Case of Anaemia, Secondary to Copper Deficiency

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Copper deficiency
Trilineage hematopoietic maturation with severe dyserythropoiesis, including enlarged immature nuclei and nuclear irregularity (Panel A), and immature myeloid cells (Panel B)

Copper Deficiency

This article describes the case of a 73-year-old woman who was referred to the haematology clinic for evaluation of anaemia, as detected by her primary care physician during an evaluation for fatigue. Doctors diagnosed the patient with copper deficiency. The patient’s medical history revealed alcohol use disorder. She had no complaints of blood in her stool or urine.

Doctors advised laboratory tests which showed haemoglobin levels of 8.5 g per decilitre and 96.3 fl mean corpuscular volume. The platelet and white cell counts were within normal range. Other laboratory tests including liver-function tests, serum iron, folate, and vitamin B12 levels were also normal.

Doctors further performed a bone marrow biopsy which showed trilineage hematopoietic maturation with severe dyserythropoiesis, a defective development of red blood cells.

The problem is either congenital, acquired or inherited. Some of the red blood cells destroy during the maturation process within the bone marrow, whereas other abnormal cells may enter the circulation. Other findings included an enlarged immature nuclei and nuclear irregularity with immature myeloid cells and vacuoles in erythroid precursors. Immature myeloid cells were also evident. The karyotype was normal, but the appearance of bone marrow led doctors to suspect the diagnosis of a myelodysplastic syndrome, the findings are also seen in copper deficiency. The patient’s copper level was 40 μg per decilitre.

Doctors initiated treatment with oral copper supplementation. The patient’s fatigue showed significant improvement at 3 months follow-up and the anaemia had resolved.

Clinical copper deficiency is a frequent diagnosis with anaemia; it can present as anaemia and neutropenia, histologically. Thrombocytopenia is, however, relatively rare. It can manifest as myelopathy and peripheral neuropathy which stimulated subacute degeneration. Findings of the bone marrow often mimic myelodysplasia which results in inappropriate bone marrow transplantation referral, although occasionally. Other condition that may present similarly include lymphoma with bone marrow involvement, aplastic anaemia, myelodysplastic syndrome, folate deficiency, autoimmune B12 deficiency, autoimmunity, and drug toxicity.

References

Copper Deficiency https://www.nejm.org/doi/full/10.1056/NEJMicm2103532

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.

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