title: [Copper deficiency anemia morphologically mimicking myelodysplastic syndrome].
abstract: A 64-year-old man underwent kidney transplantation for progressive chronic renal failure which had developed 8 years after allogeneic bone marrow transplantation for acute myeloid leukemia. Because of post-operative complications, he had been placed on intravenous hyperalimentation. Three months after the transplantation, anemia rapidly progressed (hemoglobin, 7.9 g/dl). The proportion of reticulocytes was 0.2%, but white blood cell and platelet counts remained within normal ranges. Serum iron, vitamin B12, and folate levels were normal. Bone marrow examination showed the presence of ringed sideroblasts and cytoplasmic vacuoles in a fraction of erythroid cells. Megakaryocytes were adequate in number with normal morphology. Although the findings were consistent with refractory anemia with ringed sideroblasts according to the WHO classification, cytoplasmic vacuolations were also observed in myeloid cells, suggesting copper deficiency. Indeed, serum copper and ceruloplasmin levels were found to be low (33 μg/dl and 11 mg/dl, respectively), and oral copper supplementation at a daily dose of 1 mg was initiated. There was a prompt increase in reticulocytes, and the hemoglobin level was normalized within one month, in response to this regimen. In progressive anemia cases with ringed sideroblasts in the bone marrow, copper deficiency should be considered in the differential diagnosis.
authors.affiliation: Division of Hematology, Department of Medicine, Keio University School of Medicine.
authors.forename: Taku
authors.initials: T
authors.lastname: Kikuchi
authors.forename: Takehiko
authors.initials: T
authors.lastname: Mori
authors.forename: Takayuki
authors.initials: T
authors.lastname: Shimizu
authors.forename: Shinya
authors.initials: S
authors.lastname: Morita
authors.forename: Hidaka
authors.initials: H
authors.lastname: Kono
authors.forename: Ken
authors.initials: K
authors.lastname: Nakagawa
authors.forename: Takayuki
authors.initials: T
authors.lastname: Mitsuhasi
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Murata
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Okamoto
mesh_terms: D000284:Administration, Oral; D000756:Anemia, Sideroblastic / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology*; D015415:Biomarkers / Q000097:blood; D001853:Bone Marrow / Q000473:pathology*; D016026:Bone Marrow Transplantation; D002570:Ceruloplasmin; D003300:Copper / Q000008:administration & dosage / Q000097:blood / Q000172:deficiency*; D003937:Diagnosis, Differential; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy; D016030:Kidney Transplantation; D015470:Leukemia, Myeloid, Acute / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes
chemical_list: D015415:Biomarkers; D003300:Copper; D002570:Ceruloplasmin