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copper deficiency

Etiology: - copper-deficient parenteral nutrition - gastrectomy or gastric bypass surgery (bariatric surgery) - chelation - excessive zinc a) zinc competes with copper for absorption by the gut b) supplements c) denture cream - genetic a) Menkes disease b) X-linked congenital failure of copper absorption Pathology: - myelopathy with predilection for posterior columns & corticospinal tracts [3] - abnormal collagen crosslinking Clinical manifestations: - myelopathy with or without an associated neuropathy - muscle weakness - hypopigmentation - decrease sensation to light touch & pinprick - loss of sensation to vibration & proprioception - paresthesias, numbness - gait ataxia & spasticity (video) [4] - fatigue Laboratory: - complete blood count a) iron-refractory hypochromic anemia - macrocytic anemia [4] b) leukopenia (neutropenia) c) thrombocytopenia - serum copper is low - serum ceruloplasmin is low * also see ARUP consult [6] Differential diagnosis: - vitamin B12 deficiency (overlap of clinical manifestations) [3] Management: - copper supplementation - balancing zinc intake with copper intake * prognosis: - hematologic abnormalities generally resolve with copper supplementation; neurologic responses are more variable [4]

Related

copper in serum

General

metabolic disease

References

  1. Wikipedia: Copper deficiency http://en.wikipedia.org/wiki/Copper_deficiency
  2. Henry's Clinical Diagnosis & Management by Laboratory Methods, 21st edition, McPherson RA & Pincus MR (es), W.B. Saunders Co., Philadelphia, PA. 2007, pg 385
  3. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010 - Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
  4. Saly DL, Brewster UC, Sze GK, Louis ED, Shirali AC. An Element of Unsteadiness. N Engl J Med 2017; 377:1379-1385. October 5, 2017 PMID: 28976866 http://www.nejm.org/doi/full/10.1056/NEJMcps1701934
  5. D'Angelo G. Copper deficiency mimicking myelodysplastic syndrome. Blood Res. 2016 Dec;51(4):217-219. PMID: 28090480 Free PMC Article
  6. ARUP Consult: Trace Elements - Deficiency and Toxicity The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/trace-minerals