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ONCOLOGY 361
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6
Vascular System and Hematology
Michele P. West and Jaime C. Paz
Introduction
Alterations in the integrity of the vascular and hematologic systems
can alter a patient's activity tolerance. The physical therapist must
be aware of the potential impact that a change in blood composition
or blood flow has on a multitude of body functions, including cardiac Output, hemostasis, energy level, and healing. The objectives of this chapter are to provide the following:
1.
A review of the structure and function of blood and
blood vessels
2.
A review of vascular and hematologic evaluation, includ-
ing physical examination and diagnostic and laboratory tests
3.
A description of vascular and hematologic diseases and
disorders, including clinical findings, medical and surgical management, and physical therapy inrervenrion
363
364
ACUTE CARE HANDBOOK FOR PHYSICAL 1l-1ERAPISTS
Structure
The network of arteries, veins, and capillaries comprises the vascular system. Living blood cells and plasma within the blood vessels are the structures that comprise the hemarologic system. The lymphatic system assists the vascular system by draining unabsorbed plasma from tissue spaces and returning this fluid (lymph) ro the
heart via the thoracic duct, which empties into the left jugular
vein. The flow of lymph is regulated by intrinsic contractions of
the lymph vessels, muscular contractions, respiratory movements,
and gravity.'
Vascular System Structure
All blood vessels are composed of three similar layers. Table 6-1
describes the strucrural characteristics of the three different blood vessel layers. Blood vessel diameter, length, and wall thickness vary according ro location and function. Table 6-2 describes the unique
characteristics of arteries, veins, and capillaries.
Table 6-1. Blood Vessel Layers
Layer
Description
Function
Tunica intima
Innermost layer
Provides a smooth sur
Endothelial layer over a
face for laminar blood
basement membrane
now
Tunica media
Middle layer
Constricts and dilates for
Smooch muscle cells and
blood pressure regulation
elastic connective tissue with sympathetic
innervation
Tunica adventitia Outermost layer
Protects and attaches
Composed of collagen
blood vessels to
fibers, lymph vessels,
nearby structures
and (he blood vessels
that supply nutrients
to the blood vessel
Source: Dam from The Cardiovascular System: Blood Vessels. In EN Marich, Human
Anatomy and Physiology (3rd cd). Redwood City, CA: Benjamin-Cummings, 1995.
VASCULAR SYSTEM AND HEMATOLOGY
365
Table 6-2. Characteristics of Blood Vessels
Vessel
Description
Artery
Small, medium, or large in diameter.
Larger arteries are located closer to the heart.
Thick tunica media layer allows arteries to readily
accommodate to pressure changes from the heart.
Vein
Small, medium, or large in diameter.
Thin runica media and thick tunica adventitia.
Valves prevenr back flow of blood to maintain venous
return to the heart.
Capillary nerwork
The inrerface of the arterial and venous systems where
blood cells, fluids, and gases are exchanged.
Capilbry beds can be open or closed, depending on the
circulatory requiremenrs of the body.
Source: D:lt:1 from The C1rdiovascular Syslem: Blood. In EN Maricb, Human Anatomy
and Physiology (3rd cd). Redwood Cicy, CA: Benjamin·Cummings, 1995.
Hematologic System Stmctllre
Blood is composed of living cells in a nonliving plasma solution and
accounts for 8% of total body weight, or 4-5 liters in women and
5-6 liters in men. Table 6-3 describes the characteristics of the different blood cells. Plasma is composed almost completely of water and contains more than 100 dissolved substances. The major solutes
include albumin, fibrinogen, protein globules, nitrogenous substances, nutrients, electrolytes, and respiratory gases.2
Function
The function of the blood vessels is to carry blood throughout the
body to and from the heart. Normal alterations in the vessel diameter
will occur depending on circulating blood volume and the metabolic
needs of the tissues.
The following are the seven major functions of blood2:
I .
The transport of oxygen and nutrients to body cells from
the lungs and gastroinrestinal organs, respectively