The outcome of vascular-targeted therapies is generally determined by how efficiently vascular-targeted carriers localize and adhere to the endothelial wall at the targeted site. This study investigates the impact of leukocytes, platelets and red blood cells on the margination of vascular-targeted polymeric nanospheres and microspheres under various physiological blood flow conditions. We report that red blood cells either promote or hinder particle adhesion to an endothelial wall in a parallel plate flow chamber depending on the blood flow pattern, hematocrit, and particle size. Leukocytes prevent microspheres - but not nanospheres - from adhering in laminar and pulsatile flows via (1) competition for the available binding space and (2) physical removal of previously bound spheres. In recirculating blood flow, the negative effect of leukocytes on particle adhesion is minimal for large microspheres in the disturbed flow region beyond the flow reattachment. Resting platelets were found to have no effect on particle binding likely due to their dimensions and minimal interaction with the endothelial wall. Overall, the findings of the present work would be critical for designing effective vascular-targeted carriers for imaging and drug delivery applications in several human diseases.