Skip to main content

Advertisement

SpringerLink
Log in

Severe leukocytopenia due to copper deficiency induced by zinc supplementation in a patient on peritoneal dialysis: a case report

  • Case Report
  • Published:
CEN Case Reports Aims and scope Submit manuscript

Abstract

Zinc deficiency is one cause of anemia. However, it has been reported that some patients who were treated with zinc supplementation to resolve this anemia subsequently experienced copper deficiency, which lead to continued anemia, as well as leukocytopenia and other symptoms. However, only two patients with copper deficiency induced by zinc supplementation undergoing peritoneal dialysis have been reported. Here, we report the case of a 59 year-old man with copper deficiency after zinc supplementation undergoing peritoneal dialysis (PD). He took meals only once a day and drank about 750 mL/day of wine every day. He had been receiving zinc supplementation for 4 months. He was diagnosed with severe leukocytopenia and worsening anemia at a planned outpatient visit; in addition, his copper levels had markedly decreased. Thus, zinc supplementation was discontinued, and the patient was instructed to take cocoa for copper supplementation. Because of severe leukocytopenia, he was admitted to our hospital, and granulocyte colony-stimulating factor was administered. Red blood cell transfusions were performed for anemia. After discontinuing zinc supplementation, his white blood cell count and hemoglobin levels improved.

To avoid Cu deficiency, patients’ dietary history should be checked in detail and Cu should be monitored carefully when Zn is supplemented in patients undergoing PD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Availability of data and materials

Not applicable.

Abbreviations

Zn:

Zinc

CKD:

Chronic kidney disease

Cu:

Copper

HD:

Hemodialysis

PD:

Peritoneal dialysis

CAPD:

Continuous ambulatory peritoneal dialysis

APD:

Automated peritoneal dialysis

Hb:

Hemoglobin

ESA:

Erythropoiesis-stimulating agent

CRP:

C-reactive protein

iPTH:

Intact parathyroid hormone

WBC:

White blood cell count

CTR1:

Copper transporter 1

MTF-I:

Metal-responsive transcription factor I

MT:

Metallothionein

RCT:

Randomized controlled trial

References

  1. Kobayashi H, Abe M, Okada K, Tei R, Maruyama N, Kikuchi F, et al. Oral zinc supplementation reduces the erythropoietin responsiveness index in patients on hemodialysis. Nutrients. 2015;7:3783–95.

    Article  CAS  Google Scholar 

  2. Murphy EW, Willis BW, Watt BK. Provisional tables on the zinc content of foods. J Am Diet Assoc. 1975;66:345–55.

    Article  CAS  Google Scholar 

  3. Myint ZW, Oo TH, Thein KZ, Tun AM, Saeed H. Copper deficiency anemia: review article. Ann Hematol Annals Hematol. 2018;97:1527–34.

    Article  CAS  Google Scholar 

  4. Eleftheriadis T, Pissas G, Antoniadi G, Filippidis G, Golfinopoulos S, Spanoulis A, et al. Serum copper and ferroportin in monocytes of hemodialysis patients are both decreased but unassociated. Int Urol Nephrol. 2014;46:1825–31.

    Article  CAS  Google Scholar 

  5. Nishime K, Kondo M, Saito K, Miyawaki H, Nakagawa T. Zinc burden evokes copper deficiency in the hypoalbuminemic hemodialysis patients. Nutrients. 2020;12:1–10.

    Article  Google Scholar 

  6. Becton DL, Schultz WH, Kinney TR. Severe neutropenia caused by copper deficiency in a child receiving continuous ambulatory peritoneal dialysis. J Pediatr. 1986;108:735–7.

    Article  CAS  Google Scholar 

  7. Saly DL, Brewster UC, Sze GK, Louis ED, Shirali AC. An element of unsteadiness. N Engl J Med. 2017;377:1379–85.

    Article  Google Scholar 

  8. van den Berghe PVE, Klomp LWJ. New developments in the regulation of intestinal copper absorption. Nutr Rev. 2009;67:658–72.

    Article  Google Scholar 

  9. Willis MS, Monaghan SA, Miller ML, McKenna RW, Perkins WD, Levinson BS, et al. Zinc-induced copper deficiency: a report of three cases initially recognized on bone marrow examination. Am J Clin Pathol. 2005;123:125–31.

    Article  Google Scholar 

  10. Rowin J, Lewis SL. Copper deficiency myeloneuropathy and pancytopenia secondary to overuse of zinc supplementation. J Neurol Neurosurg Psychiatr. 2005;76:750–1.

    Article  CAS  Google Scholar 

  11. Griffith DP, Liff DA, Ziegler TR, Esper GJ, Winton EF. Acquired copper deficiency: a potentially serious and preventable complication following gastric bypass surgery. Obes (Silver Spring). 2009;17:827–31.

    Article  CAS  Google Scholar 

  12. Kumar P, Hamza N, Madhok B, De Alwis N, Sharma M, Miras AD, et al. Copper deficiency after gastric bypass for morbid obesity: a systematic review. Obes Surg. 2016;26:1335–42.

    Article  Google Scholar 

  13. Tan JC, Burns DL, Jones HR. Severe ataxia, myelopathy, and peripheral neuropathy due to acquired copper deficiency in a patient with history of gastrectomy. JPEN J Parenter Enteral Nutr. 2006;30:446–50.

    Article  Google Scholar 

  14. Goodman BP, Mistry DH, Pasha SF, Bosch PE. Copper deficiency myeloneuropathy due to occult celiac disease. Neurologist. 2009;15:355–6.

    Article  Google Scholar 

  15. Halfdanarson TR, Kumar N, Hogan WJ, Murray JA. Copper deficiency in celiac disease. J Clin Gastroenterol. 2009;43:162–4.

    Article  Google Scholar 

  16. Fuhrman MP, Herrmann V, Masidonski P, Eby C. Pancytopenia after removal of copper from total parenteral nutrition. J Parenter Enter Nutr. 2000;24:361–6.

    Article  CAS  Google Scholar 

  17. Lindow CW. The copper content of plant and animal foods. J Biol Chem. 1929;82:465–71.

    Article  CAS  Google Scholar 

  18. Xiang S, Yao Y, Wan Y, Liang W, Meng R, Jin Q, et al. Comparative study on trace element excretions between nonanuric and anuric patients undergoing continuous ambulatory peritoneal dialysis. Nutrients. 2016;8(12):126.

    Article  Google Scholar 

  19. Shibazaki S, Uchiyama S, Tsuda K, Taniuchi N. Copper deficiency caused by excessive alcohol consumption. BMJ Case Rep. 2017;2017:12–5.

    Google Scholar 

  20. Okamoto T, Hatakeyama S, Konishi S, Okita K, Tanaka Y, Imanishi K, et al. Comparison of zinc acetate hydrate and polaprezinc for zinc deficiency in patients on maintenance hemodialysis: a single-center, open-label, prospective randomized study. Ther Apher Dial. 2020;24:568–77.

    Article  CAS  Google Scholar 

  21. Kadoya H, Uchida A, Kashihara N. A case of copper deficiency-induced pancytopenia with maintenance hemodialysis outpatient treated with polaprezinc. Ther Apher Dial. 2016;20:422–3.

    Article  Google Scholar 

  22. Hirase N, Abe Y, Sadamura S, Yufu Y, Muta K, Umemura T, et al. Anemia and neutropenia in a case of copper deficiency: Role of copper in normal hematopoiesis. Acta Haematol Karger Publishers. 1992;87:195–7.

    Article  CAS  Google Scholar 

  23. Zidar BL, Shadduck RK, Zeigler Z, Winkelstein A. Observations on the anemia and neutropenia of human copper deficiency. Am J Hematol Am J Hematol. 1977;3:177–85.

    Article  CAS  Google Scholar 

  24. Peled T, Glukhman E, Hasson N, Adi S, Assor H, Yudin D, et al. Chelatable cellular copper modulates differentiation and self-renewal of cord blood-derived hematopoietic progenitor cells. Exp Hematol. 2005;33:1092–100.

    Article  CAS  Google Scholar 

  25. Dunlap WM, James GW, Hume DM. Anemia and neutropenia caused by copper deficiency. Ann Intern Med. 1974;80:470–6.

    Article  CAS  Google Scholar 

  26. Nagano T, Toyoda T, Tanabe H, Nagato T, Tsuchida T, Kitamura A, et al. Clinical features of hematological disorders caused by copper deficiency during long-term enteral nutrition. Intern Med. 2005;44:554–9.

    Article  CAS  Google Scholar 

  27. Gregg XT, Reddy V, Prchal JT. Copper deficiency masquerading as myelodysplastic syndrome. Blood. 2002;100:1493–5.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

None.

Funding

Not applicable.

Author information

Authors and Affiliations

  1. Department of Nephrology, National Hospital Organization Osaka National Hospital, 2-1-14, Hoenzaka Chuo-ku, Osaka, 540-0006, Japan

    Yoshiki Kimura, Yuki Mori, Shoki Notsu, Saki Bessho, Aimi Kobori, Takuya Kubota, Akihiro Shimomura & Hirotsugu Iwatani

Authors
  1. Yoshiki Kimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yuki Mori
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shoki Notsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Saki Bessho
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Aimi Kobori
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takuya Kubota
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Akihiro Shimomura
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hirotsugu Iwatani
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors discussed this case and read and approved the final manuscript.

Corresponding author

Correspondence to Hirotsugu Iwatani.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethics approval and consent to participate

Because of case report, approval from a local ethics committee is not necessary.

Consent for publication

Written informed consent was obtained from the patient.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kimura, Y., Mori, Y., Notsu, S. et al. Severe leukocytopenia due to copper deficiency induced by zinc supplementation in a patient on peritoneal dialysis: a case report. CEN Case Rep 12, 78–83 (2023). https://doi.org/10.1007/s13730-022-00722-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13730-022-00722-1

Keywords

Search

Navigation