title: [Copper deficiency with pancytopenia, bradycardia and neurologic symptoms].
abstract: A 48-year-old man was referred to our hospital in December, 2005 because of general fatigue, gait disturbance and bradycardia. He had a history of polysurgery due to recurrent ileus and had been treated with home total parenteral nutrition for the short-bowel syndrome since 2003. Clinical findings on admission included marked emaciation and severe weakness of the extremities. Pancytopenia was noted in the peripheral blood. The serum levels of copper and ceruloplasmin were 3 microg/dl and 3 mg/dl, respectively, while Vit. B12 and folate were within the normal range. The bone marrow demonstrated cytoplasmic vacuolation in the myeloid and megakaryocytic series, and sideroblastic changes. No evidence of hematologic malignancies was presented. The diagnosis was copper deficiency and the patient was treated with copper supplementation. Four weeks after copper therapy, the serum level of copper rose to 50 microg/dl and ceruloplasmin to 14 mg/dl. Significant improvements in the hematologic profile, ECG findings and weakness of extremities were noted. Although bicytopenia (anemia and neutropenia) is considered to be a feature of hematologic disorders caused by copper deficiency, the present case showed pancytopenia. The exact mechanism of the unusual association of thrombocytopenia and other abnormalities with copper deficiency remains to be elucidated.
authors: Division of Hematology, Tokushima Red Cross Hospital.
authors: Hirokazu
authors: H
authors: Miki
authors: Yasuharu
authors: Y
authors: Kuwayama
authors: Tomoko
authors: T
authors: Hara
authors: Keiji
authors: K
authors: Oaki
authors: Yoshiko
authors: Y
authors: Kanezaki
authors: Tomonori
authors: T
authors: Yoshida
authors: Yasumi
authors: Y
authors: Shintani
authors: Keiko
authors: K
authors: Miya
authors: Tetsuya
authors: T
authors: Goto
mesh_terms: D001919:Bradycardia / Q000188:drug therapy / Q000209:etiology*; D003300:Copper / Q000172:deficiency* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000188:drug therapy / Q000209:etiology*; D010198:Pancytopenia / Q000188:drug therapy / Q000209:etiology*; D010289:Parenteral Nutrition, Total / Q000009:adverse effects; D012778:Short Bowel Syndrome / Q000150:complications*; D016896:Treatment Outcome
chemical_list: D003300:Copper