1. Booth, Wallace, and Fitzgerald
Chapter 2
PowerPoint ® Presentation to Accompany
Phlebotomy for Health Care Personnel
Booth, Wallace, and Fitzgerald
Chapter 2

2. Blood Circulation, Function, and Composition
Chapter 2

3. Learning Outcomes
Upon Completion of this chapter, you should be able to:
Describe circulation and the purpose of the vascular system.
Discuss three types of circulation.
List and describe the three layers of blood vessels.
Identify and describe the structures and functions of the different types of blood vessels.
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4. Learning Outcomes (cont’d)
Locate and name the veins most commonly used for phlebotomy procedures.
List the functions of blood.
Identify the major components of blood.
Describe the major functions of red blood cells, white blood cells, and platelets.
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5. Learning Outcomes (cont’d)
List the different types of white blood cells and give the function of each.
Differentiate between serum and plasma.
Define hemostasis and describe the basic coagulation process.
Describe how ABO and Rh blood types are determined.
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6. Introduction
San Francisco
New York
The human vascular system consists of approximately 70,000 miles of blood vessels; this could reach from New York to San Francisco about 24 times!!
Blood vessels, along with the heart, are responsible for the circulation of blood throughout the body.
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7. Circulation and the Vascular System
Septum divides the heart into a right and left side
Has four chambers:
Right and left atrium
Right and left ventricle
Valves allow blood to pass from the atria to the ventricles
The pulmonary artery and aorta carry blood away from the heart
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8. Click picture for larger view.
Coronary Circulation
Provides blood supply to the heart
Receives oxygenated blood from the aorta into the coronary arteries
Coronary veins carry deoxygenated blood to the right atrium
Click picture for larger view.
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9. Coronary Circulation
Click to return to previous slide.
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10. Pulmonary Circulation
Pulmonary circulation occurs when blood that has been used by the cells of the body is returned to the heart and transported to the lungs for gas exchange. O 2 CO
Exchange of gases
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11. Systemic Circulation
This network of blood vessels carrying oxygenated blood picks up essential nutrients from the digestive tract to deliver to all other cells of the body.
Digestive system
Venous Blood
Arterial Blood
Has a larger concentration of carbon dioxide
Pumped by the heart to the lungs
Has a larger concentration of oxygen than carbon dioxide
Pumped by the heart to the body cells
Systemic circulation also removes waste products from the body cells.
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12. Pulmonary Circulation
Systemic and Pulmonary Circulation
Exchange of oxygen and carbon dioxide in the lungs’ capillaries
Pulmonary Circulation
Blood rich in oxygen
Blood low in oxygen
Blood moves from the vena cava to the right atrium and ventricle for pulmonary circulation. Blood then moves to the left atrium and ventricle and into the aorta for systemic circulation.
Systemic Circulation
O2 and CO2 exchange between capillary beds and body tissues.
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13. Circulation of Blood Aorta Arteries Arterioles Capillaries Venules
Arteries carry blood away from the heart and veins carry blood toward the heart. The capillaries are exchange vessels located between the arterial and venous systems.
Veins
Vena Cava
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14. Apply Your Knowledge Identify the four chambers of the heart.
ANSWER: Right atrium, left atrium, right ventricle, and left ventricle
BRAVO!
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15. Apply Your Knowledge Good Job!
What is the purpose of pulmonary circulation?
ANSWER: To exchange oxygen and carbon dioxide
Good Job!
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16. Blood Vessels
Arteries and veins are comprised of three layers of tissue:
Tunica intima
Innermost, smooth layer
Tunica media
Middle, thickest layer
Tunica adventitia
Outer covering
Capillaries comprise only one layer of tissue.
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17. Arteries Transport blood away from the heart
Carry blood under high pressure
Are elastic, muscular, and thick-walled
Dilate and constrict, which creates a pulse
Appear bright red due to high oxygen levels
Please add figure 2-5 on page 37.
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18. Capillaries Are the smallest blood vessels
Provide a link from arterioles to venules
All gas exchange occurs at this level
Walls are very thin to allow for gas and nutrient exchange
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19. Veins Carry deoxygenated blood to the heart Contain one-way valves
Store about 65% to 70% of the body’s total blood volume
Blood appears darker in color
Blood flows in a slow manner
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20. Artery or Vein?
At a venipuncture site, a vein will feel bouncy and resilient, while an artery will feel firm and pulsate.
In case of an accidental puncturing of an artery, withdraw the needle and apply firm pressure for at least 5 minutes.
Instruct the patient to remain still and notify a nurse to assist in hematoma prevention.
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21. Selecting a Vein
After properly selecting a vein, the phlebotomist must use proper technique and avoid “probing” around at the site.
Accidental puncturing of a nerve could result in a temporary loss of function and constitutes an act of negligence.
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22. Primary Veins Used For Phlebotomy Which vein is BEST for venipuncture?
The most commonly used veins for venipuncture are located in the antecubital fossa.
Which vein is BEST for venipuncture?
1st Choice
Median cubital vein
Cephalic vein
2nd Choice
Basilic vein
3rd Choice
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23. Other Sites for Venipuncture
Hand Veins
Dorsal venous arch
Metacarpal plexus
When the antecubital veins are not accessible, the hand veins may be used for venipuncture.
Hand veins are smaller and less anchored.
This can be very painful for the patient.
NOTE:
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24. Apply Your Knowledge Great!
What are the three layers of tissue that comprise the artery and vein?
ANSWER: Tunica intima, tunica media, tunica adventitia
Great!
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25. Apply Your Knowledge
Which type of vessel is the smallest, forming the link between arterioles and venules?
ANSWER: Capillaries
Bravo!
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26. Apply Your Knowledge
Which site is the best for performing venipuncture?
ANSWER: Median cubital vein
GREAT!
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27. Blood and Blood Components
Blood, when allowed to stand, will separate into two components:
Liquid
Solid
Plasma, which is a straw-colored fluid comprised mostly of water
Cellular components, including:
-red blood cells
-white blood cells
-platelets
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28. Erythrocytes Originate in the bone marrow
Resemble the shape of a doughnut without a hole (biconcave)
Average lifespan is 120 days
Normal value = approximately 4.5 to 5 million per cubic millimeter of blood
Contains an iron-rich protein molecule called hemoglobin
Responsible for carrying oxygen and removing carbon dioxide from every body cell
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29. Erythrocytes I’m just so tired! Normal Hemoglobin Levels
Male = 14–18 grams/100 mL of blood
Female = 12–16 grams/100 mL of blood
Symptoms of Anemia
Weakness
Headache
Pale skin color
Difficulty breathing
An abnormally low hemoglobin level and/or decrease in the number of red blood cells is called anemia.
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30. Leukocytes Types of White Blood Cells Granulocytes Agranulocytes
Also known as white blood cells
Primarily responsible for destroying foreign substances such as pathogens
Appear round and white because they lack hemoglobin
Normal adult has 5,000 to 10,000 white blood cells per cubic millimeter of blood
Types of White Blood Cells
Granulocytes
Agranulocytes
Neutrophils
Eosinophils
Basophils
Monocytes
Lymphocytes
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31. Granulocytes Basophils Neutrophils Eosinophils
Most numerous of all the WBCs
Main warriors against infection (phagocytosis)
Least common granulocyte
Assist with the inflammatory process
Release histamine and heparin
Eosinophils
Present in a very small quantity
Ingest and destroy foreign proteins
Secrete chemicals to destroy parasites
Increase during allergic reactions and parasitic infections
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32. Agranulocytes Monocytes Lymphocytes
Largest in size of all the white blood cells
Primary function is phagocytosis
Survive for several months
Effective against chronic infections
Assist with the immune system
Produce antibodies that destroy pathogens
Aid in controlling allergic reactions
Quantities of each type of WBC can be determined with a blood test known as a differential.
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33. Thrombocytes Also known as platelets
Smallest of all the cellular components
Normal adult has 150,000 to 450,000 per cubic millimeter of blood
Average lifespan is 9 to 12 days
Prevent blood loss following an injury
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34. Liquid Component (Plasma)
Composition of Plasma
Water
Nutrients
Hormones
Electrolytes
Proteins
Waste
Protective substances
Centrifugation is a procedure that separates blood into liquid and cellular components.
Serum is the liquid portion of clotted blood.
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35. Immunocompromised Patients
Require extra measures to be taken in order to prevent infection
Standard Precautions, hand hygiene and PPE must be used to protect the patient from exposure to harmful organisms
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36. Apply Your Knowledge Good Job!
What are the two types of white blood cells?
ANSWER: Granulocytes and agranulocytes
Good Job!
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37. Apply Your Knowledge
What is the primary function of thrombocytes or platelets?
ANSWER: To prevent blood loss following an injury
GREAT!
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38. Hemostasis and Blood Coagulation
Following an injury, four events are available to stop the bleeding:
Blood Vessel Spasm 1
Platelet Plug Formation 2
Vessels decrease in size to stop bleeding in small vessels
Inner torn layer of the vessels releases chemical signals that call platelets to the site of injury
Blood Clotting 3
Fibrinolysis 4
Requires the presence of certain clotting factors to form fibrin
Begins the repair process
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39. Hemostasis and Blood Coagulation
I. Blood vessel spasm
II. Platelet plug Formation
III. Blood clotting
IV. Fibrinolysis
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40. Lack of Clotting Factors
Patients on anticoagulants or those lacking natural clotting ability require close monitoring following venipuncture.
Apply manual pressure for a minimum of 3 to 5 minutes to ensure that bleeding has stopped.
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41. Apply Your Knowledge
Identify the four events necessary to stop blood flow to an injured site.
ANSWER: Blood vessel spasm, platelet plug formation, blood clotting, fibrinolysis
GOOD JOB!
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42. ABO and Rh Blood Types
The blood group system recognizes four blood types:
Type A, B, AB, and O
They are distinguished from each other in part by their antigens and antibodies.
Specific antibodies are found in the serum based on the type of antigen on the surface of the RBC.
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43. ABO and Rh Blood Types Compatibility Chart A B AB O A, O B, O
Can Accept From
Can Donate To A B AB O
A, O
B, O
A, B, AB, O O
A, AB
B, AB AB
O, A, AB, B
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44. The Rh Factor Rh-Positive Rh-Negative
Contains the Rh antigen No Rh antigen
Will make antibodies if given Rh-positive blood
Agglutination can occur if given Rh positive blood
Clinically, it is very important for a female to know her Rh type if she becomes pregnant.
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45. Type and Cross-Match Blood Specimens
For all “type and cross-match” orders, additional identification is usually required. This may include a signature and identification number as well as initialing the tube and requisition form.
Always follow your facility’s policy
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46. Apply Your Knowledge Answer: Kala type O
Mary is type O and she requires a blood transfusion. Which of the following people can she receive blood from?
John (type AB)
Harry (type B)
Kala (type O)
Answer: Kala type O
BRAVO!
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47. Chapter 2 Summary
The vascular system consists of the heart and blood vessels providing for circulation of blood.
Coronary circulation provides blood to the heart, while systemic circulation provides blood to the body.
Blood vessel layers include the tunica intima, tunica media, and tunica adventitia.
Arteries, except the pulmonary artery, carry blood to the body. Veins, except the pulmonary vein, carries blood back to the heart.
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48. Chapter 2 Summary (cont’d)
The three veins most commonly used for phlebotomy are located in the antecubital fossa.
Blood is responsible for transporting oxygen, fluids, hormones, and antibodies and for eliminating waste materials.
The major components of blood include the formed elements and plasma.
RBCs transport oxygen and carbon dioxide; WBCs destroy foreign invaders.
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49. Chapter 2 Summary (cont’d)
WBCs include granulocytes and agranulocytes.
Plasma is the liquid portion of unclotted blood. Serum is the liquid portion of clotted blood.
Hemostasis includes four stages: blood vessel spasm, platelet plug formation, blood clotting, and fibrinolysis.
ABO and Rh types are determined by the antigen found on the RBCs.
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50. Logic is the anatomy of thought. --John Locke
END OF CHAPTER 2
Logic is the anatomy of thought.
--John Locke
Chapter 2