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A display of different vegetables including broccoli, and carrots, an orange and apple.
Figure 9.1 Nutritional deficiencies are known to cause hematologic changes that can impact quality of life. (credit: modification of work “display of vegetables and one orange” by Baileynorwood/Wikimedia Commons, CC0 1.0)

Metabolic processes with high energy requirements are sensitive to nutrient deficiencies. The production of blood cells, called hematopoiesis, is an energy-intensive metabolic process essential for oxygen and nutrient transport and protects against invasion of pathogens while maintaining hemostasis. The appropriate balance of water and cellular components—such as albumin, electrolytes, macronutrients, and micronutrients—is necessary for blood to optimally function. In the bone marrow, where hematopoiesis occurs, amino acids build the hemoglobin contained in each red blood cell. Red blood cells use only glucose as fuel, which must be in constant supply to support red blood cell metabolism (American Society of Hematology, n.d.).

Consider this case: Grant is a nurse and Ms. Foster is a client. Ms. Foster was sent to the emergency department by her primary care physician after receiving results of her annual laboratory testing that revealed severe anemia (a reduction in circulating red blood cells). Ms. Foster is a 75-year-old widow from a senior living facility who prepares her own meals and is independent in her activities of daily living (ADLs). She has a history of type 2 diabetes and hypertension; she reports that she recently had an episode of fainting and is no longer able to walk to her building’s elevator without stopping for rest.

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