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10 Cardiovascular System – Blood Vessels and Blood
WTCS Learning Objectives
Apply the rules of medical language to build, analyze, spell, pronounce, abbreviate, and define terms as they relate to the blood
Identify meanings of key word components of the blood
Spell medical terms of the blood vessels and blood and use correct abbreviations
Categorize diagnostic, therapeutic, procedural or anatomic terms related to the blood
Use terms related to the blood
Use terms related to the diseases and disorders of the blood
Blood Vessels and Blood Word Parts
Click on prefixes, combining forms, and suffixes to reveal a list of word parts to memorize for the Cardiovascular System – Blood.
Introduction to the Blood Vessels and Blood
Our large, complex bodies need blood to deliver nutrients to and remove wastes from our trillions of cells. The heart, as discussed in the previous chapter, pumps blood throughout the body in a network of blood vessels. Together, these three components—blood, heart, and vessels—makes up the cardiovascular system.
Virtually every cell, tissue, organ, and system in the body is impacted by the circulatory system. This includes the generalized and more specialized functions of transport of materials, capillary exchange, maintaining health by transporting white blood cells and various immunoglobulins (antibodies), hemostasis, regulation of body temperature, and helping to maintain acid-base balance. Table 10.1 summarizes the important relationships between the circulatory system and the other body systems.
Table 10.1 Interaction of the Circulatory System with Other Body Systems. A table depicting the various body systems and the role of the circulatory system in each. Adapted from Betts, et al., 2021. Licensed under CC BY 4.0.
ROLE OF CIRCULATORY SYSTEM
Absorbs nutrients and water; delivers nutrients (except most lipids) to liver for processing by hepatic portal vein; provides nutrients essential for hematopoiesis and building hemoglobin.
Delivers hormones: atrial natriuretic hormone (peptide) secreted by the heart atrial cells to help regulate blood volumes and pressures; epinephrine, ANH, angiotensin II, ADH, and thyroxine to help regulate blood pressure; estrogen to promote vascular health in women and men.
Carries clotting factors, platelets, and white blood cells for hemostasis, fighting infection, and repairing damage; regulates temperature by controlling blood flow to the surface, where heat can be dissipated; provides some coloration of integument; acts as a blood reservoir.
Transports various white blood cells, including those produced by lymphatic tissue, and immunoglobulins (antibodies) throughout the body to maintain health; carries excess tissue fluid not able to be reabsorbed by the vascular capillaries back to the lymphatic system for processing.
Provides nutrients and oxygen for contraction; removes lactic acid and distributes heat generated by contraction; muscular pumps aid in venous return; exercise contributes to cardiovascular health and helps to prevent atherosclerosis.
Produces cerebrospinal fluid (CSF) within choroid plexuses; contributes to blood-brain barrier; cardiac and vasomotor centers regulate cardiac output and blood flow through vessels via the autonomic system.
Aids in erection of genitalia in both sexes during sexual arousal; transports gonadotropic hormones that regulate reproductive functions.
Provides blood for critical exchange of gases to carry oxygen needed for metabolic reactions and carbon dioxide generated as byproducts of these processes.
Provides calcium, phosphate, and other minerals critical for bone matrix; transports hormones regulating buildup and absorption of matrix including growth hormone (somatotropin), thyroid hormone, calcitronins, and parathyroid hormones; erythropoietin stimulates myeloid cell hematopoiesis; some level of protection for select vessels by bony structures.
Delivers 20% of resting circulation to kidneys for filtering, reabsorption of useful products, and secretion of excesses; regulates blood volume and pressure by regulating fluid loss in the form of urine and by releasing the enzyme renin that is essential in the renin-angiotensin-aldosterone mechanism.
Cardiovascular System – Blood Vessels and Blood Medical Terms
Anatomy of the Blood Vessels
Blood pumped by the heart flows through a series of vessels known as arteries, arterioles, capillaries, venules, and veins before returning to the heart.
transport blood away from the heart and branch into smaller vessels, forming arterioles.
distribute blood to capillary beds, the sites of exchange with the body tissues.
A is a microscopic channel that supplies blood to the tissues themselves, a process called .
Exchange of gases and other substances occurs in the capillaries between the blood and the surrounding cells and their tissue fluid (interstitial fluid).
For capillaries to function, their walls must be leaky, allowing substances to pass through.
Capillaries lead back to small vessels known as .
Venules are small that converge into larger veins.
A vein is a blood vessel that conducts blood toward the heart
Compared to arteries, veins are thin-walled vessels with large and irregular lumens
Larger veins are commonly equipped with valves that promote the unidirectional flow of blood toward the heart and prevent backflow toward the capillaries caused by the inherent low blood pressure in veins as well as the pull of gravity
Other ways in which the body assists the transport of venous blood back to the heart involve contractions of skeletal muscles in the extremities (see figure below), as well as pressure variations caused by breathing motion in the chest.
Select the correct bolded word: Arteries always carry blood away from/towards the heart
Select the correct bolded word: Veins always carry blood away from/towards the heart.
Both arteries and veins have the same three distinct tissue layers, called tunics, for the garments first worn by ancient Romans. From the most interior layer to the outer, these tunics are the tunica intima, the tunica media, and the tunica externa. The smooth muscle in the middle layer, the tunica media, provides the vessel with the ability to and as needed to ensure sufficient blood flow. The table below compares the features of arteries and veins.
Table 10.2. Comparison of Arteries and Veins. From Betts, et al., 2021. Licensed under CC BY 4.0.
Direction of blood flow
Conducts blood away from the heart
Conducts blood toward the heart
Irregular, often collapsed
Relative oxygen concentration
Higher in systemic arteries
Lower in pulmonary arteries
Lower in systemic veins
Higher in pulmonary veins
Present most commonly in limbs and in veins inferior to the heart
The Major Arteries and Veins in the Human Body
Many arteries and veins share the same names, parallel one another throughout the body, and are very similar on the right and left sides of the body. For example, you will find a pair of femoral arteries and a pair of femoral veins, with one vessel on each side of the body. In contrast, some vessels closer to the midline of the body, such as the aorta, are unique and not paired. Names of vessels may change with location. Like a street that changes name as it passes through an intersection, an artery or vein can change names as it passes an anatomical landmark. For example, the left subclavian artery becomes the axillary artery as it passes into the axillary region, and then becomes the brachial artery as it enters the upper arm. The next two diagrams illustrate the major arteries and veins in the human body.
Without looking back at the images of the main arteries and veins of the body, can you name and locate 3 arteries and 3 veins in your body?
Physiology of the Blood Vessels
Arteries and veins transport blood in two distinct circuits: the systemic circuit and the pulmonary circuit. Systemic arteries provide blood rich in oxygen to the body’s tissues. The blood returned to the heart through systemic veins has less oxygen, since much of the oxygen carried by the arteries has been delivered to the cells. In contrast, in the pulmonary circuit, arteries carry blood low in oxygen exclusively to the lungs for gas exchange. Pulmonary veins then return freshly oxygenated blood from the lungs to the heart to be pumped back out into systemic circulation.
Blood pressureis the force exerted by blood upon the walls of the blood vessels or the chambers of the heart. Blood pressure may be measured in capillaries and veins, as well as the vessels of the pulmonary circulation; however, the general term ‘blood pressure’ refers to the pressure of blood flowing in the arteries of the systemic circulation. Blood pressure is one of the critical parameters measured on virtually every patient in every healthcare setting.The technique used today was developed more than 100 years ago by a pioneering Russian physician, Dr. Nikolai Korotkoff. Turbulent blood flow through the vessels can be heard as a soft ticking while measuring blood pressure; these sounds are known as Korotkoff sounds. Blood pressure is measured in mm Hg and is usually obtained from the using a and a stethoscope. Blood pressure is recorded as over .
Did You Know?
120/80 mm Hg is a normal, healthy blood pressure. 60-100 beats per minute is a normal, resting, adult pulse.
Five variables influence blood flow and blood pressure:
Volume of the blood
of the blood
Blood vessel length and diameter
Each time the heart ejects blood forcefully into the circulation, the arteries must expand and then recoil to accommodate the surge of blood moving through them. This expansion and recoiling of the arterial wall is called the pulse and allows us to measure . Pulse can be palpated manually by placing the tips of the fingers across an artery that runs close to the body surface, such as the radial artery or the common carotid artery. These sites and other pulse sites are shown in the figure below.
Both the rate and the strength of the pulse are important clinically. A high or irregular pulse rate can be caused by physical activity or other temporary factors, but it may also indicate a heart condition. The pulse strength indicates the strength of ventricular contraction and cardiac output. If the pulse is strong, then systolic pressure is high. If it is weak, systolic pressure has fallen, and medical intervention may be warranted.
The Composition (Anatomy) of Blood and the Functions of the Components
Blood is a connective tissue made up of cellular elements and an extracellular matrix. The cellular elements are referred to as the formed elements and include red blood cells (RBCs), white blood cells (WBCs), and platelets. The extracellular matrix, called plasma, makes blood unique among connective tissues because it is fluid. This fluid, which is mostly water, perpetually suspends the formed elements and enables them to circulate throughout the body within the cardiovascular system.
Did You Know?
Blood constitutes approximately 8% of adult body weight.
In the laboratory, blood samples are often in order to separate the components of blood from one another (see the figure below). are the heaviest elements in blood and settle at the very bottom of the tube. Above the erythrocyte layer we see the buffy coat, a pale, thin layer of and , which together make up less than 1% of the sample of whole blood. Above the buffy coat is the blood plasma, normally a pale, straw-colored fluid, which constitutes the remainder of the sample.
In normal blood, about 45 percent of a sample is erythrocytes, which is referred to as the . The hematocrit of any one sample can vary significantly, however, about 36–50 percent, according to gender and other factors. Not counting the buffy coat, which makes up less than 1% of the blood, we can estimate the mean plasma percentage to be the percent of blood that is not erythrocytes: approximately 55%.
Like other fluids in the body, plasma is composed primarily of water. In fact, it is about 92% water. Dissolved or suspended within this water is a mixture of substances, most of which are proteins. The major components of plasma and their functions are summarized in the table below.
Formed Elements (Erythrocytes, Leukocytes, Thrombocytes)
The table below summarizes the main facts about the formed elements in blood.
Table 10.3 Summary of Formed Elements in Blood. Adapted from Betts, et al., 2021. Licensed under CC BY 4.0.
NUMBER PRESENT PER MICROLITER (µL)AND MEAN (RANGE)
APPEARANCE IN A STANDARD BLOOD SMEAR
SUMMARY OF FUNCTIONS
Erythrocytes (red blood cells)
5.2 million ( 4.4-5.0 million)
Flattened biconcave disk; no nucleus; pale red colour
Transport oxygen and some carbon dioxide between tissues and lungs
Lifespan of approximately 120 days
Leukocytes (white blood cells)
7000 (5000 – 10,000)
Obvious dark-staining nucleus
All function in body defenses
Exit capillaries and move into tissues; lifespan of usually a few hours or days
Leukocytes (white blood cells) Types
Granulocytes including neutrophils, eosinophils, and basophils
Abundant granules in cytoplasm; nucleus normal lobed
Nonspecific (innate) resistance to disease
Classified according to membrane-bound granules in cytoplasm
Nuclear lobes increase with age; pale lilac granules
Phagocytic; particularly effective against bacteria. Release cytotoxic chemicals from granules
Most common leukocyte; lifespan of minutes to days
Nucleus generally two-lobed; bright red-orange granules
Phagocytic cells; particularly effective with antigen-antibody complexes. Release antihistamines. Increase in allergies and parasitic infections
Lifespan of minutes to days
Nucleus generally two-lobed but difficult to see due to presence of heavy, dense, dark purple granules
Least common leukocyte; lifespan unknown
Agranulocytes including lymphocytes and monocytes
Lack abundant granules in cytoplasm; have a simple-shaped nucleus that may be indented
Group consists of two major cell types from different lineages
Spherical cells with a single often large nucleus occupying much of the cell’s volume; stains purple; see in large (natural killer cells) and small (B and T cells) variants
Primarily specific (adaptive) immunity; T cells directly attack other cells (cellular immunity). B cells release antibodies (humoral immunity); natural killer cells are similar to T cells but nonspecific
Initial cells originate in bone marrow, but secondary production occurs in lymphatic tissue; several distinct subtypes; memory cells form after exposure to a pathogen and rapidly increase responses to subsequent exposure; lifespan of many years
Largest leukocyte with an indented or horseshoe-shaped nucleus
Very effective phagocytic cells engulfing pathogens or worn out cells; also serve as antigen-presenting cells (APCs) for other components of the immune system
Produced in red bone marrow; referred to as macrophages after leaving circulation
350,000 (150,000 – 500,000)
Cellular fragments surrounded by a plasma membrane and containing granules; purple stain
Hemostasis plus release growth factors for repair and healing of tissue
Formed from megakaryocytes that remain in the red bone marrow and shed platelets into circulation
The most abundant formed elements in blood, erythrocytes are basically sacs packed with an oxygen-carrying compound called hemoglobin. Production of erythrocytes in the red bone marrow occurs at the staggering rate of more than 2 million cells per second. For this production to occur, raw materials including iron, copper, zinc B-vitamins, glucose, lipids, and amino acids must be present in adequate amounts. Erythrocytes live only 120 days on average, and thus must be continually replaced. Worn-out erythrocytes are by and their hemoglobin is broken down. The breakdown products are recycled or removed as wastes.
Leukocytes protect the body against invading microorganisms and body cells with mutated DNA, and they clean up debris, thus they are a major component of the body’s defenses against disease. Figure 10.7 shows the different types of leukocytes. Leukocytes routinely leave the bloodstream to perform their defensive functions in the body’s tissues, where they are often given distinct names, such as macrophage or microglia, depending on their function.
What is hemoglobin?
Can you name the 5 types of leukocytes?
Lymphocytes are one of the types of leukocytes and will be discussed in more detail here, since they tie into the next chapter which discusses the body’s defenses The three major groups of lymphocytes include natural killer cells, B cells, and T cells.
Natural killer (NK) cells are capable of recognizing cells that do not express “self” proteins on their plasma membrane or that contain foreign or abnormal markers. These “nonself” cells include cancer cells, cells infected with a virus, and other cells with atypical surface proteins.
B lymphocytes (B cells) and T lymphocytes (T cells), play prominent roles in defending the body against specific pathogens (disease-causing microorganisms) and are involved in specific immunity. B cells undergo a maturation process in the bone marrow, whereas T cells undergo maturation in the thymus. This site of the maturation process gives rise to the name B and T cells.
Plasma cells, a type of B cell, produce the antibodies or immunoglobulins that bind to specific foreign or abnormal components of plasma membranes.
T cells provide immunity by physically attacking foreign or diseased cells.
Memory cells are a variety of both B and T cells that form after exposure to a pathogen and mount rapid responses upon subsequent exposures. Unlike other leukocytes, memory cells live for many years.
After entering the circulation, approximately one-third of the newly-formed platelets migrate to the spleen for storage for later release in response to any rupture in a blood vessel. They then become activated to perform their primary function, which is to limit blood loss. Platelets remain only about 10 days, then are by .
Platelets are key players in hemostasis, the process by which the body seals a ruptured blood vessel and prevents further loss of blood. Although rupture of larger vessels usually requires medical intervention, hemostasis is quite effective in dealing with small, simple wounds. There are three steps to the process: vascular spasm or vasoconstriction, the formation of a platelet plug, and coagulation (blood clotting). Failure of any of these steps will result in . The figure below summarizes the steps of hemostasis.
Fibrinolysis is the process in which a clot is degraded in a healing vessel. An anticoagulant is any substance that opposes coagulation. Several circulating plasma anticoagulants play a role in limiting the coagulation process to the region of injury and restoring a normal, clot-free condition of blood.
Can you explain what happens in each step of hemostasis?
Describe an anticoagulant.
Physiology of Blood
Although carrying oxygen and nutrients to cells and removing wastes from cells is the main function of blood, it is important to realize that blood also serves in defense, distribution of heat, and maintenance of homeostasis.
Nutrients from the foods you eat are absorbed in the digestive tract. Most of these travel in the bloodstream directly to the liver, where they are processed and released back into the bloodstream for delivery to body cells.
Oxygen from the air you breathe diffuses into the blood, which moves from the lungs to the heart, which then pumps it out to the rest of the body.
Endocrine glands scattered throughout the body release their products, called hormones, into the bloodstream, which carries them to distant target cells.
Blood also picks up cellular wastes and byproducts, and transports them to various organs for removal. For instance, blood moves carbon dioxide to the lungs for exhalation from the body, and various waste products are transported to the kidneys and liver for excretion from the body in the form of urine or bile.
Leukocytes protect the organism from disease-causing bacteria, cells with mutated DNA that could multiply to become cancerous, or body cells infected with viruses.
When damage to the vessels results in bleeding, blood platelets and certain proteins dissolved in the plasma, interact to block the ruptured areas of the blood vessels involved. This protects the body from further blood loss.
If you were exercising on a warm day, your rising core body temperature would trigger several homeostatic mechanisms, including increased transport of blood from your core to your body periphery, which is typically cooler. As blood passes through the vessels of the skin, heat would be dissipated to the environment, and the blood returning to your body core would be cooler. In contrast, on a cold day, blood is diverted away from the skin to maintain a warmer body core. In extreme cases, this may result in frostbite.
Blood helps to regulate the water content of body cells.
Blood also helps to maintain the chemical balance of the body. Proteins and other compounds in blood act as buffers, which thereby help to regulate the of body tissues. The pH of blood ranges from 7.35 to 7.45.
These three terms all sound similar. Can you explain them by breaking down the word parts?
In order to understand blood types, it is important to understand several terms that relate to the body’s immune functions (discussed in detail in the next chapter)
are substances that the body does not recognize as belonging to itself (“self”) and that therefore trigger a defensive response from the leukocytes of the immune system. Many people have antigens on the surfaces of their red blood cells. More than 50 antigens have been identified on erythrocyte membranes, but the most significant in terms of their potential harm to patients are classified in two groups: the ABO blood group and the Rh blood group.
are proteins which are produced by in response to a “non-self” antigen being present in the body. Antibodies attach to the antigens on the plasma membranes of the erythrocytes in a blood transfusion and cause them to adhere to one another.
Agglutination refers to the resulting clumps of red blood cells that are formed in such an antigen-antibody reaction. These clumps can block small blood vessels, thereby cutting of the supply of oxygen and nutrients to the tissues.
, or the breakdown of the erythrocyte’s cell membrane, takes place as the clumps of red cells start to degrade. The resulting release of the cell’s contents, mainly hemoglobin, into the bloodstream can cause kidney failure.
ABO Blood Group
ABO blood types are genetically determined. Each type is determined by the presence or absence of certain antigens on the individual’s red blood cell membrane, as well as the presence or absence of certain antibodies. Normally the body must be exposed to a foreign antigen before an antibody can be produced. This is not the case for the ABO blood group, in which some blood types come preloaded with their own set of antibodies against another type. The figure below shows the ABO blood group as well as the universal donor and recipient in relation to blood transfusions.
Blood Type A
People whose erythrocytes have A antigens on their erythrocyte membrane surface.
People who have type A blood, without any prior exposure to incompatible blood, have preformed circulating in their blood. These antibodies will cause a serious immune reaction if they encounter blood that has B antigens.
Blood Type B
People whose erythrocytes have B antigens.
People with type B blood has inherent anti-A antibodies.
Blood Type AB
People can also have both A and B antigens on their erythrocytes, in which case they are blood type AB.
Individuals with type AB blood, do not have inherent antibodies to either A or B antigens.
Blood Type O
People with neither A nor B antigens are designated blood type O.
People with type O blood have both anti-A and anti-B antibodies circulating in their blood plasma.
Rh Blood Group
The Rh blood group is classified according to the presence or absence of a second erythrocyte antigen identified as Rh. Those who have the Rh D antigen present on their erythrocytes are described as Rh positive (Rh+) and those who lack it are Rh negative (Rh−). Note that the Rh group is distinct from the ABO group, so any individual, no matter their ABO blood type, may have or lack this Rh antigen. When identifying a patient’s blood type, the Rh group is designated by adding the word positive or negative to the ABO type. For example, A positive (A+) means ABO group A blood with the Rh antigen present, and AB negative (AB−) means ABO group AB blood without the Rh antigen.
Hemolytic Disease of the Newborn (HDN)
Antibodies to the Rh antigen are produced only in Rh− individuals after exposure to the antigen. This process, called sensitization, occurs following a transfusion with Rh-incompatible blood or, more commonly, with the birth of an Rh+ baby to an Rh− mother.
In a first pregnancy problems are rare, since the baby’s Rh+ cells rarely cross the . However, during or immediately after birth, the Rh− mother can be exposed to the baby’s Rh+ cells (Figure below). Research has shown that this occurs in about 13−14 percent of such pregnancies. After exposure, the mother’s immune system begins to generate anti-Rh antibodies.
In a second pregnancy if a mother should conceive a Rh+ baby, the Rh antibodies she has produced can cross the placenta into the fetal bloodstream and destroy the fetal RBCs. This condition, known as hemolytic disease of the newborn (HDN) or erythroblastosis fetalis. This may cause anemia in mild cases, but the agglutination and hemolysis can be so severe that without treatment the fetus may die in the womb or shortly after birth.
A drug known as RhoGAM, short for Rh immune globulin, can temporarily prevent the development of Rh antibodies in the Rh− mother, thereby averting this potentially serious disease for the fetus. RhoGAM antibodies destroy any fetal Rh+ erythrocytes that may cross the placental barrier. RhoGAM is normally administered to Rh− mothers during weeks 26−28 of pregnancy and within 72 hours following birth.
Figure 10.11 is an example of a commercially produced “bedside” card which enables quick typing of both a recipient’s and donor’s blood before transfusion. The card contains three reaction sites or wells. One is coated with an anti-A antibody, one with an anti-B antibody, and one with an anti-D antibody (tests for the presence of Rh factor D). Mixing a drop of blood and saline into each well enables the blood to interact with a preparation of type-specific antibodies, also called anti-seras. Agglutination of RBCs in a given site indicates a positive identification of the blood antigens, in this case A and Rh antigens for blood type A+. To avoid serious and potentially fatal immune reactions, the donor’s and recipient’s blood types must match
To avoid transfusion reactions, it is best to transfuse only matching blood types; that is, a type B+ recipient should ideally receive blood only from a type B+ donor and so on. That said, in emergency situations, when acute threatens the patient’s life, there may not be time for cross matching to identify blood type. In these cases, blood from a universal donor may be transfused.
Blood Vessel Medical Terms Not Easily Broken into Word Parts
Common Diseases and Disorders of Blood Vessels and/or Blood
is normally defined as the more generalized loss of , “hardening of the arteries,” whereas is a more specific term for the build-up of in the walls of the vessel and is a specific type of arteriosclerosis.
When arteriosclerosis causes vessel compliance to be reduced, pressure and resistance within the vessel increase. This is a leading cause of and , as it causes the heart to work harder to overcome this resistance. Any artery in the body can be affected by these pathological conditions, and individuals who have pathologies like coronary artery disease, may also be at risk for other vascular injuries, like strokes or peripheral arterial disease.
Atherosclerosis is a type of arteriosclerosis in which plaques form when circulating triglycerides, cholesterol and other substances seep between the damaged endothelial lining cells and become trapped within the artery wall, resulting in narrowed arteries and impaired blood flow (see Figure 10.12) (Wikimedia Commons, 2019).
Sometimes a plaque can rupture, causing microscopic tears in the artery wall that allow blood to leak into the tissue on the other side. When this happens, platelets rush to the site to clot the blood. This clot can further obstruct the artery and—if it occurs in a coronary or cerebral artery—cause a sudden heart attack or stroke. Alternatively, plaque can break off and travel through the bloodstream as an until it blocks a more distant, smaller artery.
Peripheral arterial disease (PAD, also called peripheral vascular disease, PVD), occurs when atherosclerosis affects arteries in the legs. A major risk factor for both arteriosclerosis and atherosclerosis is advanced age, as the conditions tend to progress over time. There is also a distinct genetic component, and pre-existing hypertension and/or diabetes also greatly increase the risk. However, obesity, poor nutrition, lack of physical activity, and tobacco use all are major risk factors.
Treatment of atherosclerosis includes lifestyle changes, such as weight loss, smoking cessation, regular exercise, and adoption of a diet low in sodium and saturated fats. Medications to reduce cholesterol and blood pressure may be prescribed. For blocked coronary arteries, or surgery may be warranted. In an carotid endarterectomy, plaque is surgically removed from the walls of a the , which is the main source of oxygenated blood for the brain (Betts, et al., 2021).
Edema and Varicose Veins
Despite the presence of valves and the contributions of other anatomical and physiological adaptations that assist in moving blood through veins, over the course of a day, some blood will inevitably pool, especially in the lower limbs, due to the pull of gravity. Any blood that accumulates in a vein will increase the pressure within it, which can then be reflected back into the smaller veins, venules, and eventually even the capillaries. This increased pressure in the capillaries will push of fluids out of the capillaries and into the interstitial fluid, causing a condition called .
Most people experience a daily accumulation of tissue fluid, especially if they spend much of their work life on their feet (like most health professionals). However, clinical edema goes beyond normal swelling and requires medical treatment. Edema has many potential causes, including and heart failure, severe protein deficiency, renal failure, and many others. In order to treat edema, which is a sign rather than a discrete disorder, the underlying cause must be diagnosed and alleviated.
Edema may be accompanied by varicose veins, especially in the superficial veins of the legs (see Figure 10.13). This disorder arises when defective valves allow blood to accumulate within the veins, causing them to distend, twist, and become visible on the surface of the skin. Varicose veins may occur in both sexes, but are more common in women and are often related to pregnancy. More than simple cosmetic blemishes, varicose veins are often painful and sometimes itchy or throbbing. Without treatment, they tend to grow worse over time. The use of support hose, as well as elevating the feet and legs whenever possible, may be helpful in alleviating this condition (Betts, et al., 2021).
Hypertension is defined as chronic and persistent blood pressure measurements of 140/90 mm Hg or above. Pressures between 120/80 and 140/90 mm Hg are defined as prehypertension. Hypertension is typically a and patients may fail to recognize the seriousness of their condition and fail to follow their treatment plan, putting them at risk for a heart attack or stroke. Hypertension may also lead to an , , chronic kidney disease, or heart failure (Betts, et al., 2021).
Minor blood loss is managed by and repair. Hemorrhage is a loss of blood that cannot be controlled by hemostatic mechanisms. Initially, the body responds to hemorrhage by initiating mechanisms aimed at increasing blood pressure and maintaining blood flow. Ultimately, however, blood volume will need to be restored, either through physiological processes or through medical intervention. If blood loss is less than 20 percent of total blood volume, fast-acting homeostatic mechanisms causing increased cardiac output and vasoconstriction, would usually return blood pressure to normal and redirect the remaining blood to the tissues. Blood volume will then need to be restored via slower-acting homeostatic mechanisms, to increase body fluids and erythrocyte production (Betts, et al., 2021).
The loss of too much blood may lead to circulatory shock, a life-threatening condition in which the circulatory system is unable to maintain blood flow to adequately supply sufficient oxygen and other nutrients to the tissues to maintain cellular metabolism. It should not be confused with emotional or psychological shock. Typically, the patient in circulatory shock will demonstrate an increased heart rate but decreased blood pressure. Urine output will fall dramatically, and the patient may appear confused or lose consciousness. Unfortunately, shock is an example of a positive-feedback loop that, if uncorrected, may lead to the death of the patient (Betts, et al., 2021).
There are several recognized forms of shock:
shock in adults is typically caused by hemorrhage, although in children it may be caused by fluid losses related to severe vomiting or diarrhea.
shock results from the inability of the heart to maintain cardiac output. Most often, it results from a myocardial infarction (heart attack), but it may also be caused by arrhythmias, valve disorders, cardiomyopathies, cardiac failure, or simply insufficient flow of blood through the cardiac vessels.
Vascular shock occurs when arterioles lose their normal muscular tone and dilate dramatically. It may arise from a variety of causes, and treatments almost always involve fluid replacement and medications, called inotropic or pressor agents, which restore tone to the muscles of the vessels.
Anaphylactic shock is a severe allergic response that causes the widespread release of histamines, triggering vasodilation throughout the body.
Obstructive shock, as the name would suggest, occurs when a significant portion of the vascular system is blocked. It is not always recognized as a distinct condition and may be grouped with cardiogenic shock, including and . Treatments depend upon the underlying cause and, in addition to administering fluids intravenously, often include the administration of anticoagulants, removal of fluid from the pericardial cavity, or air from the thoracic cavity, and surgery as required. The most common cause is a pulmonary embolism. Other causes include stenosis of the aortic valve; cardiac tamponade; and a (Betts, et al., 2021).
Changes in the levels of RBCs can have significant effects on the body’s ability to effectively deliver oxygen to the tissues (Betts, et al., 2021).
Did You Know?
Did you know?
‘O2 sat’ or ‘percent sat’ is the percent saturation; that is, the percentage of hemoglobin sites occupied by oxygen in a patient’s blood.
The size, shape, and number of erythrocytes, and the number of hemoglobin molecules can have a major impact on a person’s health. When the number of RBCs or hemoglobin is deficient, the general condition is called . There are more than 400 types of anemia.
Anemia can be broken down into three major groups: those caused by blood loss, those caused by faulty or decreased RBC production, and those caused by excessive destruction of RBCs. In addition to these causes, various disease processes also can lead to anemias. These include chronic kidney diseases often associated with a decreased production of , , some forms of cancer, , and (Betts, et al., 2021).
Blood Loss Anemias:
Bleeding from wounds or other lesions, including ulcers, hemorrhoids, inflammation of the stomach (gastritis), and some cancers of the gastrointestinal tract
The excessive use of aspirin or other nonsteroidal anti-inflammatory drugs such as ibuprofen can trigger ulceration and gastritis
Excessive menstruation and loss of blood during childbirth.
Anemias Caused by Faulty or Decreased RBC Production:
Sickle cell anemia
A genetic disorder involving the production of an abnormal type of hemoglobin which delivers less oxygen to tissues and causes erythrocytes to assume a sickle (or crescent) shape. See Figure 10.14.
Iron deficiency anemia
The most common type of anemia and results when the amount of available iron is insufficient to allow production of sufficient heme.
Vitamin deficiency anemia (Generally insufficient vitamin B12 and folate).
Megaloblastic anemia involves a deficiency of vitamin B12 and/or folate, often due to inadequate dietary intake.
Pernicious anemia is caused by poor absorption of vitamin B12 and is often seen in patients with , surgical removal of the intestines or stomach (common in some weight loss surgeries), intestinal parasites, and .
Aplastic anemia is the condition in which myeloid stem cells are defective or replaced by cancer cells, resulting in insufficient quantities of RBCs being produced. This condition by be inherited, or it may be triggered by radiation, medication, chemotherapy, or infection.
Thalassemia is an inherited condition typically occurring in individuals from the Middle East, the Mediterranean, African, and Southeast Asia, in which maturation of the RBCs does not proceed normally. The most severe form is called Cooley’s anemia (Betts, et al., 2021).
Polycythemia is an elevated RBC count and is detected in a patient’s elevated . It can occur transiently in a person who is dehydrated; when water intake is inadequate or water losses are excessive, the plasma volume falls. As a result, the hematocrit rises. A mild form of polycythemia is chronic but normal in people living at high altitudes. Some elite athletes train at high elevations specifically to induce this phenomenon. Finally, a type of bone marrow disease called polycythemia vera causes an excessive production of immature erythrocytes. Polycythemia vera can dangerously elevate the of blood, raising blood pressure and making it more difficult for the heart to pump blood throughout the body. It is a relatively rare disease that occurs more often in men than women, and is more likely to be present in elderly patients those over 60 years of age (Betts, et al., 2021).
Platelet Disorders/Clotting Disorders
Thrombocytosis is a condition in which there are too many platelets. This may trigger , a potentially fatal disorder. A thrombus (plural = thrombi) is an aggregation of platelets, erythrocytes, and even WBCs typically trapped within a mass of fibrin strands. While the formation of a clot is a normal step in , thrombi can form within an intact or only slightly damaged blood vessel, adhering to the vessel wall and decreasing or obstructing the flow of blood. (Betts, et al., 2021).
Thrombophilia, also called hypercoagulation, is a condition in which there is a tendency to form thrombosis. This may be an inherited disorder or may be caused by other conditions including lupus, immune reactions to heparin, , , , pregnancy, and even obesity.
When a portion of a thrombus breaks free from the vessel wall and enters the circulation, it is referred to as an embolus. An embolus that is carried through the bloodstream can be large enough to block a vessel critical to a major organ. When it becomes trapped, an embolus is called an embolism. In the heart, brain, or lungs, an embolism may accordingly cause a heart attack, a stroke, or a pulmonary embolism (Betts, et al., 2021).
Thrombocytopenia is a condition in which there is an insufficient number of platelets, possibly leading to ineffective blood clotting and excessive bleeding (Betts, et al., 2021).
Hemophilia is a group of related genetic disorders in which certain plasma clotting factors are lacking or inadequate or nonfunctional. Patients with hemophilia bleed from even minor internal and external wounds, and leak blood into joint spaces after exercise and into urine and stool. Regular infusions of clotting factors isolated from healthy donors can help prevent bleeding in hemophiliac patients. At some point, genetic therapy will become a viable option (Betts, et al., 2021).
Leukopenia is a condition in which too few leukocytes are produced. If this condition is pronounced, the individual may be unable to ward off disease (Betts, et al., 2021).
Leukocytosis is excessive leukocyte proliferation. Although leukocyte counts are high, the cells themselves are often nonfunctional, leaving the individual at increased risk for disease (Betts, et al., 2021).
Leukemia is a cancer involving an abundance of leukocytes. It may involve only one specific type of leukocyte from either the myeloid line (myelocytic leukemia) or the lymphoid line (lymphocytic leukemia). In chronic leukemia, mature leukocytes accumulate and fail to die. In acute leukemia, there is an overproduction of young, immature leukocytes. In both conditions the cells do not function properly (Betts, et al., 2021).
Lymphoma is a form of cancer in which masses of malignant T and/or B lymphocytes collect in lymph nodes, the spleen, the liver, and other tissues. As in leukemia, the malignant leukocytes do not function properly, and the patient is vulnerable to infection. Some forms of lymphoma tend to progress slowly and respond well to treatment. Others tend to progress quickly and require aggressive treatment, without which they are rapidly fatal (Betts, et al., 2021).
Other Conditions Related to Abnormal Leukocyte Counts
Table 10.4. Conditions Related to Abnormal White Blood Cell Counts. From Betts, et al., 2021. Licensed under CC BY 4.0.
CONDITIONS RELATED TO HIGH COUNTS
CONDITIONS RELATED TO LOW COUNTS
Infection, inflammation, burns, unusual stress
Drug toxicity, other disorders
Allergies, parasitic worm infestations, some autoimmune diseases
Drug toxicity, stress
Allergies, parasitic infections, hypothyroidism
Pregnancy, stress, hyperthyroidism
Viral infections, some cancers
chronic illness, immunosuppression (due to HIV or steroid therapy)
Viral or fungal infections, tuberculosis, some forms of leukemia, other chronic diseases
Bone marrow suppression
Bone Marrow Biopsy/Bone Marrow Transplant
Sometimes, a healthcare provider will order a bone marrow biopsy, a diagnostic test of a sample of red bone marrow, or a bone marrow transplant, a treatment in which a donor’s healthy bone marrow—and its stem cells—replaces the faulty bone marrow of a patient. These tests and procedures are often used to assist in the diagnosis and treatment of various severe forms of anemia, such as and , as well as some types of cancer, specifically leukemia.
In the past, bone marrow sampling or transplant was very painful, as the procedure involved inserting a large-bore needle into the region near the iliac crest of the pelvic bones. Now, direct sampling of bone marrow can often be avoided as stem cells can be isolated in just a few hours from a sample of a patient’s blood. The isolated stem cells are then grown in culture using the appropriate , and analyzed or sometimes frozen for later use.
For an individual requiring a transplant, a matching donor is essential to prevent the immune system from destroying the donor cells—a phenomenon known as . To treat patients with bone marrow transplants, it is first necessary to destroy the patient’s own diseased marrow through radiation and/or chemotherapy. Donor bone marrow stem cells are then infused into the recipient’s bloodstream, so that they can establish themselves in the recipient’s bone marrow (Betts, et al., 2021).
Common Cardiovascular System – Blood, Abbreviations
Many terms and phrases related to the cardiovascular system – blood are abbreviated. Learn these common abbreviations by expanding the list below.
Medical Terms in Context
Medical Specialties and Procedures Related to the Blood Vessels and Blood
Vascular surgery is a specialty in which the physician treats diseases of the blood and lymphatic vessels. This includes repair and replacement of diseased or damaged vessels, removal of plaque from vessels, minimally invasive procedures including the insertion of venous catheters, and traditional surgery (Betts, et al., 2021; Society for Vascular Surgery, n.d.). For more information, please visit Society for Vascular Surgery website.
Hematologists are specialist physicians that diagnose and treat blood disorders. These physicians must be well-versed in a wide array of laboratory procedures, basic medical disciplines, and clinical medicine (American Medical Association, 2019). To learn more about hematologists, visit the American Medical Association’s specialty profile on hematology
Vascular sonography is a challenging yet rewarding profession. As a sonographer working in this field, you’ll use ultrasound machines to produce images of patients’ veins and arteries using high-frequency sound waves. To learn more, visit the Vascular Sonography Credentials web page.
Phlebotomists are professionals trained to draw blood (phleb- = “a blood vessel”; -tomy = “to cut”). When more than a few drops of blood are required, phlebotomists perform a venipuncture, typically of a surface vein in the arm. They perform a capillary stick on a finger, an earlobe, or the heel of an infant when only a small quantity of blood is required. An arterial stick is collected from an artery and used to analyze blood gases. After collection, the blood may be analyzed by medical laboratories or perhaps used for transfusions, donations, or research (Betts, et al., 2021).
Medical Laboratory Scientist/Technician
Medical or clinical laboratories employ a variety of individuals in technical positions. Training is provided through a variety of institutions and certification is through the Canadian Society for Medical Laboratory Science. Specialized positions are:
Medical technologist (MT) tests and analyzes blood, other body fluids, and tissue samples.
Medical laboratory scientists (MLS) perform complex analyses of tissue, blood, and other body fluids.
Medical laboratory assistants (MLA) spend the majority of their time receiving, preparing, testing, and processing specimen samples (American Society for Clinical Pathology, n.d.)
Blood vessels that transport blood away from the heart.
A very small artery that leads to a capillary
A microscopic channel that supplies blood to the tissues through perfusion
The delivery of blood to an area/tissue/organ
Extremely small vein
Blood vessels that carry blood back to the heart.
The smooth muscle layer in the blood vessel wall contracts, causing the vessel diameter to narrow. This increases blood pressure in the vessel.
The smooth muscle layer in the wall of the blood vessel relaxes, allowing the vessel to widen. This decreases blood pressure in the vessel.
large artery in the upper arm near the biceps muscle
Instrument used to measure blood pressure.
The systolic pressure is the higher value (typically around 120 mm Hg) and reflects the arterial pressure resulting from the ejection of blood during ventricular contraction, or systole.
The diastolic pressure is the lower value (usually about 80 mm Hg) and represents the arterial pressure of blood during ventricular relaxation, or diastole.
Cardiac output is the measurement of blood flow from the heart through the ventricles, and is usually measured in liters per minute. Any factor that causes cardiac output to increase, by elevating heart rate or stroke volume or both, will elevate blood pressure and promote blood flow.
Compliance is the ability of any compartment to expand to accommodate increased content. The greater the compliance of an artery, the more effectively it is able to expand to accommodate surges in blood flow without increased resistance or blood pressure.
Viscosity is the thickness of fluids that affects their ability to flow
The number of times the heart contracts in one minute.
A centrifuge is a common piece of laboratory equipment used to spin test tubes at a high speed in order to separate components in a liquid by weight.
red blood cells
also spelled leucocyte, these are white blood cells
also called platelets, these are cell fragments that aid in blood clotting
percentage by volume of red cells in your blood.
also phagocytosed, this is the process by which certain cells are able to 'eat' other cells or substances by engulfing them
a type of leukocyte (usually a monocyte) that has the ability to ingest and destroy other cells or pathogens
excessive or uncontrolled bleeding from the blood vessels
pH is a measure of how acidic or alkaline a substance is, as determined by the number of free hydrogen ions in the substance.
A substance that provokes an immune response. This happens because the immune system sees the antigen as foreign, or 'non-self" (does not belong in that body)
also called immunoglobulins, proteins produced by B lymphocytes in response to a non-self antigen
A type of B lymphocyte that produces antibodies which bind to specific foreign or abnormal antigens, in order to destroy them
Breaking apart of the erythrocyte cell membrane, allowing its contents to leak out
proteins that will mount an immune response against B antigens
the organ of gas and nutrient exchange between the baby and the mother
hardening of arteries
the ability of the blood vessels to dilate and constrict as needed
a hardening of the arteries that involves the accumulation of plaque
a fatty material including cholesterol, connective tissue, white blood cells, and some smooth muscle cells
High blood pressure
also called coronary artery disease (CAD); the blood vessels that supply blood to the myocardium become hardened and narrowed, impairing the delivery of oxygen to the heart muscle
a freely moving piece of a substance (plaque or blood clot) that travels through the circulation until it blocks a smaller blood vessel, cutting of the supply of oxygen to the tissue
a balloon-tip catheter is fed through a blood vessel up to the site of the narrowing, the balloon is inflated to re-open the artery. A stent is sometimes placed at the site to reinforce the arterial wall and to prevent re-occlusion.
In a coronary bypass procedure, a non-vital superficial vessel from another part of the body (often the great saphenous vein) or a synthetic vessel is inserted to create a path around the blocked area of a coronary artery.
large artery in the neck
a disease or disorder that often lacks signs or symptoms
Weakening of the wall of a blood vessel, causing it to thin and balloon out, and possibly eventually burst, resulting in internal bleeding
obstruction of vessels in peripheral regions of the body
the process by which the body seals a ruptured blood vessel to prevent further blood loss
hypo=below, lower than normal, volemic=pertaining to volume (in this case, the volume of blood in the body)
Cardio=pertaining to the heart
genic=originating from, created by
Cardiogenic means originating from the heart
A piece of a blood clot or other substance has broken free from its original location and traveled through the bloodstream to lodge in a smaller vessel in the lungs. This causes an obstruction in that vessel and hypoxia to the tissues supplied by that vessel.
The pericardial sac surrounding the heart has filled with blood or other fluid and the resulting pressure is preventing the heart from beating effectively
An excessive amount of air is present in the thoracic cavity, outside of the lungs, putting pressure on the lungs and interfering with venous return, pulmonary function, and delivery of oxygen to the tissues
Lack of (without) sufficeint healthy red blood cells in the blood
Erythropoietin is a hormone produced by the kidneys that plays an important role in the homeostasis of red blood cells levels in the body
Underactive thyroid gland, insufficient production of thyroid hormones (T3 and T4)
An autoimmune disease in which the body mounts an immune response against its own tissues, causing chronic inflammation and tissue damage
An autoimmune disorder in which the body mounts an immune response against its own joint tissues, causing inflammation and damage to the joints
A type of inflammatory bowel disease
(Acquired Immunodeficiency Syndrome). A disease in which there is a severe loss of the body's cellular immunity, greatly lowering the resistance to infection and malignancy.
formation of unwanted blood clots
A type of bone marrow disease that causes an excessive production of immature erythrocytes
A condition in which there are too many platelets
Also called sickle cell anemia: A genetic disorder involving the production of an abnormal type of hemoglobin which delivers less oxygen to tissues and causes erythrocytes to assume a sickle (or crescent) shape
An inherited condition typically occurring in individuals from the Middle East, the Mediterranean, African, and Southeast Asia, in which maturation of the RBCs does not proceed normally. The most severe form is called Cooley’s anemia.
Also called sickle cell anemia: A genetic disorder involving the production of an abnormal type of hemoglobin which delivers less oxygen to tissues and causes erythrocytes to assume a sickle (or crescent) shape
Chemical messengers which promote the proliferation and differentiation of formed elements and include erythropoietin, thrombopoietin, colony-stimulating factors, and interleukins.
Also called organ rejection. The recipient's immune system recognizes the transplanted tissue, the graft, as non-self and mounts an immune response against it, ultimately destroying it.