CIRCULATORY SYSTEM UNIT-4

Introduction:-The circulatory system is transport system carry oxygen, nutrient, hormones and other substance
to the tissue and conveying carbon dioxide to the lungs and other waste product to the kidney.
The cardiovascular system consists of cardiac (heart)and vascular (blood vessels). The circulatory system is
discovered by William harvey.

Heart:- The heart is a hollow muscular organ which

lies obliquely in thorax, in the mediastrnum between
the lungs and immediately above the diaphragm.
In, adult , its average weight is 300gmsin male and
250gm in female. The adult heart is approximately
12cm long, 9cm broad and 6cm thick.
 4 chambers
 4 valves
 2 Atrium and 2 Ventricles
 Right side receives blood from the body and
send it to the lungs (pulmonary)
 Left side receives blood from lungs and
sends it to the body (systemic)
Chamber of the heart:-
 Right atrium  Left atrium
 Right ventricle  Left ventricle

Atrial
 Features:- Small, thin – walled chambers
Functions:-
 Receiving chambers for blood returning to the heart from the circulation.
 Push the blood into the adjacent ventricles.
• Receive blood from
 Right side:- Deoxygenated blood from Superior and inferior venacava
 Left side:- Oxygenated blood from four Pulmonary vein

Ventricles
 Features:-
 Make up most of the mass of the heart
 The walls of the left ventricle are 3x thicker than those of the right
• Ventricles:-
 Discharging chambers of the heart
 Propel blood to pulmonary trunk(Right ventricle), Aorta (Left ventricle)
 Receive blood from:-
 Right Ventricle:- Receive blood from the right atrium through the tricuspid
 Left Ventricle:- Oxygenated blood from the left atrium to the left ventricles through mitral(Bicuspid)

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 The wall of the left ventricles is thicker than the right ventricle but the structure is similar.
 The thick wall is necessary to pump oxygenated blood at high pressure through the systemic circulation.

Position of the heart:-

 The heart is in the thoracic cavity between the lungs, behind the sternum and between second to the sixth
ribs.
 Approximately 2/3 of the heart lies on the left to the midline. Posteriorly the heart rests on the bodies of
the fifth to eight thoracic vertebrae.
 It lies obliquely , a little more to the right and present a base above and on apex below.

Organ associated with heart:-

I. Superiorly:- The great blood vessels ie the aorta, superior venacava , pulmonary artery and pulmonary
veins.
II. Inferiorly:- The apex rests on the central tendon of the diaphragm.
III. Anteriorly:- The sternum, ribs and intercostals muscle.
IV. Posteriorly:- The esophagus, trachea, left and right bronchi, descending aorta, inferior venacava and
thoracic vertebra.
V. Laterally:-The lungs, the left lungs overlaps the left side of the heart.

Structure of the heart :- the heart is composed of three layer of tissue

 Pericardium
• Myocardium
• Endocardium

Fig:- Layer of heart wall

A) Pericardium :- The pericardium is the outer most layer and made of two layer. The outer sac consists of
Fibrous tissue and inner of continuous double layer of serous membrane. It enclosed the pericardial cavity
which contain pericardial fluid.
• Fibrous pericardium:- It is the most superfacial layer of the pericardium . It is made up of dense and loose
connective tissue.

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• Serious pericardium:- It is divided into two layer visceral and perietal pericardial layer , there is a
potential space called pericardial cavity which contain a supply of lubricating serous fluid known as
pericardial fluid.
Function:-
• Fixes heart in mediastrnum and limits its motion.
• Protect it from infection.
• Lubricates the heart.
• Prevents excessive dilatation of the heart.
Pericardial arteries supply blood to the dorsal portion of pericardium.
B) Myocardium:- The myocardium is the muscular wall of the heart (cardiac muscle)(or the heart muscle)
and forms a thick middle layer between the outer epicardium layer and the inner endocardium layer. The
myocardial muscle is similar to the skeletal muscle in that it is striated and is not under voluntary control.
The myocardium is stimulated by the action of SAnode without nerve stimulus. The muscular layer is
thicker in the left ventricle as it has to pump more blood to the aorta where as in the right ventricle, it is
thinner because it only drives the blood to the lungs. Myocardium gets the blood supply from the left and
right coronary arteries.
C) Endocardium:- The endocardium is the innermost layer of tissue that lies the chamber of the heart. It
consists of single layer of epithelium, which provides a smooth lining for the blood to flow over. It
continuous with the valves of the heart and blood vessels. Function:-
• The endocardium provides smooth muscle for the inside of the heart. The smooth surface of wall allows
blood to freely flow along the tissue.
• The endocardium plays a role in the heart beat by containing the purkinging fibres. The purkinging fibres
in endicardium helps to relay an electrical signal through the heart. The electricity is cause the heart
muscle to move, which causes the heart to beat.

Properties of cardiac muscle:-

• Excitability • Contractility • Autorhythmicity

Valves of the heart:- The heart valves open and close permitting blood to flow in one direction only. The valves
allow the blood to flow from the atria into the ventricles and from ventricles to arteries. These valves prevents a
back flow from ventricles to the atria and from artery to ventricles. There are four types of valve present in the
heart:-
I. Bicuspid valve(two flaps)
II. Tricuspid valve (three flap) Atrioventricular valve
III. Aortic valve
IV. Pulmonary valve Semilunar valve
Chamber of the heart:-
• Right atrium • Left atrium
• Right ventricle • Left ventricle

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Internal structure of the heart:-

Internal structure of the heart is divided into a right and left sided by the septum, a portion consisting of
myocardium covered by atrioventricular valve into four chamber, the atrium and a lower chamber the ventricle.
The atria serve as a receving chambers. The right sided of the heart pump venous blood into the pulmonary
circulation and the left sided pump atrial blood into the systemic circulation.

Arterial supply of the heart :- The arterial supply of the heart is provided by the right and left coronary arteries,
which arise from the ascending aorta immediately above the aortic valve

Venous drainage of the heart :-Most blood from the heart wall drains into the right atrium through the coronary
sinus.

Function of Heart
 Circulation forward:. Blood transporting A) Oxygen B) Nutrients C) Hormones/Chemical messengers to
all tissues
 Circulates return for Execretion, collects blood on return from body circulate thru lungs to excrete Carbon
Dioxide and other Nitrogen wastes thru lungs.
 Circulates blood to peripheral tissues to maintain body temperature regulating heating and cooling
 Circulates Immune cells - White blood cells to fight infections
 Circulates platelets and clotting factors to seal off wounds

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Different kinds of circulation:-

 Pulmonary circulation
 Systemic circulation
 Portal circulation
 Fetal circulation

 Pulmonary circulation:- The pulmonary circulation consists of the circulation of blood from the right
ventricle of the heart to the lungs and back to the left atrium during which CO2 is excreted and O2 is

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absorbed. The pulmonary artery, carrying deoxygenated blood, leaves the right ventricles of the heart. The
pulmonary artery divides into left and right pulmonary artery. The left pulmonary artery runs to the root of
the left lungs and right pulmonary artery runs to the root of the right lungs. Within the lungs these arteries
subsequently becoming arterioles and the lungs tissue that the interchange of gases occurs. The capillary now
containing oxygenated blood join up with one another and eventually from two veins.
Two pulmonary veins leave from each lungs. Therefore , four pulmonary veins carrying oxygenated blood
enter the left atrium of the heart. During atrial systole this blood passes into the left ventricles and during
ventricular systole , it is forced into the aorta and goes to the general circulation.

Fig :- Flow chart of systemic and pulmonary circulation

 Systemic circulation:- The general or systemic circulation involved the circulation in which the blood
pumped out from the left ventricle is carried by the branches of the aorta around the body and is returned to
the right atrium of the heart by the superior or inferior venecava.
The circulation of blood to the different parts of the body will be described in the order in which their
arteries branch off from the aorta which is the first artery of general circulation.

 Portal circulation:- The portal circulation , blood passes from the abdominal part of the digestive system and
the spleen via the liver and the inferior venacava to the heart.
The liver is unusual in that it has a double blood supply , the right and left hepatic arteries carry oxygenated
blood to the liver , and the portal vein carries venous blood from the GI tract to the liver.
The hepatic portal system collects nutrients rich venous blood draining from the digestive viscera and delivers
it to liver. The livers collects the absorbed nutrients for metabolic processing or for storage before releasing
them back to the blood stream to general cellular use.
The hepatic portal system is very important for two reasons one is that it provides a major source of blood
supply to the liver. The other reason is that blood drained from the intestines carry toxins absorbed from the
GI tract. Many of these toxins are metabolites produced by bacteria within the gastrointestinal system. The
liver these toxins in such a way to make them less harm full to other organ of the body.
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This is formed by following veins forming together:-
I. Inferior mesenteric vein(Rectum, pelvic, descending colon )
II. Superior mesenteric vein(Small intestine)
III. Gastric veins(Stomach)
IV. Cystic vein(Gall bladder)

Hepatic artery Through portal vein(Nutrition)

O2 Liver

Aorta Hepatic vein

Inferior venacava

Deoxygenated blood
Heart
Fig :-Hepatic portal circulation

 Fetal circulation:- In utero , mother and fetal blood nerve mix unless there is pathological condition . There
is only the exchange of CO2, O2 and nutrition occure within the capillaries inside the placenta.
From the placenta , blood passes along the umbilical vein through abdominal wall to the liver. This is only
vessels which carries purely oxygenated blood . In abdominal area , where one branch supply blood to liver
and other branches ductus venosus mixed with inferior venecava, which collected impure blood from lower
limbs. From there the blood passes into the right atrium and directed across through the foramen ovale into
the left atrium. It enter left ventricle through mitral valve and pump into aorta through aortic valve . The
brain, heart, upper and lower limbs supply oxygenated blood from its branches.

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Blood collected from upper part of the body returns to the right atrium by superior venacava. This stream of
blood is depleted of oxygen and nutrients. This stream of blood cross the stream entering from inferior
venecava and reaches right ventricle , then it is pumped into pulmonary artery. It supplies blood to the lungs
for the development.
The remaining pass into aorta through temporary structure ductus arteriousus then , it descends and branches
off into iliac arteries which goes to placenta. These are called hypogastric arteries. They carry deoxygenated
blood from the fetus .The blood is again oxygenated by placenta and continues circulation occurs. This is
called fetal circulation.
There are four temporary structures which initiate the fetal circulation or differentiate between adult and
fetal circulation, these are:-
 Ductus venosus  Umbilical arteries(Hypogastric arteries
 Foramen ovale  Ductus arteriosus

At birth:-
Umbilical cord is clamped

First breath Closure of ductus venosus

(Blood transport to liver
Lungs expands and fluid is expelled and portal system)

Pulmonary resistance Ligamentum venosum

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Increase pressure of left atrium

Closure of foramen oval

Fossa ovali
In fetus After birth
Ductus venosus Ligamentum venosum
Foramen ovale Fossa ovalis
Ductus arteriosus Ligamentum arterisum
Umbilical arteries Umbilical ligamentum
Umbilical vein Ligamentum arteriosum

Cardiac Conduction system

Cardiac conduction is the rate at which the heart
conducts electrical impulses. These impulses cause
the heart to contract and then relax. The constant
cycle of heart muscle contraction followed by
relaxation causes blood to be pumped throughout the
body .
Cardiac conduction can be influenced by various
factors including exercise, temperature, and
endocrine system hormones.

Step 1: Sinoatrial (SA) node (Pacemaker Impulse Generation)

The sinoatrial (SA) node (also referred to as the pacemaker of the heart) contracts generating nerve impulses that
travel throughout the heart wall. This causes both atria to contract. The SA node is located in the upper wall of
the right atrium. It is composed of nodal tissue that has characteristics of both muscle and nervous tissue.
Step 2: AV Node Impulse Conduction
The atrioventricular (AV) node lies on the right side of the partition that divides the atria, near the bottom of the
right atrium.When the impulses from the SA node reach the AV node they are delayed for about a tenth of a
second. This delay allows the atria to contract and empty their contents first.
Step 3: Atrioventricular Bundle
The impulses are then sent down the atrioventricular bundle. It is originates from AV node and extends to the
introventricularseptum.This bundle of fibers branches off into two bundles and the impulses are carried down the
center of the heart to the left and right ventricles.
Step 4: Purkinje Fibers (bundle of his)
At the base of the heart the atrioventricular bundles start to divide further into Purkinje fibers. When the impulses
reach these fibers they trigger the muscle fibers in the ventricles to contract. The right ventricle sends blood to the
lungs via the pulmonary artery. The left ventricle pumps blood to the aorta.

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Cardiac Cycle
Cardiac cycle means a complete heartbeat that consist of contraction(systole) and relaxation(diastole) of both
atria plus contraction and relaxation of both ventricles . The normal cardiac per minute is range from 60-80.
 Atrial Systole- Contraction of the atria (0.1 Sec)
 Ventricular Systole –Contraction of the Ventricles (0.3 sec)
 Complete Cardiac Diastole – Relaxation of the atria and Ventricles (0.4 sec)

The cardiac cycle refers to a complete heartbeat

from its generation to the beginning of the next beat,
and so includes the diastole, the systole, and the
intervening pause. The frequency of the cardiac
cycle is described by the heart rate, which is
typically expressed as beats per minute. Each beat of
the heart involves five major stages. The first two
stages, often considered together as the "ventricular
filling" stage, involve the movement of blood from
the atria into the ventricles. The next three stages
involve the movement of blood from the ventricles
to the pulmonary artery (in the case of the right
ventricle) and the aorta (in the case of the left
ventricles.
The first stage, " diastole," is when the semilunar valves (the pulmonary valve and the aortic valve) close, the
atrioventricular (AV) valves (the mitral valve and the tricuspid valve) open, and the whole heart is relaxed.
The second stage, "atrial systole," is when the atrium contracts, and blood flows from atrium to the ventricle.
The third stage, "isovolumic contraction" is when the ventricles begin to contract, the AV and semilunar
valves close, and there is no change in volume.
The fourth stage, "ventricular systole," is when the ventricles are contracting and emptying, and the semilunar
valves are open.
During the fifth stage, "isovolumic relaxation time", pressure decreases, no blood enters the ventricles, the
ventricles stop contracting and begin to relax, and the semilunar valves close due to the pressure of blood in the
aorta.

Heart Sound
Heart sounds are the noises generated by the beating heart and the resultant flow of blood through it. In cardiac
auscultation, an examiner may use a stethoscope to listen for these unique and distinct sounds that provide
important auditory data regarding the condition of the heart.
In healthy adults, there are two normal heart sounds often described as a lub and a dub (or dup), that occur in
sequence with each heartbeat. These are the first heart sound (S1) and second heart sound (S2), produced by the
closing of the AV valves and semilunar valves,
The closing of the mitral and tricuspid valves (known together as the atrioventricular valves) at the beginning of
ventricular systole cause the first part (the lubb) of the "lubb-dubb" sound made by the heart as it beats. Formally,

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this sound is known as the first heart sound, or S1.
The second part (the dubb) of the "lubb-dubb" (the second heart sound, or S2), is caused by the closure of the
aortic and pulmonary valves at the end of ventricular systole.

Ventricular diastole is the period during which the ventricles are filling and relaxing, while atrial diastole is the
period during which the atria are relaxing.
Ventricular systole is the period of contraction of the ventricles and Atrial systole is period of contraction of
atria.
Stroke volume (SV) is the amount of blood pumped out of the heart (left ventricle - to the body) during each
contraction measured in mL/beat (millilitres per beat). It is about 70 ml.
Stroke volume is equal to different between End diastolic volume(EDV) and End systolic volume(ESV).
Stroke volume = EDV-ESV
End diastolic volume(EDV) is the volume of the blood which remains in the ventricle at the end of ventricular
diastole. It is about 110-120 ml.
End systolic volume(ESV) is the volume of the blood which remains in the ventricle at the end of ventricular
systole. It is about 40-50 ml.
cardiac output (Q), the amount of blood that is ejected by each ventricle the in each minute is called cardiac
output, measured in L/minute, can be calculated by multiplying stroke volume by heart rate (Q = SV x
HR).Normal cardiac output is about 5 lit/min.

BLOOD
Blood is a liquid Connective tissue that is ubiquitous in the body. It consists of the cell and fluid within the closed
circulatory system that flow in a regular unidirectional movement propelled mainly by the rhythmic contraction
of the heart.
Blood is the fluid that circulates through the heart, arteries, capillaries and vein, carrying nutrient materials and
O2 to the tissues and removing waste product and CO2 from tissue.

Characteristics of Blood
 It is thick red fluid. It is bright red in arteries due to presence of O2 (pure blood)and dark purplish red in
vein due to presence of CO2 (impure blood).
 Slightly alkaline in reaction - PH 7.35-7.45.  Temperature – 36 -38 deg C
 Volume - 5-6 liters (7.8%of total body  Osmotic pressure – 25 mm of Hg
weight)  Taste - Salty
 Specific gravity - 1.052-1.060  Normal output from heart in one contraction
 Viscosity - 4.5 times more than water - 70-80 ml

Function of blood
 Transportation
 Regulation
 Protection

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CIRCULATORY SYSTEM UNIT-4

- It carries oxygen from the lungs to the body tissue and CO2 from tissue to lungs for excretion.
- It transports nutrients materials from the digestive tract to the cell and remove waste products from
there.
- It carries hormones , enzymes , vitamin and other chemical to target organ or tissue.
 Regulation
- It distribute the heat and regulates the body temperature.
- It maintain water and electrolyte balance.
- It maintain acid base balance.

 Protection
- It carries materials (Platelets) that clot blood, preventing its
loss from a rupture blood vessels.
- It contains agent (WBC) which protect against the infection.
- It passes through monitoring organ and enables the
detection of variation in hormone level, osmotic pressure, PH ,
temperature, Blood pressure.

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 CIRCULATORY SYSTEM UNIT-4

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REDBLOOD CELL(RBC) or ERYTHROCYTES

 These are shaped like a small wheel and are biconcave on both side.
 The central part of the red corpuscle is thinness than the circumference.
 They are correctly called corpuscle rather than cell because they have no nucleus.
 This non- nucleated discs diameter is about 7 microns.
 The normal RBC count in the blood is slightly lower in women than men.
 They are 500-600 times more than WBC.
 Life span :- 120 days.
 Male :- 4.5-6.5 million/mm3.
Female:- 4.5- 5 million/mm3.
 They helps transport of respiratory gases.
 It helps to maintain acid base balance , iron balance and maintaince of blood viscosity.
 It also bears surface antigen used to detect blood grouping.
 In embroyonic stage the RBC are formed in liver and spleen but after birth they are formed in the red
bone marrow. This process of formation of RBCis known as erythropoiesis.
FUNCTIONS:-
 The main function of RBC to carry oxygen from the lungs to tissue and co2 from tissue to lungs.
 The antigens on the plasma membrane of RBCs determine the person’s blood group.
 RBC also has a role in the iron balance

WHITE BLOOD CEEL (WBC) or LEUCOCYTES

• They are colourless cells containing nuclei .
• They are little larger in size than the RBC and much less number (1wbc to 500 RBC).
• Normal leucocytes count:- 4000-11000 per cu mm.
• It is formed in Red Bone marrow.
• Life span :-
• It also helps to defence mechanism.

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Functions of WBC:-
 To fight with bacterial infection .
 To ingest and digest deal tissue called phagocytosis.

 Leucocytes are divided into two types:- (Based on presence of granules)

• Granulocytes (Polymorphonuclear):- This is so called because its nucleus is irregular and variables in
shapes its cytoplasm contains granules. Its forms about 75% of total WBC.
• A granulocytes(Mononuclear) :- These are non granular cells and constitute about 25% of total number of
WBC . They are distinguished from the polymorphonuclear cells by having a large nucleus.

• Neutrophils are the most abundant white blood cell, constituting 60-70% of the circulating
leukocytes.They defend against bacterial or fungal infection. They are usually first responders to
microbial infection; their activity and death in large numbers forms pus. Neutrophils are active in
phagocytosing bacteria and are present in large amount in the pus of wounds. The life span of a
circulating human neutrophil is about 5.4 days. Function:-
 Phagocytosis of bacteria
 Release of antimicrobial chemicals
 Initiation of inflammatory response by activation of the complementary system
 Neutrophils seem to be especially important for preventing infections of the skin and mucosal surface.

• Eosinophils:- Eosinophils compose about 2-4% of the WBC total. This count fluctuates throughout the
day, seasonally, and during menstruation. It rises in response to allergies, parasitic infections, They are
rare in the blood, but increased in allergic condition such as asthma ,hay fever, and during sensitivity and
skin condition. Function:-
• Phagocytosis of antigen – antibody complexes, allergens and inflammatory chemicals
• Release enzymes that weaken or destroy parasites such as worms.
• Eosinophils also degrade histamine and decrease the allergic reaction

• Basophil:- Basophils are chiefly responsible for allergic and antigen response by releasing the chemical
histamine causing the dilation of blood vessels. Because they are the rarest of the white blood cells (less
than 0.5% of the total count. They excrete two chemicals that aid in the body's defenses: histamine and
heparin. Histamine is responsible for widening blood vessels and increasing the flow of blood to injured
tissue. It also makes blood vessels more permeable so neutrophils and clotting proteins can get into
connective tissue more easily. Heparin is an anticoagulant that inhibits blood clotting and promotes the
movement of white blood cells into an area. Basophils can also release chemical signals that attract
eosinophils and neutrophils to an infection site. Function:-
• Secrete histamine which increase blood flow to a tissue.
• Secrete heparine which promotes mobility of other WBCs by preventing clotting.
• Basophils possible play a role in the onset of certain allergic reaction.
• They may also protect us from some parasitic infection:- Scabies

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 Lymphocytes : Lymphocytes are associated with the protection of the body against foreign
materials.
• B-lymphocytes, which is not present in man . They are arise from bone marrow, gut and lymphnoid
tissue. They are humoral or antibody mediated immune system. It donot moves the site of infection and
donot reacts against transplants and cancer cells.
• T-lymphocytes , They are arise from bone marrow and thymus and they are against pathogens including
protest and fungi. It moves to the site of infection . It reacts against transplants and cancer cells which is
sensitized when they encounter an antigen for the first time.
 Monocytes:-
These are large cell with a large nucleus that originate in red bone marrow. They are amoeboid in shape. It
main function is phagocytsis, antigen production and cytokine production. It helps to increase temperature
during microbial infection.

PLATELETS OR THROMBOCYTES
• Platelets, also called thrombocytes, are a component of blood whose function (along with
the coagulation factors) is to stop bleeding by clumping and clotting blood vessel injuries. Platelets have
no cell nucleus ,they are fragments of cytoplasm that are derived from the bone marrow, and then enter
the circulation. These unactivated platelets are biconvex discoid (lens-shaped) structures. They are found
only in mammals.
• Men as a group have slightly higher mean value the women.
• Old platelets are destroyed by phagocytosis in liver.
• Normal platelets counts:-1,50000-4,00,000 mm3
• Life span:- 8- 9 days.
• The main function of platelets is to contribute to hemostasis: the process of stopping bleeding at the site of
interrupted.
Function:-
 The functions of platelets are primarily related to hemostasis.
 They secrete procoagulants or clotting factors, which promotes blood clotting.
 They secret vasoconstrictors which cause vascular spasm in broken vessels.
 They form temporary platelet plug to stop bleeding.
 They dissolve blood clot that have out lasted their usefulness.
 They secrete chemicals that attract neutrophils and monocytes to the site of inflammation.
 They secrete growth factors that simulate mitosis in the vascular wall. These factors help to maintaining
the lining of damaged blood vessel.

Plasma
Plasma is a pale yellow, water solution .It makes up about 55% ot the total volume of our blood (6.4-
8.4gm/100ml)
It acts as a solvent for important proteins, nutrients, electrolytes, gases and other substances which is
essential to life.
It has composition of

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a) Water (90- 92 %)
b) Solid (8- 10 %)
Solid plasma :-
I. Plasma protein(Albumin, globulin, fibrinogen, prothrombin)
II. Mineral salt :- Sodium, potassium, calcium, magnesium, sodium bicarbonate, phosphorus, iron, iodine,
copper cobalt, chloride.
III. Nutrient material:- Vitamins, Carbohydrates(amino acids), protein, fatty acid and fats
IV. Organic waste product: Urea, uric acid, creatinine.
V. Gases:- Oxygen, carbon dioxide , nitrogen
VI. Enzyme:-Pepsinogen, trypsinogen, amylage
VII. Antibodies and antotoxine:- Different types immunoglobin eg:- IgG, IgM, IgA
VIII. Different endocrinal hormones:- Tsh, T3, T4.

Main function
 Albumins helps to maintain the correct amount of fluid circulation in the body.
 It helps to control bleeding and work together with platelets to ensure the blood clot effectively.
 Immunoglobulins are part of the immune system.
 They produce variety of antibodies that they fight against infection.

Cells Decrease count Increase count

RBC Anaemia Polycythemia or
erythrocytes
WBC Leukopenia Leukocytes/ leukemia

PLATELETS Thrombocytopenia Thrombocytosis

Haemostasis:-
It is a series of responses that stop the blood flow when blood vessels are ruptured.
This response is fast, localized and carefully controlled.
It involves many blood coagulation factors present in plasma and other substances released by platelets and
injured tissues.
There are three mechanism of haemostatic mechanism:
Vascular spasm(Vasoconstriction)
Platelet plug formation
Blood clotting(Coagulation)

i. Vascular Spasm:
The smooth muscle in blood vessel walls contracts immediately the blood vessel is broken. This response reduces
blood loss for some time, while the other haemostatic mechanisms become active.

ii. Platelet Plug Formation:

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When blood platelets encounter a damaged blood vessel they form a “platelet plug” to help to close the gap in the
broken blood vessel. (The key stages of this process are called platelet adhesion, platelet release reaction, and
platelet aggregateon)

iii. Coagulation:
Following damage to a blood vessel, vascular spasm occurs to reduce blood loss while other mechanisms also
take effect. Blood platelets congregate at the site of damage and amass to form a platelet plug. This is the
beginning of the process of the blood “breaking down” from its usual liquid form in such a way that its
constituents play their own parts in processes to minimize blood loss.
Blood normally remains in its liquid state while it is within the blood vessels but when it leaves them the blood
may thicken and form a gel (coagulation). Blood clotting (technically “blood coagulation”) is the process by
which (liquid) blood is transformed into a solid state.
This blood clotting is a complex process involving many clotting factors (incl. calcium ions, enzymes, platelets,
damaged tissues) activating each other.

Blood clotting(Coagulation)
Coagulation(clotting) of the blood is the last but most effective defense against bleeding,. Coagulation is the
process by which a liquid blood is transformed to a gel. It is important for the blood to clot quickly when a
vessels has been broken, but equally important for it not to clot in the absence of vessels damage. It is most
complex process in the body, involving 30 chemical reactions.
Many substances necessary for clotting are normally inactive in the blood stream. These factors include calcium
ions, several inactive enzymes and other molecules released by the platelets or damaged tissues. Factors that
enhance clot formation are called procoagulants, those that inhibit clotting are called anticoagulatios.
A balance is maintained between procoagulants and anticoagulants. Most procoagulants are proteins produced by
the liver. They are always present in plasma in inactive form.
When an injury occurs, the procoagulants(clotting simultaneously to form a complex substance
factors) are activated. When one factors is activated, called prothrombin
it functions as an enzyme that activates the next one activator(prothrombinase). From this point
in the clotting pathway and finally a clot is formed on, the clotting mechanism have a common
Blood clotting involves a series of reactions in which pathway.
each clotting factors depends on the activation of the 2. Prothrombin activators converts a plasma
preceding one. Mainly three critical events are protein called prothrombin into thrombin.
involves in coagulation; 3. Thrombin converts fibrinogen(a plasma
1. Two reaction pathways to coagulation called protein) into fibrin mesh, which traps blood
the extrinsic and intrinsic pathway work cells and seals the hole.

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Blood clotting factors

Number Name Origin

I Fibrinogen Liver
II Prothrombin Liver
III Tissue thromboplastin Perivascular tissue
IV Calcium ions Diet, bones, and platelets
V Proaccelerin, Labile factors Liver, Platetets and endothelial cell
VII Proconvertin, stable factors Liver
VIII Antihemphilic factor A Liver
IX Antihemphilic factor A , Christmas factor Liver
X Thrombokinnase, stuart factors Liver
XI Antihemophilic factor C Liver
XII Hageman factor, Antihemoplilic factor D Liver, Platelets
XIII Fibrin stabilizing factors Platelets, Plasma

BLOOD GROUPING
• A blood type (also called a blood group) is a classification of blood based on the presence or absence of
inherited antigenic substances on the surface of red blood cells (RBCs). A blood type (also called a blood
group) is a classification of blood based on the presence or absence of antigenic substances on the surface
of red blood cells (RBCs).
• Antigen:-A substance that when introduced into the body stimulates the production of an antibody. Antige
ns includetoxins, bacteria, foreign blood cells, and the cells of transplanted organs.
• Antibody:-
A Y-shaped protein on the surface of B cells that is secretedinto the 

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blood or lymph in response to an antigenic stimulus,such as a bacterium, virus, parasite, or transplanted organ, an
dthat neutralizes the antigen by binding specifically to it; an immunoglobulin.

Blood group AB individuals have both A and B antigens on the surface of their RBCs, and their blood plasma
does not contain any antibodies against either A or B antigen. Therefore, an individual with type AB blood can
receive blood from any group but cannot donate blood to any group other than AB. They are known as universal
recipients.
Blood group Aindividuals have the A antigen on the surface of their RBCs, and blood serum containing IgM
antibodies against the B antigen. Therefore, a group A individual can receive blood only from individuals of
groups A or, and can donate blood to individuals with type A or AB.
Blood group Bindividuals have the B antigen on the surface of their RBCs, and blood serum containing IgM
antibodies against the A antigen. Therefore, a group B individual can receive blood only from individuals of
groups B or, and can donate blood to individuals with type B or AB.
Blood group O individuals do not have either A or B antigens on the surface of their RBCs, and their blood
serum contains IgM anti-A and anti-B antibodies against the A and B blood group antigens. Therefore, a group O
individual can receive blood only from a group O individual, but can donate blood to individuals of any ABO
blood group (i.e., A, B, O or AB).It is Universal donar.

THE RHESUS FACTOR

The RH Factor named for the rheus monkey because it was first studies using the blood of this animal.
Beside from the antigen of the ABO syatem, those of the RH syatem are of the greatest clinical important.

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Each blood type is also grouped by its rheusfactos or RH factor. Blood is either RH positive(RH +) or RH
negative(RH -) .
Rheus refers to another type of antigen or protein on the surface of red blood cells. The rheus comes from
RHEUSES MONKEY, in which protein was discovered.

Rh incompatibility
Rh incompatibility is a condition that develops when a pregnant woman has Rh-negative blood and the baby in
her womb has Rh-positive blood.
If the blood of a person , who is RH positive ,is transfused to a person who is RH negative the recipient slowly
produces an antibody against this agglutinogen. This antibody is called anti RH factor.
If the mother is Rh-negative, and her immune system treats Rh-positive fetal cells as if they were a foreign
substance. The mother's body makes antibodies against the fetal blood cells. These antibodies may cross back
through the placenta during delivery.Stimulating the mother to produce the anti rheuses factor against the RH
positive blood . No reaction occur during first child but when the mother become pregnant in second time, the
anti RH factor able to destroy the baby's circulating red blood cells. They cause severe anemia to fetus, even it is
also cause fetal death.
Firstborn infants are often not affected unless the mother had past miscarriages or abortions that sensitized her
immune system. This because it takes time for the mother to develop antibodies. However, all children she has
later who are also Rh-positive may be affected.
To prevent such occurrence it is now recommended to give special anti D immunoglobulin injection to mother
who is RH negative within 72 hours of delivery.

HEMOGLOBIN(HB%)
• Hemoglobin  also spelled haemoglobin and abbreviated Hb or Hgb, is the iron -containing oxygen-
transport metalloprotein in the red blood cells of all vertebrates.
•  The main function of hemoglobin is to transport oxygen from the lungs to the tissues and then transport
CO2 back from the tissues to the lungs.
• Hemoglobin level:-
Male:- 14-18 gram/dl
Female :- 12-16 gram/dl

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Newborn:-20-22 gram/dl
( dl=100ml)

The BLOOD VESSELS

The blood vessels are the part of the circulatory system that transports blood throughout the human body.
The word vascular, meaning relating to the blood vessels, is derived from the Latin vas, meaning vessel.
There are three major types of blood vessels: the arteries, which carry the blood away from the heart; the
capillaries, which enable the actual exchange of water and chemicals between the blood and the tissues; and the
veins, which carry blood from the capillaries back toward the heart.

Classification of blood vessels

 Anatomical 
 Functional
Anatomical
Artery
Vein
Capillary

Functional
Distributing vessels:-Arteries
Resistance vessels:-Arterioles and pre-capillary
spinctures.
Exchange vessels:-Capillaries
Capacitance vessels:-Veins and venacava
Conducting vessels:-Aortra and its branches

Artery:- Arteries are the blood vessels that transport away from the heart. It always carries pure blood except
pulmonary artery. The size of artery is vary according to the site but but have the same structure.

Vein:- The vein are the blood vessels that transport blood to the heart. It always carries deoxygenated blood
except pulmonary vein in adult and umbilical vein in fetal circulation. The size of artery is vary according to the
site but but have the same structure.

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Capillaries are the smallest of a body's blood vessels (and lymph vessels) that make up the microcirculation.
Their endothelial linings are only one cell layer thick. These microvessels, measuring around 5 to 10 micrometres
(µm) in diameter, connect arterioles and venules, and they help to enable the exchange of water, oxygen, carbon
dioxide, and many other nutrients and waste substances between the blood and the tissues.

The arteries and veins have three layers, but the

middle layer is thicker in the arteries than it is in the
veins:
Tunica intima
Tunica media
Tunica adventitia

Tunica intima (the inner layer): The inner coat of blood vessels is called tunica intima . It consist of single layer
of simple squamous endothelial cells called endothelium, which line the artery and separated from the middle
muscular coat by a layer of elastic fiber.
Tunica media (the thickest layer in arteries): The middle coat of blood vessels is called tunica media. It consists
of elastic fiber and connective tissue. The tunica media may (especially in arteries) be rich in vascular smooth
muscle, and arranged in a circular manner which controls the caliber of the vessel.

Tunica adventitia: (the thickest layer in veins) It is composed of connective tissue. It also contains nerves that
supply the vessel as well as nutrient capillaries in the larger blood vessels.

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Function of the blood vessels
 Arteries transport the oxygen rich blood away from the heart to the all body tissues.
(with the exception of the pulmonary arteries, it carries oxygen poor blood to the lungs)
 Vein carry the oxygen poor blood from the body tissues back to the heart.(But pulmonary veins carry
oxygenated blood from the lungs to the left atrium)
 Vein also carry waste products away from the organs and tissues, while the veins associated with the
small intestine carry digested food via the liver to the inferior venacave.
 The capillaries allow for gaseous exchange to take place between the capillaries and the tissue fluids.
 Venules collect blood from the capillaries and deliver it to veins.

Location of the common Arteries and Vein

Names of Systemic Arteries

 The Aorta and its branches
 The ascending aorta
 The arch of aorta
 The thoracic aorta
 The abdominal aorta

The Aorta and its branches:-

 The ascending aorta:- It is the first portion of the aorta. It begins at the aortic valve.
 The arch of aorta:- It is located immediately beyond the ascending aorta.
 The thoracic aorta:- It is continuation of the arch of the aorta. It is also called descending aorta.
 The abdominal aorta:- It is a continuation of the thoracic aorta in the abdominal cavity. It is the section
between the diaphragm and the common iliac arteteries.

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The ascending aorta;- The ascending aorta has two branches near the heart that supply the all parts of the
myocardium. They are:-
 The left coronary arteries
 The right coronary arteries
The arch of aorta :- The arch of aorta gives off three large branches: the brachiocephalic trunk, the left common
carotid and the left subclavican

o The brachiocephalic trunk:-It is a short artery. Its names means that is supplies the head and the arm.
 After extending upward, it divided inti the right subclavical artery and the right common carotid artery.
 The right subclavical artery supplies the right uper extremity and the right side of the head and neck.
 The right common carotid artery supplies the right side of the head and the neck.
o The left common carotid artery is the second branch which extends upward from the highest part of the
aortic arch. It supplies the left side of the neck and the head.
o The left subclavian artery extends under the left collar bone (Clavical) and supplies the left upper
extremity.

The thoracic aorta:- The third part of the aorta, the thoracic, consists of parietal and visceral branches . They
supply branches to the chest wall, to the esophagus, and to the bronchi and their treelike subdivision in the lungs.
 Parietal branches of the thoracic aorta include:-
o Posterior intercostals arteries supply the intercostals and deep muscle of the back.
o Subcostal arteries supply the same region of the posterior intercostals arteries
o Superior phrenic arteries supply the posterior part of the diaphragm
 The visceral branches of the thoracic aorta include:-
o Pericardial arteries supply the pericardium of the heart.
o Bronchial arteries supply the lungs, bronchi and pleurae.
o Esophageal arteries supply the oesophagus.
o Mediastinal areteries supply the posterior mediastinum.

The abdominal aorta :- The abdominal aorta also consists of parietal and visceral branches that supply the
abdominal viscera.
 The visceral branches consists of
o The celiac trunk that subdivides into three branches; the left gastric artery goes to the stomach, the splenic
artery goes to the spleen, and the hepatic artery carries oxygenated blood to the liver.
o The superior mesenteric artery, the largest of these branches, carries blood to most of the small intestine
as well as to the first half of the large intestine.
 The much smaller inferior mesenteric artery supplies the second one half of the large intestine.
 The suprarenal arteries supply the adrenal(Suprarenal) glands.
 The renal arteries, the largest in this group, carry blood to the kidney.

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 The gonadal arteries(ovarian arteries in the female and testicular arteries in the male), Supply the sex
glands
 The parietal branches consists of:-
o Inferior phrenic arteries supply the diaphragm
o Four pairs of lumber arteries supply the lumber vertebrae, spinal cord and muscle and skin of the lumber
region of the back.
o Median sacreal arteries supply the sacrum and coccyx.
Arteries of the pelvis and lower limbs
 The abdominal aorta finally divided into two common iliac arteries. Both of these vessels extend into the
pelvis, where each one subdivided into an internal and an external iliac artery.
 The internal iliac vessels then send branches to the pelvic organ, including the urinary bladder, the
rectum, and some of the reproductive organs.
 The external iliac arteries continue into the thigh as the femoral arteries. These vessels gives off branches
in the thigh and then become the popliteal arteries, which subdivide below the knee. The subdivisions
include the tibial arteries, fibular arteries, and dorsalis pedis, which supply the leg and the foot.

Other sub – branches of systemic Arteries

 Hundreds of names might be included, but we shall mention only a few. For example;-
 Each common carotid artery gives off branches to the thyroid gland and other structures in the neck
before dividing into the external and internal carotid artery, which supplies parts of the head.
 The hand receives blood from the subclavian artery, which becomes the axillary in the axilla.
 The longest part of this vessel, the brachial artery, is in the arm proper. It subdivides into two branches
near the elbow; the radial artery, which continues down the thumb side of the forearm and wrist, and the
ulnar artery, which extends along the medial or little finger side into the hand.

Major veins of the systemic circulation

Two terminal systemic veins, the superior and inferior venacava, along with their other veins, drain blood and
return to the heart.
 The superior Venacava:- The superior venacava receives blood from the regions superior to the
diaphragm except from the pulmonary circuit. It is formed by the union of the right and left
brachiocephalic veins and empties into the right atrium . It drains the head, neck, chest and upper limbs.
The largest veins of the upper limbs are the cephalic, the basilic and the median cubital veins.
 The inferior venacava:- The inferior venacava , which is much longer than the superior venacava returns
the blood to the heart from all body regions below the diaphragm. It begins in the lower abdomen the by
the union of the two common iliac veins. It then ascends along the back wall of the abdomen, receiving
venous blood draining from the pelvis, kidney and lower limbs. Just before it penetrates the diaphragm, it
is joined by the hepatic veins, which transport blood from the liver, and then it enters the inferior aspect of
the right atruim of the heart. The saphenous veins of the lower extremities are the longest veins of the
body.
 Drainage into the inferior venacave is more complicated than drainage into the superior venacave. The
large veins below the diaphragm may be divided into two group:-

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 The right and left veins that drain paired parts and organs.
 They include the iliac veins from near the groin, four pairs of lumber veins from the dorsal part of the
trunk and from the spinal cord, the testicular veins from the testes of the male and the ovarian vein from
the ovaries of the female, the renal and suprarenal veins from the kidneys and adrenal glands near the
kidneys, and finally the large hepatic veins from the liver.
 For the most part, these vessels empty directly into the inferior venacava.
 The left testicular in the male and the left ovarian in female empty in to the left renal vein, which then
take this blood to the inferior venacava ; these veins thus constitute exceptions to the rule that the paired
veins empty directly into venacava.
 Unpaired veins that come from the spleen and from parts of the digestive tract(stomach and intestine)and
empty into a vein called the portal vein.
 Unlike other veins, which empty into inferior venacava , the hepatic portal vein is part of a special system
that enable blood to circulate through the liver before returning to the heart.

Important questions of circulatory system:-

 Draw a well label diagram of the heart and describe the function of heat.
 Explain the pulmonary and systemic circulation with diagram.
 Describe the anatomy of heart and describe the flow of blood through the heart with well label diagram.
 Write the composition and function of blood.
 Explain the portal circulation with well label diagram.
 Explain the fetal circulation with well label diagram.
 Define blood vessels and describe the structure and function of blood vessels.
 Define blood grouping and describe types of blood.
 Discuss the mechanism of blood coagulation/ clotting
 Define pulse and list the sites of taking pulse.
 Define blood pressure and describe the types of blood pressure.
 Write short notes:-
 Cardiac cycle  Different between arteries , vein , capillaries
 Conduction system
 Heart sound

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