Iatrogenic copper deficiency causing anaemia and neutropenia

Abstract

A 79-year-old woman presented with an obstructed femoral hernia and had a wedge resection of the small intestine. Post-operatively she developed wound dehiscence and spent 3 days in the adult critical care unit. Good recovery followed and she was allowed home after 2 months in hospital. Six months later she presented with anaemia, neutropenia and a very low serum copper concentration. Review of her notes revealed that she had been given oral zinc therapy while in the critical care unit and this treatment had been continued on discharge from hospital. Serum copper, haemoglobin and white cell count recovered after oral zinc was discontinued. Oral zinc treatment can lead to symptomatic copper deficiency in susceptible patients.

AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, THE OBESITY SOCIETY, AND AMERICAN SOCIETY FOR METABOLIC & BARIATRIC SURGERY MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE PERIOPERATIVE NUTRITIONAL, METABOLIC, AND NONSURGICAL SUPPORT OF THE BARIATRIC SURGERY PATIENT

“…Proven selenium deficiency‐associated anemias have not been reported in bariatric surgery patients. Copper deficiency can induce anemia (normocytic or macrocytic) and neutropenia ( 596 (EL 3), 597 (EL 3)) . The detrimental effects of copper deficiency on tissue release, resulting in elevated ferritin levels, may be mediated by hephestin, a ceruloplasmin homologue, and divalent metal transporter‐1 ( 598 (EL 4)) .…”

Anemia and neutropenia associated with copper deficiency of unclear etiology

“…Copper deficiency is generally considered a relatively rare cause of anemia and neutropenia in the adult population. Copper deficiency in adults has been found in association with underlying malabsorptive problems [1], excessive zinc ingestion [2], or prolonged TPN without adequate copper supplementation [3]. We report on two adult patients with severe neutropenia and anemia secondary to copper deficiency not clearly associated with any of these causes.…”

Copper Deficiency in Wilson's Disease with a Normal Zinc Value

“…In these reports, some patients had normal serum zinc levels. They had either diarrheal diseases, such as celiac disease ( 13 ), or a history of upper gastrointestinal surgery, such as small bowel resection ( 14 ). This implies that zinc administration can exacerbate copper malabsorption collaboratively.…”