Nitrogen Balance and Its Impact on Hematological Function in Sickle Cell Patients: A Review

Sickle cell disease (SCD) is a chronic genetic disorder marked by recurrent hemolysis, anemia, and vaso-occlusive events, all of which significantly elevate the body's metabolic and nutritional demands. Among the critical nutritional parameters, nitrogen balance—reflecting the equilibrium between nitrogen intake and excretion—emerges as a key indicator of protein metabolism and tissue maintenance. Patients with SCD often face challenges in maintaining adequate nitrogen balance due to chronic inflammation, increased erythropoietic drive, and elevated protein turnover, particularly during disease exacerbations or infections. Negative nitrogen balance in SCD is associated with several hematological complications, including impaired hemoglobin synthesis, decreased red blood cell production, and weakened immune defense. The continuous need for red blood cell replacement due to chronic hemolysis further amplifies the demand for amino acids, making protein sufficiency essential for effective hematopoiesis. Furthermore, nitrogen depletion can worsen the overall clinical picture by contributing to growth delays in children, reduced physical endurance, and increased frequency of hospital admissions.