Zinc‐induced copper deficiency, sideroblastic anemia, and neutropenia: A perplexing facet of zinc excess

An 11-month-old full-term female infant was referred to the hematology clinic due to marked anemia and neutropenia. She was almost exclusively breastfed and rejecting all trials for supplementary food including artificial formulas. Bone marrow aspirate revealed cytoplasmic vacuolization in precursors of the myeloid and erythroid series with significant dysgranulopoiesis and dyserythropoiesis and ringed sideroblasts. Flow cytometry analysis revealed increased hematogones with aberrant loss/downregulation of CD33 on granulocytes and monocytes (sign of dysmyelopoiesis). Laboratory investigation revealed low serum copper and ceruloplasmin. Administration of a multivitamin including a high concentration of copper for only 1 week improved her hemoglobin and absolute neutrophil count up to 1.9 × 103/µL, then dropped to 0.3 103/µL after she stopped taking the copper multivitamin. Her blood counts improved till total normalization and up to the time this report is issued. The probable role of unrecognized copper deficiency in causing anemia in infants more than 6 months of age is discussed, and the importance of serum copper examination in refractory anemia and neutropenia is emphasized. This case shows that copper deficiency should be an integral part of the differential diagnosis of refractory anemia including sideroblastic anemia and dysplasia. To the best of our knowledge, no such case has previously been described in the literature.

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Myelopolyneuropathy Due to Copper Deficiency or Zinc Excess?

Archives of Neurology ◽

10.1001/archneur.61.4.604-b ◽

2004 ◽

Vol 61 (4) ◽

pp. 604 ◽

Cited By ~ 7

Author(s):

Neeraj Kumar ◽

J. Eric Ahlskog

Keyword(s):

Copper Deficiency ◽

Zinc Excess

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Copper Deficiency Myeloneuropathy with Hypozincemia Due to Zinc Excess, Gastrectomy, and Low Serum Ceruloplasmin (P03.191)

Neurology ◽

10.1212/wnl.78.1_meetingabstracts.p03.191 ◽

2012 ◽

Vol 78 (Meeting Abstracts 1) ◽

pp. P03.191-P03.191

Author(s):

A. Josiah ◽

A. Salomon ◽

D. Tacker ◽

L. Gutmann

Keyword(s):

Copper Deficiency ◽

Serum Ceruloplasmin ◽

Zinc Excess ◽

Low Serum

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Pennies for Your Thoughts: A Case Series of Pancytopenia Due to Zinc-induced Copper Deficiency in the Same Patient

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2019.7.43697 ◽

2019 ◽

Vol 3 (4) ◽

pp. 341-344

Author(s):

Bram Dolcourt ◽

James Paxton ◽

Keenan Bora ◽

Cynthia Aaron

Keyword(s):

Half Life ◽

Copper Deficiency ◽

Case Series ◽

Serum Zinc ◽

Sideroblastic Anemia ◽

Elimination Half Life ◽

Elimination Half ◽

Whole Bowel Irrigation

A 47-year-old schizophrenic male presented on three separate occasions with pancytopenia and sideroblastic anemia due to copper deficiency from massive zinc penny ingestion. The poisoning was treated differently on each visit: intravenous (IV) copper plus surgical decontamination and chelation with calcium disodium versenate (CaNa2EDTA); IV copper plus whole bowel irrigation; and IV copper with surgical decontamination only. Serum zinc half-lives were 80.0 hours, 233.2 hours, and 83.9 hours, respectively. Importantly, chelation with CaNa2EDTA did not significantly alter the elimination half-life. This is the first reported case of the same patient being treated on three different occasions with three different regimens for this condition.

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A neurological and hematological syndrome associated with zinc excess and copper deficiency

Journal of Neurology ◽

10.1007/s00415-004-0263-0 ◽

2004 ◽

Vol 251 (1) ◽

pp. 111-114 ◽

Cited By ~ 41

Author(s):

Steven A. Greenberg ◽

Hannah R. Briemberg

Keyword(s):

Copper Deficiency ◽

Zinc Excess

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Copper deficiency and sideroblastic anemia associated with zinc ingestion

American Journal of Hematology ◽

10.1002/ajh.2830280310 ◽

1988 ◽

Vol 28 (3) ◽

pp. 181-183 ◽

Cited By ~ 42

Author(s):

Sheryl R. Simon ◽

Richard F. Branda ◽

Barbara H. Tindle ◽

Stanley L. Burns

Keyword(s):

Copper Deficiency ◽

Sideroblastic Anemia

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Aortic lesions in copper deficiency: Modification by dietary carbohydrates

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100143419 ◽

1986 ◽

Vol 44 ◽

pp. 358-359

Author(s):

U. Bielenberg

Keyword(s):

Copper Deficiency ◽

Male Rats ◽

Dietary Carbohydrates ◽

Dietary Copper ◽

Serum Ceruloplasmin ◽

Hepatic Copper ◽

Dietary Treatments ◽

Feeding Diets ◽

Ceruloplasmin Activity ◽

Simple Carbohydrate

Copper deficiency can cause cardiovascular lesions in experimental animals. Previous experiments have shown that the biochemical and itDrphologic lesions induced by deprivation of dietary copper can be suppressed by feeding diets containing starch or can be magnified by a high sucrose diet. In a recent study it was found that the more severe signs of copper deficiency in rats fed sucrose as compared to starch were due to the fructose moiety of sucrose. Although fructose as compared to starch markedly enhanced the symptoms of copper deficiency, the possibility that an effect of dietary carbohydrates due to the nature of the simple carbohydrate (fructose vs glucose) cannot be excluded. The present study was designed to determine if the severity of copper deficiency in rats fed sucrose as compared to starch is due to the glucose as well as the fructose moiety of sucrose. This portion of the study assessed the morphologic changes in aortas of seventy weanling male rats who were fed, for 9 weeks, copper deficient or copper supplemented diets containing either 62% starch, fructose or glucose. The starch-fed copper supplemented group served as the most normal controls. Rats were sacrificed after 9 weeks of dietary treatments. Copper deficiency was verified by reduced serum ceruloplasmin activity and serum and hepatic copper concentration.

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Abstract #337: A Rare Case of Copper Deficiency and Celiac Disease

Endocrine Practice ◽

10.1016/s1530-891x(20)44083-2 ◽

2006 ◽

Vol 12 ◽

pp. 96-97

Author(s):

Mihaela Cosma ◽

Daniel L. Hurley

Keyword(s):

Celiac Disease ◽

Rare Case ◽

Copper Deficiency

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