10.4 – Blood Vessels Diseases, Disorders and Diagnostic Testing

Common Diseases and Disorders of Blood Vessels and/or Blood

Arteriosclerosis

Arteriosclerosis is normally defined as the more generalized loss of compliance, “hardening of the arteries,” whereas atherosclerosis is a more specific term for the build-up of plaque in the walls of the vessel and is a specific type of arteriosclerosis.

When arteriosclerosis causes vessel compliance to be reduced, pressure and resistance within the vessel increase. This is a leading cause of hypertension and coronary heart disease, as it causes the heart to work harder to overcome this resistance. Any artery in the body can be affected by these pathological conditions, and individuals who have pathologies like coronary artery disease may also be at risk for other vascular injuries, like strokes or peripheral arterial disease.

Atherosclerosis is a type of arteriosclerosis in which plaques form when circulating triglycerides, cholesterol and other substances seep between the damaged endothelial lining cells and become trapped within the artery wall, resulting in narrowed arteries and impaired blood flow (see Figure 10.16) (Betts et al., 2013).

Sometimes a plaque can rupture, causing microscopic tears in the artery wall that allow blood to leak into the tissue on the other side. When this happens, platelets rush to the site to clot the blood. This clot can further obstruct the artery and—if it occurs in a coronary or cerebral artery—cause a sudden heart attack or stroke. Alternatively, plaque can break off and travel through the bloodstream as an embolus until it blocks a more distant, smaller artery.

Peripheral arterial disease (PAD, also called peripheral vascular disease, PVD), occurs when atherosclerosis affects arteries in the legs. A major risk factor for both arteriosclerosis and atherosclerosis is advanced age, as the conditions tend to progress over time. There is also a distinct genetic component, and pre-existing hypertension and/or diabetes also greatly increase the risk. However, obesity, poor nutrition, lack of physical activity, and tobacco use all are major risk factors.

Treatment of atherosclerosis includes lifestyle changes, such as weight loss, smoking cessation, regular exercise, and adoption of a diet low in sodium and saturated fats. Medications to reduce cholesterol and blood pressure may be prescribed. For blocked coronary arteries, angioplasty or coronary artery bypass graft (CABG) surgery may be warranted. In an carotid endarterectomy, plaque is surgically removed from the walls of a the carotid artery, which is the main source of oxygenated blood for the brain (Betts et al., 2013).

Edema and Varicose Veins

Despite the presence of valves and the contributions of other anatomical and physiological adaptations that assist in moving blood through veins, over the course of a day, some blood will inevitably pool, especially in the lower limbs, due to the pull of gravity. Any blood that accumulates in a vein will increase the pressure within it, which can then be reflected back into the smaller veins, venules, and eventually even the capillaries. This increased pressure in the capillaries will push of fluids out of the capillaries and into the interstitial fluid, causing a condition called edema.

Most people experience a daily accumulation of tissue fluid, especially if they spend much of their work life on their feet (like most health professionals). However, clinical edema goes beyond normal swelling and requires medical treatment. Edema has many potential causes, including hypertension and heart failure, severe protein deficiency, renal failure, and many others. In order to treat edema, which is a sign rather than a discrete disorder, the underlying cause must be diagnosed and alleviated.

Edema may be accompanied by varicose veins, especially in the superficial veins of the legs (see Figure 10.17). This disorder arises when defective valves allow blood to accumulate within the veins, causing them to distend, twist, and become visible on the surface of the skin. Varicose veins may occur in both sexes, but are more common in women and are often related to pregnancy. More than simple cosmetic blemishes, varicose veins are often painful and sometimes itchy or throbbing. Without treatment, they tend to grow worse over time. The use of support hose, as well as elevating the feet and legs whenever possible, may be helpful in alleviating this condition (Betts, et al., 2013).

Hypertension

Hypertension is defined as chronic and persistent blood pressure measurements of 140/90 mm Hg or above. Pressures between 120/80 and 140/90 mm Hg are defined as prehypertension. Hypertension is typically a silent disorder and patients may fail to recognize the seriousness of their condition and fail to follow their treatment plan, putting them at risk for a heart attack or stroke. Hypertension may also lead to an aneurysm, peripheral arterial disease, chronic kidney disease, or heart failure (Betts et al., 2013).

Hemorrhage

Minor blood loss is managed by hemostasis and repair. Hemorrhage is a loss of blood that cannot be controlled by hemostatic mechanisms. Initially, the body responds to hemorrhage by initiating mechanisms aimed at increasing blood pressure and maintaining blood flow. Ultimately, however, blood volume will need to be restored, either through physiological processes or through medical intervention. If blood loss is less than 20 percent of total blood volume, fast-acting homeostatic mechanisms causing increased cardiac output and vasoconstriction would usually return blood pressure to normal and redirect the remaining blood to the tissues. Blood volume will then need to be restored via slower-acting homeostatic mechanisms to increase body fluids and erythrocyte production (Betts et al., 2013).

Circulatory Shock

The loss of too much blood may lead to circulatory shock, a life-threatening condition in which the circulatory system is unable to maintain blood flow to adequately supply sufficient oxygen and other nutrients to the tissues to maintain cellular metabolism. It should not be confused with emotional or psychological shock. Typically, the patient in circulatory shock will demonstrate an increased heart rate but decreased blood pressure. Urine output will fall dramatically, and the patient may appear confused or lose consciousness. Unfortunately, shock is an example of a positive-feedback loop that, if uncorrected, may lead to the death of the patient (Betts et al., 2013).

There are several recognized forms of shock:

• Hypovolemic shock in adults is typically caused by hemorrhage, although in children it may be caused by fluid losses related to severe vomiting or diarrhea.
• Cardiogenic shock results from the inability of the heart to maintain cardiac output. Most often, it results from a myocardial infarction (heart attack), but it may also be caused by arrhythmias, valve disorders, cardiomyopathies, cardiac failure, or simply insufficient flow of blood through the cardiac vessels.
• Vascular shock occurs when arterioles lose their normal muscular tone and dilate dramatically. It may arise from a variety of causes, and treatments almost always involve fluid replacement and medications, called inotropic or pressor agents, which restore tone to the muscles of the vessels.
• Anaphylactic shock is a severe allergic response that causes the widespread release of histamines, triggering vasodilation throughout the body.
• Obstructive shock, as the name would suggest, occurs when a significant portion of the vascular system is blocked. It is not always recognized as a distinct condition and may be grouped with cardiogenic shock, including pulmonary embolism and cardiac tamponade. Treatments depend upon the underlying cause and, in addition to administering fluids intravenously, often include the administration of anticoagulants, removal of fluid from the pericardial cavity, or air from the thoracic cavity, and surgery as required. The most common cause is a pulmonary embolism. Other causes include stenosis of the aortic valve, cardiac tamponade, and a pneumothorax (Betts et al., 2013).

Blood Disorders

Erythrocyte Disorders

Changes in the levels of RBCs can have significant effects on the body’s ability to effectively deliver oxygen to the tissues (Betts et al., 2013).

Anemia

The size, shape, and number of erythrocytes, and the number of hemoglobin molecules can have a major impact on a person’s health. When the number of RBCs or hemoglobin is deficient, the general condition is called anemia. There are more than 400 types of anemia.

Anemia can be broken down into three major groups: those caused by blood loss, those caused by faulty or decreased RBC production, and those caused by excessive destruction of RBCs. In addition to these causes, various disease processes also can lead to anemias. These include chronic kidney diseases often associated with a decreased production of EPO, hypothyroidism, some forms of cancer, lupus, and rheumatoid arthritis (Betts, et al., 2013).

Blood Loss Anemias:

Causes:

• Bleeding from wounds or other lesions, including ulcers, hemorrhoids, inflammation of the stomach (gastritis), and some cancers of the gastrointestinal tract.
  • The excessive use of aspirin or other nonsteroidal anti-inflammatory drugs such as ibuprofen can trigger ulceration and gastritis.
• Excessive menstruation and loss of blood during childbirth.

Anemias Caused by Faulty or Decreased RBC Production:

• Sickle cell anemia

• • A genetic disorder involving the production of an abnormal type of hemoglobin which delivers less oxygen to tissues and causes erythrocytes to assume a sickle (or crescent) shape.
• Iron deficiency anemia
  • The most common type of anemia and results when the amount of available iron is insufficient to allow production of sufficient heme.
• Vitamin deficiency anemia (Generally insufficient vitamin B12 and folate).
• Megaloblastic anemia involves a deficiency of vitamin B12 and/or folate, often due to inadequate dietary intake.
• Pernicious anemia is caused by poor absorption of vitamin B12 and is often seen in patients with Crohn's disease, surgical removal of the intestines or stomach (common in some weight loss surgeries), intestinal parasites, and AIDS.
• Aplastic anemia is the condition in which myeloid stem cells are defective or replaced by cancer cells, resulting in insufficient quantities of RBCs being produced. This condition by be inherited or it may be triggered by radiation, medication, chemotherapy, or infection.
• Thalassemia is an inherited condition typically occurring in individuals from the Middle East, the Mediterranean, Africa, and Southeast Asia, in which maturation of the RBCs does not proceed normally. The most severe form is called Cooley’s anemia (Betts et al., 2013).

Polycythemia

Polycythemia is an elevated RBC count and is detected in a patient’s elevated hematocrit percentage in a complete blood cell testing. It can occur transiently in a person who is dehydrated; when water intake is inadequate or water losses are excessive, the plasma volume falls. As a result, the hematocrit rises. A mild form of polycythemia is chronic but normal in people living at high altitudes. Some elite athletes train at high elevations specifically to induce this phenomenon. Finally, a type of bone marrow disease called polycythemia vera causes an excessive production of immature erythrocytes. Polycythemia vera can dangerously elevate the viscosity of blood, raising blood pressure and making it more difficult for the heart to pump blood throughout the body. It is a relatively rare disease that occurs more often in men than women, and is more likely to be present in elderly patients those over 60 years of age (Betts et al., 2013).

Platelet Disorders/Clotting Disorders

Thrombocytosis

Thrombocytosis is a condition in which there are too many platelets. This may trigger thrombosis, a potentially fatal disorder. A thrombus (plural = thrombi) is an aggregation of platelets, erythrocytes, and even WBCs typically trapped within a mass of fibrin strands. While the formation of a clot is a normal step in hemostasis, thrombi can form within an intact or only slightly damaged blood vessel, adhering to the vessel wall and decreasing or obstructing the flow of blood (Betts et al., 2013).

Thrombophilia

Thrombophilia, also called hypercoagulation, is a condition in which there is a tendency to form thrombosis. This may be an inherited disorder or may be caused by other conditions including lupus, immune reactions to heparin, polycythemia vera, thrombocytosis, sickle cell disease, pregnancy, and even obesity.

When a portion of a thrombus breaks free from the vessel wall and enters the circulation, it is referred to as an embolus. An embolus that is carried through the bloodstream can be large enough to block a vessel critical to a major organ. When it becomes trapped, an embolus is called an embolism. In the heart, brain, or lungs, an embolism may accordingly cause a heart attack, a stroke, or a pulmonary embolism (Betts et al., 2013).

Thrombocytopenia

Thrombocytopenia is a condition in which there is an insufficient number of platelets, possibly leading to ineffective blood clotting and excessive bleeding (Betts et al., 2013).

Hemophilia

Hemophilia is a group of related genetic disorders in which certain plasma clotting factors are lacking, inadequate or nonfunctional. Patients with hemophilia bleed from even minor internal and external wounds and leak blood into joint spaces after exercise and into urine and stool. Regular infusions of clotting factors isolated from healthy donors can help prevent bleeding in hemophiliac patients. At some point, genetic therapy will become a viable option (Betts et al., 2013).

Leukocyte Disorders

Leukopenia

Leukopenia is a condition in which too few leukocytes are produced. If this condition is pronounced, the individual may be unable to ward off disease (Betts et al., 2013).

Leukocytosis

Leukocytosis is excessive leukocyte proliferation. Although leukocyte counts are high, the cells themselves are often nonfunctional, leaving the individual at increased risk for disease (Betts et al., 2013).

Leukemia

Leukemia is a cancer involving an abundance of leukocytes. It may involve only one specific type of leukocyte from either the myeloid line (myelocytic leukemia) or the lymphoid line (lymphocytic leukemia). In chronic leukemia, mature leukocytes accumulate and fail to die. In acute leukemia, there is an overproduction of young, immature leukocytes. In both conditions, the cells do not function properly (Betts et al., 2013).

Lymphoma

Lymphoma is a form of cancer in which masses of malignant T and/or B lymphocytes collect in lymph nodes, the spleen, the liver, and other tissues. As in leukemia, the malignant leukocytes do not function properly, and the patient is vulnerable to infection. Some forms of lymphoma tend to progress slowly and respond well to treatment. Others tend to progress quickly and require aggressive treatment, without which they are rapidly fatal (Betts et al., 2013).

Other Conditions Related to Abnormal Leukocyte Counts

Bone Marrow Biopsy/Bone Marrow Transplant

Sometimes, a healthcare provider will order a bone marrow biopsy, a diagnostic test of a sample of red bone marrow, or a bone marrow transplant, a treatment in which a donor’s healthy bone marrow—and its stem cells—replaces the faulty bone marrow of a patient. These tests and procedures are often used to assist in the diagnosis and treatment of various severe forms of anemia, such as thalassemia major and sickle cell anemia, as well as some types of cancer, specifically leukemia.

In the past, bone marrow sampling or transplant was very painful, as the procedure involved inserting a large-bore needle into the region near the iliac crest of the pelvic bones. Now, direct sampling of bone marrow can often be avoided as stem cells can be isolated in just a few hours from a sample of a patient’s blood. The isolated stem cells are then grown in culture using the appropriate hemopoietic growth factors, and analyzed or sometimes frozen for later use.

For an individual requiring a transplant, a matching donor is essential to prevent the immune system from destroying the donor cells—a phenomenon known as tissue rejection. To treat patients with bone marrow transplants, it is first necessary to destroy the patient’s own diseased marrow through radiation and/or chemotherapy. Donor bone marrow stem cells are then infused into the recipient’s bloodstream, so that they can establish themselves in the recipient’s bone marrow (Betts et al., 2013).

Check Your Knowledge of Cardiovascular System Terms and Abbreviations

Medical Specialties and Procedures Related to the Blood Vessels and Blood

Vascular Surgeons

Vascular surgery is a specialty in which the physician treats diseases of the blood and lymphatic vessels. This includes repair and replacement of diseased or damaged vessels, removal of plaque from vessels, minimally invasive procedures, including the insertion of venous catheters, and traditional surgery (Betts et al., 2013; Canadian Society for Vascular Surgery, n.d.). For more information, please visit the Canadian Society for Vascular Surgery website [New Tab].

Hematologists

Hematologists are specialist physicians that diagnose and treat blood disorders. These physicians must be well-versed in a wide array of laboratory procedures, basic medical disciplines, and clinical medicine (Canadian Medical Association, 2019). To learn more about hematologists, visit the Canadian Medical Association’s specialty profile on hematology [PDF].

Diagnostic Vascular Technologist

Also known as Canadian Registered Vascular Sonographers (CRVS®), these specialists are technologists that image the vascular system (Sonography Canada, 2021). To learn more, visit the Sonography Canada Credentials web page [New Tab].

Phlebotomist

Phlebotomists are professionals trained to draw blood (phleb- = “a blood vessel”; -tomy = “to cut”). When more than a few drops of blood are required, phlebotomists perform a venipuncture, typically of a surface vein in the arm. They perform a capillary stick on a finger, an earlobe, or the heel of an infant when only a small quantity of blood is required. An arterial stick is collected from an artery and used to analyze blood gases. After collection, the blood may be analyzed by medical laboratories or perhaps used for transfusions, donations, or research (Betts et al., 2013).

Image Descriptions

Figure 10.16 image description: The left panel (a) shows the cross-section of a normal and a narrowed artery. A normal artery has no plaque along the artery walls which means there is normal blood flow. In a narrow artery, plague forms on the arterial walls causing abnormal blood flow. The right panel (b) shows a micrograph of an artery with plaque in it. [Return to Figure 10.16].

Figure 10.18 image description: This photograph shows red blood cells of a person suffering from sickle cell anemia. Instead of being discoid shaped like healthy blood cells, sickle red blood cells are shaped like a sickle. [Return to Figure 10.18].

Attribution

Except where otherwise noted, this chapter is adapted from “Cardiovascular System – Blood Vessels and Blood” in Building a Medical Terminology Foundation by Kimberlee Carter and Marie Rutherford, licensed under CC BY 4.0. / A derivative of Betts et al., which can be accessed for free from Anatomy and Physiology (OpenStax). Adaptations: dividing Cardiovascular System – Blood Vessels and Blood chapter content into sub-chapters.