Acquired Copper Deficiency: A Potentially Serious and Preventable Complication Following Gastric Bypass Surgery

Abstract

Copper is an essential cofactor in many enzymatic reactions vital to the normal function of the hematologic, vascular, skeletal, antioxidant, and neurologic systems. Copper deficiency in the United States is believed to be relatively rare but has been described in the setting of zinc supplementation, myelodysplastic syndrome, use of parenteral nutrition and chronic tube feeding, and in various malabsorptive syndromes, including following gastrectomy and gastric bypass surgery. Features of copper deficiency include hematologic abnormalities (anemia, neutropenia, and leukopenia) and myeloneuropathy; the latter is a rarer and often unrecognized complication of copper deficiency. We here describe two patients who presented with severe gait abnormalities and anemia combined with neutropenia several years after roux‐en‐Y gastric bypass (RYGB) surgery for obesity who were found to be severely copper deficient. Intravenous copper repletion resulted in the rapid correction of hematologic indices; combined intravenous and oral copper supplementation and eventual oral copper supplements alone normalized serum copper levels in each patient, but resulted in only partial resolution of the neurologic deficits. This report serves to alert physicians of the association between RYGB procedures and subsequent copper deficiency in order to avoid diagnostic delays and to improve treatment outcomes.

Assessment of Serum Copper State after Gastrectomy with Roux-en-Y Reconstruction for Gastric Cancer

“…Such patients presented with hematological or neurological symptoms, usually many years after the operations (5-21 years). In those cases, copper supplementation proved effective against anemia and neutropenia, which resolved, but neurological symptoms did not usually show full recovery [26,27] . Awareness of the risk of copper deficiency over the long term after non-bariatric gastrectomy is therefore crucial.…”

“…Furthermore, copper deficiency in bariatric surgery has mainly been reported in female patients [4,[25][26][27][28] . Buchwald et al reported in a meta-analysis that the percentage of female cases in bariatric surgery was 72.6 [29] .…”

Perioperative Care of the Surgical Patient

“…Pregnancy should be avoided 12-24 months postoperatively [50]. Patients should be advised about contraception since their fertility status might be improved after weight loss [51,52].…”

“…Low plasma copper concentration and ceruloplasmin activity can be helpful to make the diagnosis. Treatment with IV copper of 2.4 mg daily for 6 days, followed by weekly intravenous copper of 2.4 mg combined with oral supplementation of 8 mg copper/daily until normal copper levels in blood are achieved was suggested [50].…”

Bread containing Brassica oleracea var. acephala as a source of copper and manganese

“…Copper is an important cofactor of enzymes involved in iron metabolism and may prevent hematologic abnormalities including anemia (GRIFFITH et al, 2009), amino acid metabolism, cholesterol and carbohydrates (MERDIVAN et al, 2004).…”