Clinical features of hematological disorders caused by copper deficiency during long-term enteral nutrition.
OBJECTIVE
Copper deficiency has been reported to cause hematological disorders. However, its clinical and hematological characteristics are not fully understood. Therefore, we investigated bedridden patients suffering from copper deficiency and tried to clarify the clinical features of hematological disorders caused by this condition.


METHODS
Five patients with typical copper deficiency who had been dependent upon enteral nutrition for a long period of time due to various diseases were investigated. We measured hematological parameters and observed the response to copper supplementation therapy and the recovery process of hematological disorders.


RESULTS
Their mean age was 82.6+/-10.4 years and the mean duration of enteral nutrition was 16.4+/-5.2 months. Their serum copper concentration was extremely decreased (range, 3 to 8 microg/dl). All five patients had anemia and neutropenia. On the other hand, platelet count remained within the normal range. After copper supplementation therapy, hemoglobin concentration increased from 6.8+/-0.7 g/dl to 9.9+/-0.7 g/dl within a few months (p<0.01). Neutrophil count also increased from 750+/-370/microl to 3,690+/-1,210/microl in a few weeks (p<0.01). Mean corpuscular volume (MCV) decreased from 94.3+/-7.3 fl to 86.0+/-4.8 fl (p<0.05). Elevated serum ferritin and erythropoietin (EPO) levels were normalized after the improvement of anemia.


CONCLUSIONS
Bicytopenia (anemia and neutropenia) with normal platelet count is a feature of hematological disorders caused by copper deficiency. MCV tends to indicate macrocytic anemia. Serum ferritin and EPO levels are elevated. These hematological abnormalities are improved within a few months after copper supplementation therapy.
Nagano
Tomoo
T
Department of Internal Medicine, Kamisu Saiseikai Hospital, Kashima-gun, Ibaraki.
Toyoda
Takashi
T
Tanabe
Hiroko
H
Nagato
Takamichi
T
Tsuchida
Takaya
T
Kitamura
Akira
A
Kasai
Gengo
G
D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood / Q000178:diet therapy / Q000209:etiology*; D001772:Blood Cell Count; D003300:Copper / Q000008:administration & dosage / Q000097:blood / Q000172:deficiency*; D019587:Dietary Supplements; D004750:Enteral Nutrition / Q000009:adverse effects*; D004921:Erythropoietin / Q000097:blood; D005260:Female; D005293:Ferritins / Q000097:blood; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009503:Neutropenia / Q000097:blood / Q000178:diet therapy / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
D004921:Erythropoietin; D003300:Copper; D005293:Ferritins