Copper deficiency-induced pancytopenia after taking an excessive amount of zinc formulation during maintenance hemodialysis

Abstract

Erythropoiesis-stimulating agent (ESA) has been recognized as an effective way in the treatment of anemia due to chronic kidney disease, but we sometimes see intractable hemodialysis (HD) patients. The causes of ESA-resistant anemia in HD patients include deficiency of trace elements. We report the case of an 89-year-old male who developed pancytopenia after taking an excessive amount of zinc formulation for ESA-resistant anemia during maintenance dialysis. He was prescribed zinc acetate hydrate formulation about 6 months before his presentation. He was found to have pancytopenia 1 month before his presentation, at which point he was introduced to our hospital. We suspected a copper deficiency at the first visit and stopped zinc and added copper, and his condition subsequently improved without being handicapped. Zinc antagonizes copper, so we must take care to diagnose patients ingesting zinc supplements.

Recent Advances in the Nutritional Screening, Assessment, and Treatment of Japanese Patients on Hemodialysis

“…We also preliminary observed improvement in salty taste thresholds in 28 patients on HD following oral Zn administration for 6 months ( Figure 3 , unpublished data). However, long-term Zn acetate administration should be avoided because Zn can directly prevent copper absorption from the intestinal tract, which may cause leukopenia and pancytopenia due to severe copper deficiency [ 59 ].…”

Nutrition for critically ill children and neonates requiring dialysis: Application of clinical practice recommendations

“…Specific trace elements (selenium, copper, and zinc) have also been shown intermittently to be deficient in children receiving chronic dialysis 42–44 . Of note, these reports also occasionally overlap with the presence of malnutrition and therefore may not be wholly related to losses but simply an overarching intake to expenditure differential.…”

“…41 Trace elements Specific trace elements (selenium, copper, and zinc) have also been shown intermittently to be deficient in children receiving chronic dialysis. [42][43][44] Of note, these reports also occasionally overlap with the presence of malnutrition and therefore may not be wholly related to losses but simply an overarching intake to expenditure differential. In a case series of five children receiving CRRT where solute clearance is the highest, only selenium was found to have a negative balance.…”

Acquired Sideroblastic Anemia: An exploratory Comparative Statistical Analysis Between Clonal and Non-clonal cases

“…Pancytopenia due to copper deficiency in a haemodialysis patient has been previously reported by Melero et al 9 Furthermore, excessive zinc intake and copper deficiency-induced SA/pancytopenia during maintenance haemodialysis has also been reported by Marumo A and his group. 10 …”

“…Pancytopenia due to copper deficiency in a haemodialysis patient has been previously reported by Melero et al 9 Furthermore, excessive zinc intake and copper deficiency-induced SA/pancytopenia during maintenance haemodialysis has also been reported by Marumo A and his group. 10 SA diagnosed during pregnancy is even a rarer event. In Case 3, the anemia was aggravated during pregnancies and normalized in between.…”