Zinc-induced copper deficiency

A report of three cases initially recognized on bone marrow examination

Monte Willis, Sara A. Monaghan, Michael L. Miller, Robert W. McKenna, Wiley D. Perkins, Barry S. Levinson, Vikas Bhushan, Steven H. Kroft

Research output: Contribution to journalArticle

129 Citations (Scopus)

Abstract

Copper deficiency is a rare cause of sideroblastic anemia and neutropenia that often is not suspected clinically. The morphologic findings in bone marrow, while not pathognomonic, are sufficiently characteristic to suggest the diagnosis, leading to further testing to establish the correct diagnosis. Excess zinc ingestion is among the causes of copper deficiency. We present 3 cases of zinc-induced copper deficiency in which the diagnosis first was suggested on the basis of bone marrow examination. The first patient was a 47-year-old man with a debilitating peripheral neuropathy that had progressed during the previous 18 months, mild anemia, and severe neutropenia. The second was a 21-year-old man receiving zinc supplementation for acrodermatitis enteropathica in whom moderate normocytic anemia and neutropenia developed. The third patient was a 42-year-old man with anemia, severe neutropenia, and a peripheral neuropathy that had progressed during 8 months. The bone marrow findings in all cases suggested copper deficiency, which was confirmed by further laboratory testing and determined to be due to zinc excess. The morphologic features, clinical manifestations, differential diagnosis, and pathogenetic mechanisms are discussed.

Original languageEnglish (US)
Pages (from-to)125-131
Number of pages7
JournalAmerican Journal of Clinical Pathology
Volume123
Issue number1
DOIs
StatePublished - Jan 1 2005
Externally publishedYes

Fingerprint

Bone Marrow Examination
Neutropenia
Zinc
Copper
Anemia
Peripheral Nervous System Diseases
Bone Marrow
Sideroblastic Anemia
Differential Diagnosis
Eating

Keywords

  • Copper deficiency
  • Cytoplasmic vacuoles
  • Ringed sideroblasts
  • Sideroblastic anemia
  • Zinc toxicity

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Willis, M., Monaghan, S. A., Miller, M. L., McKenna, R. W., Perkins, W. D., Levinson, B. S., ... Kroft, S. H. (2005). Zinc-induced copper deficiency: A report of three cases initially recognized on bone marrow examination. American Journal of Clinical Pathology, 123(1), 125-131. https://doi.org/10.1309/V6GVYW2QTYD5C5PJ

Zinc-induced copper deficiency : A report of three cases initially recognized on bone marrow examination. / Willis, Monte; Monaghan, Sara A.; Miller, Michael L.; McKenna, Robert W.; Perkins, Wiley D.; Levinson, Barry S.; Bhushan, Vikas; Kroft, Steven H.

In: American Journal of Clinical Pathology, Vol. 123, No. 1, 01.01.2005, p. 125-131.

Research output: Contribution to journalArticle

Willis, M, Monaghan, SA, Miller, ML, McKenna, RW, Perkins, WD, Levinson, BS, Bhushan, V & Kroft, SH 2005, 'Zinc-induced copper deficiency: A report of three cases initially recognized on bone marrow examination', American Journal of Clinical Pathology, vol. 123, no. 1, pp. 125-131. https://doi.org/10.1309/V6GVYW2QTYD5C5PJ
Willis, Monte ; Monaghan, Sara A. ; Miller, Michael L. ; McKenna, Robert W. ; Perkins, Wiley D. ; Levinson, Barry S. ; Bhushan, Vikas ; Kroft, Steven H. / Zinc-induced copper deficiency : A report of three cases initially recognized on bone marrow examination. In: American Journal of Clinical Pathology. 2005 ; Vol. 123, No. 1. pp. 125-131.
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