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After studying this chapter, you should be able to:

  • Describe the cellular components of blood, and their origins, how the fragility of red blood cells is controlled, the role of hemoglobin in transporting oxygen in red blood cells, and the basis of hemoglobinopathies.

  • Define the composition of plasma and lymph and identify the sources of their constituents.

  • Understand the molecular basis of blood groups and the reasons for transfusion reactions.

  • Delineate the process of hemostasis that restricts blood loss when vessels are damaged, the adverse consequences of intravascular thrombosis, and the basis of clotting disorders.

  • Identify the types of blood and lymphatic vessels that make up the circulatory system and the regulation and function of their primary constituent cell types.

  • Describe how physical principles dictate the flow of blood and lymph around the body.

  • Understand the basis of methods used to measure blood flow and blood pressure in various vascular segments.

  • Understand the basis and consequences of a sustained elevation of systemic arterial pressure (hypertension).


The circulatory system supplies inspired O2 as well as substances absorbed from the gastrointestinal tract to the tissues, returns CO2 to the lungs and other products of metabolism to the kidneys, functions in the regulation of body temperature, and distributes hormones and other agents that regulate cell function. The blood, the carrier of these substances, is pumped through a closed system of blood vessels by the heart. From the left ventricle, blood is pumped through the arteries and arterioles to the capillaries, where it equilibrates with the interstitial fluid. The capillaries drain through venules into the veins and back to the right atrium. Some tissue fluids enter another system of closed vessels, the lymphatics, which drain lymph via the thoracic duct and the right lymphatic duct into the venous system. The circulation is controlled by multiple regulatory systems that function in general to maintain adequate capillary blood flow when possible in all organs, but particularly in the heart and brain.

Blood flows through the circulation primarily because of the forward motion imparted to it by the pumping of the heart, although in the case of the systemic circulation, diastolic recoil of the walls of the arteries, compression of the veins by skeletal muscles during exercise, and the negative pressure in the thorax during inspiration also move the blood forward. The resistance to flow depends to a minor degree on the viscosity of the blood but mostly on the diameter of the vessels, and principally that of the arterioles. The blood flow to each tissue is regulated by local chemical and general neural and humoral mechanisms that dilate or constrict its vessels. All of the blood flows through the lungs, but the systemic circulation is made up of numerous different circuits in parallel (Figure 31–1). The arrangement permits wide variations in regional blood flow without changing total systemic flow.


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