PMLS 2 MODULE 3
1. Right Atrium – upper right chamber, that
MODULE 3: THE CIRCULATORY SYSTEM
Circulatory System is responsible for
transporting throughout the body.
• oxygenated blood from the heart and lungs
via the arteries. Then the oxygen-depleted
blood is returned to its origin through the
veins.
• The circulatory system delivers the oxygen
and nutrients to all cells in the human body.
It transports carbon dioxide and other
wastes to the other organs of the body and
away from the cells. It helps in the
coagulation process, regulates body
temperature, and assists the body in
fighting diseases.
• This system is made up of two main
components: the cardiovascular system
that is composed of the heart, blood
vessels, and blood which helps in the
circulation; and the lymphatic system,
which is made up of the lymph, lymph
nodes, and vessels.
Layers and Other Structures of the Heart
The heart is a hollow muscular organ
that has four chambers (left atrium, right
atrium, left ventricle, and right ventricle) and is
surrounded by a thin, fluid-filled sac called
pericardium.
Layers of the Heart
1. Epicardium – thin, watery membrane on
the outer layer of the heart. It covers the heart
and is attached to the pericardium,
2. Myocardium – thick layer of cardiac
muscles in the middle layer of the heart. It
pumps blood into the arteries by contracting.
3. Endocardium – thin layer of epithelial cells
in the inner layer of the heart. It lines the valves
and interior chambers.
Chambers of the Heart
receives deoxygenated blood from the
body.
2. Right Ventricle – lower right chamber,
that receives the blood from the right
atrium and pumps it into the pulmonary
artery.
3. Left Atrium – upper left chamber, that
receives oxygenated blood from the
lungs and pumps it into the left ventricle.
4. Left Ventricle – lower left chamber, that
receives blood from the left atrium and
pumps it into the aorta.
Heart Function
The coronary circulation supplies the
blood as well as provides drainage to the
tissues. It is composed of the left and right
coronary arteries and coronary veins. Poor
circulation could lead to ischemia which is
caused by inadequate supply of oxygen and
myocardial infarction or heart attack which
may be due to compete obstruction of the
coronary artery.
Disorders and Diagnostic Tests
The human heart may have disorders
that can be detected and addressed using the
proper diagnostic tests.
1. Angina pectoris – chest pain resulting
from reduced blood flow to the heart.
2. Aortic stenosis – a murmuring sound
produced when the aortic leaflets fail to
fully open during systole.
3. Bacterial endocarditis – an infection
that happens when a bacteria enters
and resides in the heart lining or blood
vessel.
4. Congestive heart failure – a chronic
progressive condition that affects the
pumping power of the heart muscles,
5. Myocardial infarction – known as
heart attack, it is caused by a decrease
or full stoppage of blood flow that
damages the heart muscle.
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6. Pericarditis – inflammation of the
pericardial sac that may be due to viral
infection.
List of Diagnostic Tests for Heart
Disorders:
• Arterial blood gases (ABG)
• Aspartate aminotransferase (AST) or
Serum glutamic-oxaloacetic transaminase
(SGOT)
• Cholesterol
• Creatine kinase (CK)
• Creatine kinase (CK)- MB
• Digoxin
• Electrocardiogram (ECG or EKG)
• Lactate dehydrogenase (LDH) isoenzymes
• Microbial cultures
• Myoglobin
• Potassium
• Triglycerides
• Troponin T (TnT)
Vascular System and The Pathway of the
Blood Through the Heart
The vascular system is the loop
consisting of a network of blood vessels
through which blood is circulated to the rest of
the body. There are two divisions: the
pulmonary circulation and the systemic
circulation. The pulmonary circulation moves
the blood between the right ventricle of the
heart to the lungs. During the process, oxygen
is absorbed and carbon dioxide is released,
after which, the oxygenated blood flows back
to the left atrium of the heart. The systemic
circulation moves the oxygenated blood and
nutrients from the left ventricle of the heart to
the rest of the body. The deoxygenated blood
with carbon dioxide and wastes flows back to
the right atrium.
STRUCTURE OF THE VASCULAR
SYSTEM
a. Arteries – thick-walled blood vessels that
carry oxygen-rich blood from the heart to the
tissues of the body.
• Arteries branch into smaller thinner vessels
called arterioles that connect to the capillaries.
b. Arterioles – small-diameter blood vessels
that branch out from the arteries and lead to
the capillaries.
c. Veins – tubes with thin walls that carry
deoxygenated blood from tissues to the heart.
• have thinner walls than arteries and carry
oxygen-poor blood, carbon dioxide, and
other waste products back to the heart. No
gaseous exchange takes place in the
veins, only in the capillaries. The thinner
walls of veins have less elastic tissue and
less connective tissue than arteries
because the BP in the veins is very low.
Veins have one-way valves to keep blood
flowing in one direction as the blood flows
through the veins by skeletal muscle
contraction.
• Most blood tests are performed on venous
blood. Venipuncture is the procedure for
removing blood from a vein for analysis.
The veins of choice for venipuncture are
the basilic, cephalic, and median cubital
veins located in the antecubital area of the
elbow.
d. Venules – are small veins that connect
capillaries to larger veins.
e. Capillaries – fine hair-like blood vessels
that connect arterioles and veins.
• are the smallest blood vessels.
• They consist of a single layer of
epithelial cells to allow exchanges of
oxygen, carbon dioxide, nutrients, and
waste products between the blood and
tissue cells. The blood in capillaries is a
mixture of arterial and venous blood.
BLOOD VESSEL STRUCTURE:
a. Layers – the blood vessels have three
layers:
• tunica adventitia/ externa- the
outer layer composed of connective
tissue.
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 • tunica media- the middle layer
composed of smooth muscle and
elastic tissue.
• tunica intima- the inner layer
composed of lining of epithelial cells.
b. Lumen – space inside the blood vessel
where the blood flows.
c. Valves – found inside the veins, these are
thin membranous leaflets that prevent the
backflow of blood.
PATHWAY OF THE BLOOD THROUGH
THE HEART
The two large veins, superior vena cava
and the inferior vena cava, transport oxygen-
poor blood to the right atrium of the heart. The
superior vena cava collects blood from the
upper portion of the body, and the inferior vena
cava collects blood from the lower portion of
the body. The blood passes through the
tricuspid valve to the right ventricle. The right
ventricle contracts to pump the blood through
the pulmonary semilunar valve into the right
and left pulmonary arteries that carry it to each
lung. In the lung capillaries, blood releases
carbon dioxide and acquires oxygen. The right
and left pulmonary veins carry the oxygenated
blood from the lungs to the left atrium of the
heart. The blood flows through the mitral valve
into the left ventricle that contracts to pump
blood through the aortic semilunar valve into
the aorta. Blood travels throughout the body to
the capillaries from arteries that branch off the
aorta.
Heart Rate/Pulse Rate
The heart contracts approximately 60 to
80 times per minute, which represents the
heart rate or pulse rate. The arterial pulse is a
rhythmic recurring wave that occurs through
the arteries during normal pumping action of
the heart. The pulse is most easily detected by
palpation where an artery crosses over a bone
or firm tissue. Common pulse sites are the
temporal, carotid, brachial, and radial arteries.
DISORDERS OF THE VASCULAR
SYSTEM/ BLOOD VESSELS
1. Aneurysm – enlargement of the artery
due to the weakening of the artery wall.
2. Arteriosclerosis – hardening of the
artery walls due to aging.
3. Atherosclerosis – formation of plaques
in the inner walls.
4. Embolism – clot or bubble that causes
obstruction of an artery.
5. Embolus – obstruction that is carried
and lodged in a vessel.
6. Hemorrhoids – swollen veins in the
area of the anus.
7. Phlebitis – inflammation of the veins
particularly the wall.
8. Thrombophlebitis – swelling of the
veins of the legs that usually occurs
during pregnancy.
9. Thrombus – blood clot that impedes
blood flow.
10. Varicose veins – usually found in the
legs, these are veins that have been
twisted and enlarged.
Diagnostic Tests: D-dimer, Fibrin
degradation products (FDP), Lipoproteins,
Prothrombin time (PT), Partial thromboplastin
time (PTT/APTT), Triglycerides
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Blood Pressure
BP is the pressure exerted by the blood
on the walls of blood vessels during
contraction and relaxation of the ventricles.
Systolic and diastolic readings are taken and
reported in millimeters of mercury (mmHg).
The systolic pressure is the higher of the two
numbers and indicates the BP during
contraction of the ventricles. The diastolic
pressure is the lower number and is the BP
when the ventricles are relaxed.
Blood
Blood is the body’s main fluid for
transporting nutrients, waste products, gases,
and hormones through the circulatory system.
An average adult has a blood volume of 5 – 6
liters. Blood consists of two parts: the liquid
portion called the plasma, and a cellular
portion called the formed elements.
• Plasma comprises approximately 55% of
the total blood volume. It is a clear, straw-
colored fluid that is about 91% water and
9% dissolved substances. It is the
transporting medium for the plasma
proteins, nutrients, minerals, gases,
vitamins, hormones, and blood cells, as
well as waste products of metabolism. The
formed elements constitute approximately
45% of the total blood volume and include
the erythrocytes (red blood cells (RBCs)),
leukocytes (white blood cells (WBC)), and
thrombocytes (platelets).
• Blood cells are produced in the bone
marrow, which is the spongy material that
fills the inside of the major bones of the
body. Cells originate from stem cells in the
bone marrow, differentiate, and mature
through several stages in the bone marrow
and lymphatic tissue until they are released
to the circulating blood.
Three Types of Cells in the Human Blood:
1. Erythrocytes (red blood cells) - carry O2
and CO2 and are produced in the bone
marrow.
• Are a nuclear biconcave disk that are
approximately 7.2µ (microns) in
diameter. Erythrocytes contain the
protein hemoglobin to transport oxygen
and carbon dioxide. Hemoglobin
consists of two parts, heme and globin.
The heme portion requires iron for its
synthesis. There are approximately 4.5
– 6.0 million erythrocytes per microliter
(µL) of blood, with men having slightly
higher values than women. The normal
life span of erythrocyte is 120 days.
2. Leukocytes (white blood cells) – formed
in the marrow and the lymphatic tissue. They
neutralize pathogens. The two types are
granulocytes and agranulocytes.
• provide immunity to certain diseases by
producing antibodies and destroying
harmful pathogens by phagocytosis.
Leukocytes are produced in the bone
marrow from a stem cell and develop in
the thymus and bone marrow. They
differentiate and mature through
several stages before being released
into the bloodstream.
• Leukocytes circulate in the peripheral
blood for several hours and then
migrate to the tissues through the
capillary walls. The normal number of
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 leukocytes for an adult is 4,500 to The plasma of an individual contains naturally
11,000 per (µL) of blood. occurring antibodies for those antigens not
present on the erythrocytes. Group A blood
3. Thrombocytes (platelets) – pieces of very has anti-B antibodies in the plasma, and group
large cells in the bone marrow that help form B blood has anti-A antibodies. Group O blood
blood clots. has both the anti-A and anti-B antibodies, and
• irregularly shaped disks formed from group AB blood has neither anti-A nor anti-B
the cytoplasm of very large cells in the
bone marrow called the
megakaryocytes. Platelets have a life
span of 9-12 days. The average
number of platelets is between 140,000
and 440,000 per µL of blood. Platelets
play a vital role in blood clotting in all
stages of the coagulation mechanism.

Blood Type
antibodies.
The human blood type is inherited and
determined by the antigens on the surface of
the red blood cells. The blood contains or can
Cross-matching is necessary to
develop antibodies directed at the opposite
determine the compatibility of the donor’s
blood type. Blood type match is important
blood with the recipient’s blood because an
especially during transfusion because the
individual who does not produce the D antigen
wrong type could agglutinate the red blood
will produce anti-D which could be fatal if it
cells. When a doctor mentions blood type,
encounters the D antigen.
he/she is referring to a person’s ABO blood
group system or Rhesus (Rh) factor.

ABO BLOOD GROUP SYSTEM Four Stages of Coagulation/Hemostasis:

This is a system of classifying human
blood by the presence of antigens A and B and
based on the antigenic components found on
the surface of the red blood cells. A person’s
blood could be classified as A, B, O (universal
donor), or AB (universal recipient). In Rh factor
or the “D” antigen testing, Rh positive (Rh+)
has red blood cells that have the D antigen, Stage 1, also called primary hemostasis,
while the Rh negative (Rh-) does not have the blood vessels and platelets respond to an
D antigen. injury to a blood vessel. Blood vessels
constrict to slow the flow of blood to the injured
Group A blood has the “A” antigen, and area. Platelets become sticky, clump together
group B blood has the “B” antigen. Group AB (platelet aggregation), and adhere to the
blood has both the “A” and “B” antigens, and injured blood vessel wall (platelet adhesion) to
group O blood has neither the “A” nor the “B” form a temporary platelet plug to stop the
antigens. Group O and A are the most bleeding.
common, and group AB is the least common.

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Stage 2
Formation of the primary platelet plug –
platelets stick together on the site of the injury
forming a plug.
Stage 3
The last factor in the coagulation cascade
(Factor XIII) stabilizes the fibrin clot. This
produces retraction (tightening) of the clot or
progression to the stable blood clot.
Stage 4
After the injury to the blood vessel has healed
the process of fibrinolysis degrades (breaks
down) the fibrin clot into fibrin degradation
products (fibrinolysis or dissolving of clot).
Whole blood, serum, and plasma
There are three blood specimens that
are collected for testing purposes: serum,
plasma, and whole blood. Serum is the fluid
part of the blood that is left after clotting
because it does not have fibrinogen. This can
be separated by centrifugation. Plasma refers
to the fluid portion that is separated by
centrifugation from the red blood cells, white
blood cells, and platelets. It has fibrinogen and
could be collected using an anticoagulant
tube. It is also collected in cases where serum
could not be used. The whole blood is the
same as blood in the bloodstream and it
should neither clot nor separate. Just like
plasma, it could be collected using the
anticoagulant tube and must be mixed for a
minimum of 2 minutes prior to testing.
BLOOD DISORDERS
1. Anemia – caused by not having enough
healthy red blood cells or hemoglobin.
2. Leukemia – cancer of the blood; the
formation of abnormal tissues or cells in
the bone marrow or the lymphatic
system.
3. Urinary tract infection – shown higher
number of leukocytes.
4. Leukocytosis – increased number of
white blood cells in the blood due to
illness or infection.
5. Leukopenia – reduced number of white
cells in the blood.
6. Polycythemia – the marrow produces
too many red blood cells resulting in the
thickening of blood.
7. Thrombocytosis – the body produces
too many platelets (thrombocytes) which
affect the blood clotting.
8. Thrombocytopenia – characterized by
low platelet count.
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Diagnostic Tests: Fibrinolysis
• ABO and RH type Fibrinolysis is the process in which the
• Bone marrow examination fibrin is dissolved. It has two main activities:
• Complete blood count (CBC)
1. Reopens intact vessels by
• Cross-matching
dissolving clots
• Differential (diff) count 2. Removes hemostatic clots from
• Eosinophil count the tissue as part of the healing
• Erythrocyte sedimentation rate (ESR) process.
• Ferritin
• Hematocrit (Hct) Hemostatic Disorders:
• Hemoglobin (Hb or Hgb) 1. Deep venous thrombosis (DVT)
• Hemogram 2. Disseminated intravascular
• Indices (MCH, MCV, MCHC) coagulation
• Iron (Fe) 3. Hemophilia
• Reticulocyte (retic count) 4. Thrombocytopenia
• Total iron-binding capacity (TIBC)
Diagnostic Tests:
Coagulation Factors and Pathways
• Bleeding time
Coagulation or clotting is the process • D-dimer
in which the blood changes from a liquid state • Factor assays
into a gel that forms the blood clot. • Fibrin degradation products (FDP)
The clotting cascade has two • Platelet function assay (PFA)
separates but interacting pathways: the • Prothrombin time (PT)
extrinsic pathway which is activated by • Partial thromboplastin time (PTT or APTT)
external trauma (initiates coagulation) and the
intrinsic pathway which is activated by trauma
inside the bloodstream (produces thrombin). It
has three cell-based coagulation phases,
namely initiation, amplification, and
propagation.

Role of the Thrombin

Thrombin is an enzyme that plays an

important role in coagulation. It is produced at
the site of injury from the prothrombin. It
amplifies coagulation and converts fibrinogen
into soluble fibrin. This supports the platelet
plug formation by activating factor XIII to
cross-link fibrin and also to control the
formation and coagulation process by
activating protein C.

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MAJOR ARM AND LEG VEINS IN painful. Take note: that the underside of the
VENIPUNCTURE wrist is never used as a venipuncture site.

1. Antecubital fossa, also called the elbow

pit, is the triangular area on the anterior of the
elbow, which is a site of major veins. This is
the first choice for routine venipuncture
because there are several major arm veins
called antecubital veins which are close to the
surface which makes them easy to locate and
penetrate.

2. H-shaped antecubital veins refer to a

vein arrangement that occurs in about 70% of
the population.

• Median cubital vein is the preferred

venipuncture site. It is the easiest to access
5. Leg, ankle, and foot veins must not be
and least painful for the patient.
used in venipuncture without the permission of
• Cephalic vein is the second choice for
a physician due to complications such as
venipuncture. It is harder to palpate but is
thrombosis.
usually better when drawing blood from an
obese patient.
• Basilic vein is the last choice-vein for
venipuncture as it is not well anchored and
puncture on this vein are more painful.

3. M-shaped antecubital veins ae

intermediate antebrachial veins, which include
the median, median cephalic, and median
basilic veins.

• Median vein – intermediate antebrachial

vein; first-choice vein; safest and less
painful 6. Arteries are not used for routine blood
• Median cephalic vein – intermediate collection and are limited to the collection of
cephalic vein; second choice for arterial blood gas. Special training is needed
venipuncture; less likely to roll and the procedure is risky for the patient.
• Median basilic vein – intermediate basilic
vein; last choice vein because it is more
painful

4. Other arm and hand veins are used only if

the antecubital veins are not accessible. The
veins at the back of the hand that can be used
are smaller, so using them may be very
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