adventitia
o Outer layer (connective tissue) deoxygenated blood

- Tunica media
o Middle layer (smooth muscle + elastic
tissue) From lower extremities
- Tunica Intima DISORDERS OF THE BLOOD VESSELS
o Innermost histologic layer (epithelial ANEURYSM
cells) - bulge formed by a weakness in the wall
2. Lumen- space inside the blood vessel of a blood vessel; usually an artery that
where the blood flows can burst and cause severe
3. Valves- thin leaflets that prevent backflow hemorrhage.
of blood ARTERIOSCLEROSIS
- Hardening of the artery walls
BLOOD FLOW ATHEROSCLEROSIS
- Form of arteriosclerosis characterized
by accumulation of lipids and other
materials in the lumen of the vessel to
narrow and stimulate clot formation.
 Anti- Anti- Anti-
Antibodies None
B A A&B
EMBOLISM
- Moving clot that can obstruct a blood Distribution 2nd 3rd 4th 1st
vessel
EMBOLUS
- Obstruction that is carried and lodged in
a vessel 
HEMORRHOIDS
- Swollen veins in the anus area
PHLEBITIS
- Inflammation of the vein wall
THROMBOPHLEBITIS
- Swelling of the veins of the legs that
usually occurs during pregnancy
THROMBOSIS
- Obstruction of a blood vessel by a
stationary blood clot
THROMBUS Rh Blood Group System
- Blood clot that impedes blood flow - “D” antigen or the Rh factor
VARICOSE VEINS - Rh+ has D antigens on the RBC
- Swollen peripheral veins caused by - Rh- does not have the D antigen
damage valves allowing backflow of the - Specimen for testing:
blood causing edema (swelling) o Serum
Diagnostic Tests for Blood vessel disorders o Plasma
D- dimer PT o Whole Blood
Fibrin degradation product APTT DISORDERS OF THE BLOOD
Lipoproteins TAG ANEMIA
CARDIOVASCULAR SYSTEM - Decrease RBC count or hemoglobin in
BLOOD the blood
- Red fluid that is transported throughout LEUKEMIA
the body - Increased WBC in the bone marrow and
- Composed of plasma and other formed circulating blood
elements URINARY TRACT INFECTION
- Plasma - clear, straw-colored liquid - Shown by high number of leukocytes
portion of the blood LEUKOCYTOSIS
- Cells - Increased WBC or leukocytes in the
o RBC blood due to illness (e.g. infections)
o WBC LEUKOCYTOPENIA
o Platelets - Decreased WBC or leukocytes in the
BLOOD TYPE blood (e.g. radiation therapy or
- Inherited and determined by the chemotherapy)
antigens on the surface of the RBC POLYCYTHEMIA VERA
- ABO Blood Group System - Increased RBC count causing blood to
- A person’s blood can be classified as A, be viscous
B, O and AB THROMBOCYTOPENIA
- Important in obstetrics because of the - Decreased number of circulating
HDFN platelets (e.g. chemotherapy, dengue
- Cross matching is necessary to fever)
determine the compatibility of donor’s THROMBOCYTOSIS
blood to recipient’s blood - Increased number of circulating platelets
DIAGNOSTIC TESTS FOR BLOOD
ABO Blood Groups DISORDERS
1. ABO and Rh 9. Hct
Type A B AB O type
2. Bone marrow 10. Hgb
Antigen A B A&B None examination
 3. CBC 11. Hemogram
4. Cross- 12. Indices HEMOSTASIS
matching - “the arrest or stoppage of bleeding”
5. Differential 13. Iron - body response that stops the loss of
count blood after injury without affecting the
6. Eosinophil 14. Reticulocyte flow of blood within the rest of the
count count vascular system.
7. ESR 15. TIBC - Hemostasis is a complex mechanism
8. Ferritin that involves:
o Blood vessels
LYMPHATIC SYSTEM
o Platelets
- Network of tissues and organs
o Coagulation / Clotting factors
responsible for the removal of toxins and
waste in the human body - Hemostasis is the process of forming a
- Transport the WBC to and from the blood clot to stop the leakage of blood
lymph nodes throughout the body whenever there is an injury to the blood
STRUCTURE vessel.
Lymph- fluid similar to plasma but is made up FOUR STAGES OF COAGULATION /
of 95% water HEMOSTASIS
- transported throughput the system Stage 1 (primary hemostasis)
through the lymphatic vessels, ducts, - Blood vessels and platelets respond to
and masses of lymph tissue called injury
nodes - Blood vessels constrict to slow the flow
FUNCTIONS of blood to the injured area (vessel
1. Transports the tissue fluid back into the spasm)
bloodstream - Platelets become sticky; clump together
2. Removes impurities (platelet aggregation) and adhere to the
3. Process lymphocytes injured vessel wall (platelet adhesion) to
4. Transports the fats absorbed from the form a temporary platelet plug to stop
small intestine into the bloodstream. bleeding.
DISORDERS OF THE LYMPHATIC SYSTEM Stage 2 (secondary hemostasis)
LYMPHANGITIS - Activation of coagulation cascade that
- Inflammation of the lymphatic channels initiate formation of fibrin strands to
resulting from infection strengthen the platelet plug by forming a
LYMPHADENITIS fibrin clot.
- Inflammation of the lymph nodes Stage 3
LYMPHADENOPATHY - The last factor in the coagulation
- Also called adenopathy cascade (Factor XIII) stabilizes the fibrin
- Abnormality in the size or number of clot.
lymph nodes - This produces retraction (tightening of
SPLENOMEGALY the clot)
- Enlargement of the spleen Stage 4
HODGKIN’S DISEASE
- Cancer that affects the immune system
& is characterized by enlarged lymph
nodes
LYMPHOSARCOMA
- Cancer that develops from lymphocytes
LYMPHOMA
- Cancer of the lymphatic system that
begins in the lymphocytes
DIAGNOSTIC TESTS FOR LYMPHATIC
SYSTEM DISORDERS
1. Bone marrow biopsy
2. CBC
3. Culture and sensitivity
4. Lymph node biopsy
5. Mononucleosis Test
 - After the injury to the blood vessel has - Shallow depression in the arm that is
healed; the process of fibrinolysis inferior to and below the bend of the
degrades the fibrin clot into fibrin elbow.
degradation products (FDP’s). - First-choice location for venipucture
because several major arm veins lie
close to the surface in this area, making
them easy to locate.
H – shaped Antecubital Veins
- Displayed by approximately 70% of the
population
- Median cubital vein
- Cephalic vein
- Basilic vein

DISORDERS OF THE HEMOSTATIC

PROCESS
DISSEMINATED INTRAVASCULAR Median cubital vein
COAGULATION (DIC) - Located near the center of the
- pathological; widespread clotting and antecubital area
fibrinolysis at the same time, in which - Preferred vein for venipuncture in the H-
coagulation factors are consumed to shaped pattern
such an extent that bleeding occurs - Typically larger, closer to the surface,
HEMOPHILIA better anchored and more stationary
- Hereditary condition characterized by than the others
bleeding due to increased coagulation - Easiest and least painful to puncture
time. and least likely to bruise
- Common type: Classic hemophilia Cephalic vein
(Factor VIII deficiency); Christmas - Located in the lateral aspect of the
disease/Hemophilia B (Factor IX antecubital area
deficiency) - Second choice for venipuncture in H-
THROMBOCYTOPENIA shaped pattern
- Abnormal decrease in platelet count - Often harder to palpate than median
cubital vein but is fairly well-anchored
Diagnostic Tests for Hemostatic disorders - Often the only vein that can be palpated
1. Bleeding time 5. PFA in obese patients
2. D- dimer 6. PT Basilic vein
3. Factor assays 7. APTT - Large vein located on the medial aspect
4. FDP of the antecubital fossa
- Last-choice for venipuncture
Phlebotomy-related - Generally easy to palpate but is not well
Vascular Anatomy anchored and rolls more easily,
Antecubital Fossa increasing possibility of accidental
- Means “in front of the elbow” puncture of medial cutaneous nerve
 (major nerve of the arm) or the brachial the medial cutaneous nerve and the
artery brachial artery
- Puncture in this area also tend to be
more painful REMEMBER:
Medial cutaneous nerve - Vein location differs from person to
- also called lesser internal cutaneous person, and you may not see the exact
nerve textbook pattern.
M – shaped Antecubital Veins - The important thing to remember is to
- Median vein / intermediate antebrachial choose a prominent vein that is well-
vein fixed and does not overlie a pulse, which
- Median cephalic vein / intermediate indicates the presence of an artery and
cephalic vein the potential presence of a major nerve
- Median basilic vein / intermediate basilic Other Arm and Hand veins
vein - According to CLSI, although the larger
and fuller median, median cubital,
cephalic and median cephalic veins are
used most frequently, veins on the back
of the hand and wrist are also
acceptable for venipuncture

Median vein
- First choice for venipuncture in the M-
shaped pattern CAUTION!!!
- Well-anchored, tends to be less painful Veins on the underside of the wrist are never
to puncture acceptable for venipuncture.
- Not close to major nerves or arteries as
the others, making it generally the safest Leg, Ankle and Foot veins
one to use - Because of the potential for significant
Median cephalic vein medical complications such as phlebitis
- Second choice for venipuncture in M- or thrombosis, veins of the leg, ankle
shaped pattern and foot must NOT be used for
- Accessible and is for the most part venipuncture WITHOUT permission
located away from major nerves or form the patient’s physician.
arteries, making it generally safe to
puncture
- Less likely to roll and relatively less
painful to puncture

Median basilic vein

- Last choice for venipuncture in the M-
shaped pattern eventhough it may
appear more accessible
- More painful to puncture
- Like the basilic vein, it is located near
the anterior and posterior branches of
- Puncture of the femoral vein is
performed only by physicians or
specially trained personnel.

Arteries
- NOT USED for routine blood
collection
- Arterial puncture requires special
training to perform and is generally
limited to the collection of arterial blood
gas (ABG) specimens for the evaluation
of respiratory function.