PRINCIPLES OF MEDICAL LABORATORY SCIENCE 2

[TRANS] LESSON 3: THE CIRCULATORY SYSTEM

o Tricuspid valve
o Right ventricle: lower right chamber
OUTLINE o Pulmonary semilunar valve
I Circulatory System
o Pulmonary trunk
II Layers and Other Structures of the Heart and Their
Functions o Pulmonary arteries -> carry blood to capillaries of
A Layers of the Heart lungs
B Valves of the Heart o LUNG TISSUE (PULMONARY CIRCULATION)
C Septa o Oxygenated blood
D Coronary Circulation
o Pulmonary veins
E Heart Function
III Disorders and Diagnostic Tests o Left atrium: upper left chamber
IV Vascular System o Bicuspid valve
A Structure o Left ventricle: lower left chamber
B Disorder & Diagnostic o Aortic semilunar valve
V Blood vessels
A Structure
o Aorta
VI Blood cells  Coronary arteries
VII Blood type  Heart tissue: coronary circulation
A ABO Blood Group System  Coronary sinus and cardiac veins
B Rh Blood Group System
C Disorders & Diagnostic Tests  Body tissues (for systemic circulation)
VIII Lymphatic System
A Functions
B Disorders & Diagnostic Tests  Superior and Inferior Vena Cava
IX Hemostasis, Basic Coagulation, Fibrinolysis LAYERS OF THE HEART
A Coag factors  Epicardium: thin, watery membrane; outer layer
B Role of Thrombin o Covers the heart; attached to the pericardium
C Fibrinolysis  Myocardium: thick layer of cardiac muscles in the middle
D Role of Liver in Hemostasis
E Hemostatic Disorders & Diagnostic Tests layer of heart
X Major Arm & Leg Veins in Venipuncture o Pumps blood into arteries by contracting
 Endocardium: thin layer of epithelial cells ; inner layer of
the heart
o lines the valves and interior chambers
CIRCULATORY SYSTEM 
 Transporting throughout the body oxygenated blood from VALVES OF THE HEART
the heart and lungs via the arteries.  Atrioventricular valve (AV): between each atrium and
o Oxygen depleted blood return to its origin ventricle
via the veins o Tricuspid valve: right AV valve
 Delivers oxygen and nutrients; transports CO2 and other  Between right atrium and right ventricle
wastes o Bicuspid (mitral) valve: left AV valve
 Helps in coagulation process, regulation of temperature,  between left atrium and left ventricle
assists body in fighting diseases o Pulmonary or pulmonic valve: right semilunar
 2 main components: cardiovascular system and lymphatic valve
system  Entrance of pulmonary artery
 o Aortic valve: left semilunar valve
LAYERS AND OTHER STRUCTURES OF THE HEART  Entrance of the aorta
AND THEIR FUNCTIONS
 Heart: hollow muscular organ SEPTA
o 4 chambers:  Interatrial septum: separates right from the left atria
 Left atrium  Interventricular septum: separates the right and the left
 Right atrium ventricles
 Left ventricle
 Right ventricle CORONARY CIRCULATION
o Surrounded by pericardium – thin fluid-filled sac  Heart: receives blood from right and left coronary arteries
o Same size as a clenched fist  Coronary veins: return the oxygen-depleted blood from
 heart muscle back to the heart
 The blood flow of the human heart:
o Deoxygenated blood HEART FUNCTION
o Superior / Inferior vena cava
o Right atrium: upper right chamber

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PRINCIPLES

OF obstruction
MEDICAL of coronary LABORATORY
Poor circulation = ischemia (inadequate supply of oxygen);
= myocardial infarction (complete ARTERIES SCIENCE 2
artery  Carry oxygen-rich blood from heart -> tissues
Table 1. Functions of the Human Heart
ARTERIOLES
Function Description
Cardiac cycle Systole and diastole; 0.8 seconds  Small-diameter; lead to the capillaries
Electrical Sinoatrial node (pacemaker) ->
Conduction electric impulses -> myocardium
System VEINS
Electrocardiogra Cardiac’s cycle activity  Tubes with thin walls; carry deoxygenated blood from
m tissues -> heart
Origin of Heart “Lubb” – ventricles contract; AV
Sounds valves close VENULES
“Dupp” – semilunar valves close;  Collect blood from capillaries
ventricles relax
Heart Rate and Ave:72 beats/min. CAPILLARIES
Cardiac Output  Volume of blood pumped per
min  Hair-like; connect arterioles and veins
Pulse Alternating expansion and
contraction of artery
Blood Pressure Force exerted by blood on the walls
of the vessel

DISORDERS & DIAGNOSTIC TESTS

 Angina pectoris: reduced blood flow to the heart = chest
pain
 Aortic stenosis: aortic leaflets fail to fully open during
systole = murmur
 Bacterial endocarditis: bacteria resides in the heart
lining or blood vessel = infection
 Congestive heart failure: chronic; affects pumping of the
heart muscles DISORDERS OF THE VASCULAR SYSTEM
 Myocardial infarction: aka heart attack; decreases or full  Aneurysm: weaking of artery wall
stoppage of blood flow = damage to heart muscle  Arteriosclerosis: hardening of the artery wall
 Pericarditis: viral infection = inflammation of the  Atherosclerosis: formation of plaques
pericardial sac  Embolism: clot/bubble = obstruction of an artery
 Embolus: obstruction lodged in a vessel
DIAGNOSTIC TESTS  Hemorrhoids: swollen veins around anus
 Arterial Blood Gases (ABG)  Phlebitis: inflammation of the wall of the veins
 Aspartate Aminotransferase (AST) or serum glutamic-  Thrombophlebitis: (pregnancy) swelling of veins in legs
oxaloacetic transaminase (SGOT)  Thrombus: blood clot
 Cholesterol
 Varicose veins: twisted and enlarged
 Creatinine kinase (CK)
 Creatinine kinase (CK) – MB DIAGNOSTIC TESTS
 Digoxin  D-dimer
 Electrocardiogram (ECG or EKG)  Fibrin degradation products (FDP)
 Lactate dehydrogenase (LDH) isoenzymes  Lipoproteins
 Microbial cultures  Prothrombin time (PT)
 Myoglobin  Partial thromboplastin time (PTT/APTT)
 Potassium  Triglycerides
 Triglycerides
 Troponin T (TnT) BLOOD VESSELS
VASCULAR SYSTEM BLOOD VESSEL STRUCTURE
 Vascular system: network of blood vessels through which  Layers:
blood is circulated to the rest of the body. o Tunica adventitia: outer; connective
o Pulmonary circulation: right ventricle -> lungs
o Tunica media: middle; muscle and elastic
 CO2 released, oxygenated blood flows
o Tunica intima: inner; endothelial
back to the atrium
o Systemic circulation: left ventricle -> rest of the  Lumen: space where the blood flows
body  Valves: in veins; thin membranous leaflets that prevent
 Deoxygenated blood and wastes flows backflow
back to right atrium
BLOOD CELLS
STRUCTURE OF THE VASCULAR SYSTEM  Arterial blood: O2 and nutrients are carried to the tissues

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PRINCIPLES

OF from MEDICAL
Venous blood: CO2, metabolic by-products are carried to
lungs and kidneys for removal the body. LABORATORY

SCIENCE 2
DIAGNOSTIC TESTS
ABO and RH type
 Human blood – composed of plasma and other formed  Bone marrow exam
elements  CBC
o Plasma: clear, liquid portion, 90% water;  Cross matching
contains gases, minerals, carbs, lipids, proteins.  Diff count
o Formed elements: cells, cell remnants  Eosin count
 Erythrocytes: carry O2 and CO2;  Erythrocyte sedimentation rate (ESR)
produced in bone marrow  Ferritin
 Leukocytes: formed in marrow and  Hct
lymphatic tissue
 Hgb
 Thrombocytes: help form blood clots
 Hemogram
 Indices (MCH, MCV, MCHC)
BLOOD TYPE
 Iron
 Determined by antigens on the surface of RBCs
 Retic count
 Wrong type = agglutinate
 Total iron-binding capacity (TIBC)
ABO BLOOD GROUP SYSTEM LYMPHATIC SYSTEM
 Rhesus (Rh) factor  Network of tissues and organs for the removal of toxins
and waste
 Classifying presence of A & B antigens (based on
o Transport WBCs to and from lymph nodes
antigenic components)
 ABO -> universal donor; AB -> universal recipient  Fluids, lymph, 95% water
 HDN: based on D antigen or Rh factor  Nodes: masses of lymph tissue; produces lymphocytes
o Rh+ = has RBCs that has D antigen  Excess fluid filters into lymphatic capillaries -> larger
o Rh- = doesn’t have D antigen lymphatic vessels
o Right lymphatic duct: right upper limb and right
Table 2. ABO Blood Group System half of head, neck, chest
o Thoracic duct: rest of the body
RBC type & Antibodies in Plasma Can receive
antigen blood from  Lymph: moves with help of skeletal contraction; excess
A antigen Anti-B antibodies A, O tissue
B antigen Anti-A antibodies B, O
A and B FUNCTIONS OF LYMPHATIC SYSTEM
No antibodies A, B, AB, O 1. Tissue fluids -> bloodstream
antigen
Both Anti-A and Anti-B 2. Removes impurities when lymph passes through lymph
No antigen antibodies O nodes
3. Processes lymphocytes
4. Fats (from small intestine) -> bloodstream
**an individual who doesn’t produce the D antigen will produce
anti-D = fatal
DISORDERS OF LYMPHATIC SYSTEM
RH BLOOD GROUP SYSTEM  Lymphangitis: infection at site distal to the channel =
inflammation of lymphatic channels
SERUM  Lymphadenitis: inflammation of lymph nodes
 Lymphadenopathy: size or number abnormality of lymph
 Fluid part; left after clotting; DOESN’T have fibrinogen nodes
 Can be separated by centrifugation  Splenomegaly
 Hodgkin’s disease: enlarged lymph nodes
PLASMA  Lymphosarcoma: cancer
 Fluid portion; separated by centrifugation from formed  Lymphoma: cancer of lymphatic system
elements; It has FIBRINOGEN; collected using
anticoagulant tube DIAGNOSTIC TESTS
 Bone marrow biopsy
WHOLE BLOOD  CBC
 Should NEITHER clot nor separate  Culture and sensitivity
 Collected using anticoagulant tube  Lymph node biopsy
 Mixed for min. of 2 mins. Prior to testing  Mononucleosis test

BLOOD DISORDERS HEMOSTASIS, BASIC COAGULATION &

 Anemia: not enough healthy RBC or Hg FIBRINOLYSIS PROCESSES
 Leukemia: cancer; abnormal tissues/cells in bone marrow  Hemostasis: injury = stoppage of bleeding
 UTI: high # of leukocytes o Vasoconstriction: constricted vessel walls =
 Leukocytosis: increased WBCs reduced flow of blood in the site of injury
 Leukocytopenia: decreased WBCs o Platelet plug formation: platelets stick together
 Thrombocytosis: increased platelet; affect blood clotting forming a plug
 Thrombocytopenia: low platelet count o Progression to the stable blood clot
 Polycythemia: excessive RBCs o Fibrinolysis or dissolving of clot

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PRINCIPLES OF
COAGULATION FACTORS AND PATHWAYS
Coagulation: blood - liquid -> gel MEDICAL
= blood clot LABORATORY
o SCIENCE
**vein arrangement of 70% of the population
Median cubital 2
vein: preferred, least
Coagulation factors: proteins painful, easy access
o Enzyme precursors o Cephalic vein: 2nd choice; harder to palpate;
o Cofactors for obese
o Substrates o Basilic vein: last choice; not well anchored,
Clotting cascade: more painful
o Extrinsic pathway: external trauma (initiates coag)
o Intrinsic pathway: trauma in bloodstream 3. M-shaped antecubital vein
(produces thrombin) **intermediate antebrachial veins
o Cell-based coag phases: initiation, amplification, o Median vein: 1st choice; safest, less painful
propagation o Median cephalic vein: 2nd choice; less likely
to roll
ROLE OF THROMBIN o Median basilic vein: last choice; more
 Enzyme important in coag; produced at injury site painful
 Prothrombin -> thrombin
 Thrombin – fibrinogen -> fibrin 4. Other arm and hand veins
o When antecubital veins aren’t accessible
 Supports platelet plug formation – activating factor XIII to
cross link fibrin o Underside of the wrist is NEVER USED
 Activated protein C = control in formation and coag 5. Leg, ankle and foot veins
process o Not used w/o permission
o Complication = thrombosis
Table 3. Hemostatic Process in Vivo
Vasoconstriction Platelet Secondary 6. Arteries
plug hemostatic plug o NOT USED for blood coll
formatio formation
n
REFERENCES
Due to contraction of
Amplification Learning Guide for Principles of Medical
smooth muscle fibers
Initiation Laboratory Science 2 by Ebuen et. al.
 blood flow, limits blood
phase Propagation
loss
 blood vessel diameter Notes from the discussion by Prof. Amapola
Puaso
FIBRINOLYSIS
 Fibrin is dissolved De La Salle Medical and Health Sciences
o Reopens intact vessels by dissolving clots Institute powerpoint presentation:
o Healing process: removes hemostatic clots
o Limited to coll of ABG - risky
ROLE OF LIVER IN HEMOSTASIS
 Synthesize coag factors: V, VIII, prothrombin, fibrinogen
 Produces heparin and bile salts for synthesis
 Production of bile salts  Vit K absorption

HEMOSTATIC DISORDERS
 Deep venous thrombosis (DVT)
 Disseminated intravascular coag
 Hemophilia
 Thrombocytopenia

DIAGNOSTIC TESTS
 Bleeding time
 D-dimer
 Factor assays
 Fibrin degradation products (FDP)
 Platelet function assay (PFA)
 PT
 PTT or APTT

MAJOR ARM & LEG VEINS IN VENIPUNCTURE

1. Antecubital fossa:
o aka elbow pit; anterior of elbo; site of major
veins
o FIRST CHOICE: antecubital veins near are
that are easy to locate

2. H-shaped antecubital vein

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