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Phlebotomy:
A Competency-Based
Approach
Booth and Mundt
5-2
Chapter 5:
The Cardiovascular System
McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
5-3
Upon completion of this chapter, you should
be able to:





Describe circulation and the purpose of the vascular
system.
Identify and describe the structures and functions of
the different types of blood vessels.
Locate and name the veins most commonly used for
phlebotomy procedures.
Identify the major components of blood.
Describe the major function of red blood cells, white
blood cells, and platelets.
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5-4
Upon completion of this chapter, you should
be able to:


Define hemostasis and describe the basic coagulation
process.
Describe how ABO and Rh blood types are
determined.
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5-5
The Heart and Circulation
(LO 5.1)

Average adult
8 to 12 pints of blood
 70,000 miles of blood vessels


Phlebotomist must understand
Blood composition
 How blood is transported
 Locations of blood vessels

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5-6
Structure of the Heart
(LO 5.1)

Heart chambers
Right atrium
 Right ventricle
 Left atrium
 Left ventricle

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5-7
Layers of the Heart (LO 5.1)
Endocardium
 Myocardium
 Epicardium

Visceral
 Parietal
 Pericardial
fluid

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5-8
Types of Circulation
(LO 5.1)

Coronary


Provides blood supply to the heart muscle
Pulmonary
Sends deoxygenated blood to lungs for
oxygenation
 Sends oxygenated blood back to heart


Systemic

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Sends oxygenated blood throughout the
body
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5-9
Circulation of Blood
(LO 5.1)
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5-10
Circulation of Blood
(LO 5.1)

Arterial blood


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Larger concentration
of oxygen
Pumped by the heart
to the body cells

Venous blood


Larger concentration
of carbon dioxide
Pumped by the heart
to the lungs
©2013 by McGraw-Hill Education. All rights reserved.
5-11
Apply Your Knowledge
(LO 5.1)
What is the purpose of pulmonary
circulation?
Answer: To exchange oxygen and carbon
dioxide.
BRAVO!
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5-12
Structure of Blood Vessels
(LO 5.2)
Valve
Tunica intima
Tunica media
Tunica
adventitia
Artery
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Vein
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5-13
Types of Blood Vessels
(LO 5.2)

Arteries


Carry blood away from the heart
Capillaries
Link arterioles to venules
 Carry out gas exchange


Veins

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Carry blood toward the heart
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5-14
Apply Your Knowledge
(LO 5.2)
What are the three layers of tissue
that comprise the arteries and veins?
Answer: Tunica intima, tunica media, and
tunica adventitia.
Great!
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5-15
Veins for Phlebotomy
(LO 5.3)
Cephalic vein
Basilic vein
Median cubital
vein
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Basilic vein
branch
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5-16
Veins for Phlebotomy (cont.)
(LO 5.3)
Dorsal venous
arch
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Metacarpal
plexus
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5-17
Apply Your Knowledge
(LO 5.3)
Which site is generally the best for
performing venipuncture?
Answer: Median cubital vein.
GREAT!
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5-18
Composition of Blood (LO 5.4)

Formed elements
(cellular component)



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Red blood cells
White blood cells
Platelets

Plasma (liquid
component)


Water
Solutes (dissolved
chemicals)
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5-19
Erythrocytes (RBCs) (LO 5.5)
Originate in bone marrow
 Biconcave
 Lifespan 120 days
 Contain hemoglobin
 Deliver oxygen to cells
 Remove carbon dioxide
from cells

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5-20
Leukocytes (WBCs) (LO 5.5)

Not confined to
vascular spaces

Diapedesis
Responsible for
phagocytosis
 Round and clear
(when not stained)

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5-21
WBCs: Neutrophils (LO 5.5)
Most numerous
 Nucleus has 3 or 4 lobes
 Perform phagocytosis
 Count increases during
bacterial infection or
inflammation

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5-22
WBCs: Eosinophils (LO 5.5)
Nucleus is bilobed
 Perform phagocytosis
 Destroy parasites
 Count increases during
allergic reactions and
parasitic infections

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5-23
WBCs: Basophils (LO 5.5)
Nucleus usually bilobed
 Release histamine
 Release heparin
 Produce vasodilator
 Count increases with
chronic inflammation

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5-24
WBCs: Monocytes (LO 5.5)
Largest type of WBC
 Single, kidney-shaped
nucleus
 Perform phagocytosis
 Count increases
with chronic infections

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5-25
WBCs: Lymphocytes (LO 5.5)
Single, round nucleus
 Two types

B-cell lymphocytes
 T-cell lymphocytes


Count increases during
viral infections
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5-26
Thrombocytes (Platelets) (LO 5.5)
Smallest formed element
 Fragments of
megakaryocytes
 Life span 9 to 12 days
 Help prevent blood loss

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5-27
Plasma (LO 5.5)
Pale yellow liquid
 Mostly water
 Contains several
important solutes
 Different from serum

Plasma
Buffy coat
Red blood
cells
Centrifuged, unclotted blood
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5-28
Apply Your Knowledge
(LO 5.5)
What is the primary function of
thrombocytes?
Answer: To prevent blood loss following
an injury.
GREAT!
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5-29
Hemostasis (LO 5.6)
Stops the flow of blood from injury
 Involves for major events

Blood vessel spasm
 Platelet plug formation
 Coagulation
 Fibrinolysis

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5-30
Blood Vessel Spasm (LO 5.6)
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5-31
Platelet Plug Formation (LO 5.6)
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5-32
Coagulation (LO 5.6)
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5-33
Coagulation: Clotting Cascade
(LO 5.6)
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5-34
Coagulation: Fibrin
Generation Detail (LO 5.6)
AA
B
B
E
D
D
D
Fibrinogen (I)
D
D
E
D
Fibrin monomer
E
D
D
E
E
Fibrin
polymer
D
E
D
D
D
D
E
E
D
D
Fibrin
clot
D
D
E
D
XIIIa
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5-35
Fibrinolysis (LO 5.6)
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Fibrinolysis (LO 5.6)
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5-37
Apply Your Knowledge
(LO 5.6)
Identify the four events of hemostasis.
Answer: Blood vessel spasm, platelet plug
formation, coagulation, and fibrinolysis.
GOOD JOB!
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5-38
ABO Blood Types (LO 5.7)
Based on antigens
and antibodies
 Four types

Type A
 Type B
 Type AB
 Type O

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5-39
ABO Blood Types (cont.)
(LO 5.7)
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5-40
ABO Blood Types (cont.)
(LO 5.7)
Blood type A
Blood type B
Blood type AB
Blood type O
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5-41
ABO Compatibility Chart
(LO 5.7)
Blood
Type
Can Accept Cells
From
Can Donate Cells To
A
B
A, O
B, O
A, AB
B, AB
AB
O
A, B, AB, O
O
AB
O, A, B, AB
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5-42
Rh Factor
(LO 5.7)
Rh positive
Rh negative
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Preventing Transfusion
Reactions (LO 5.7)
5-43
Always use two
patient identifiers
 Label blood and
blood products
accurately

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5-44
Apply Your Knowledge
(LO 5.7)
Mary has blood type O and requires a
transfusion. What blood type must be
used in her transfusion?
Answer: Type O.
BRAVO!
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5-45
Chapter 5 Summary
The vascular system consists of a
network of vessels that, along with the
heart, provides for circulation of the
blood.
 The three types of circulation are
coronary, pulmonary, and systemic.
 Blood vessels have three layers: tunica
intima, tunica media, and tunica
adventitia.

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5-46
Chapter 5 Summary (cont.)
All arteries except the pulmonary artery
carry oxygenated blood to the body.
 All veins except the pulmonary veins
carry deoxygenated blood to the heart.
 The five types of blood vessels are
arteries, arterioles, capillaries, venules,
and veins.
 Capillaries link arterioles and venules
and allow for gas exchange.

McGraw-Hill
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5-47
Chapter 5 Summary (cont.)
The veins most commonly used for
phlebotomy are the median cubital,
cephalic, and basilic veins in the
antecubital fossa.
 Blood transports oxygen, nutrients,
antibodies, and hormones to cells;
removes wastes from cells; and
maintains water balance.

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5-48
Chapter 5 Summary (cont.)
The major components of blood are the
formed elements (erythrocytes,
leukocytes, and platelets) and plasma.
 White blood cells include neutrophils,
eosinophils, basophils, monocytes, and
lymphocytes.
 Platelets are essential for clotting.
 Plasma is the liquid portion of
uncoagulated blood.

McGraw-Hill
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5-49
Chapter 5 Summary (cont.)
Hemostasis includes blood vessel
spasm, platelet plug formation,
coagulation, and fibrinolysis.
 ABO and Rh blood types are determined
by the type of antigen found on the red
blood cells.

McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.