Anemia and Neutropenia Caused by Copper Deficiency

Abstract

Two patients with copper deficiency had extensive bowel surgery and received long-term parenteral hyperalimentation. One was neutropenic and anemic, with dimorphous erythrocytes. Marrow examination showed a predominance of early granulocytes and cytoplasmic vacuolization of erythroid and myeloid elements. Erythroid development was megaloblastoid and diminished, with increased sideroblasts. These abnormalities disappeared after oral copper therapy, reappeared when therapy was withdrawn, and again disappeared with intravenous copper therapy. The other patient, not as severely hypocupremic, was neutropenic but not anemic. Her marrow showed normoblastic erythropoiesis with cytoplasmic vacuolization of erythroid and myeloid precursors and a predominance of early granulocytes. The neutropenia was corrected with oral copper. Possible mechanisms causing the anemia and neutropenia are discussed. The duodenum seems to be a site of copper absorption. Copper supplementation is needed for patients receiving long-term parenteral hyperalimentation.