By Craig E. Litz, M.D.

A 31-year-old previously healthy male presents with a chief complaint of weakness and shortness of breath. His blood count is as follows:

A bone marrow biopsy and aspirate smear show a mildly hypercellular marrow with a mild erythroid hyperplasia. The erythroid precursors have abundant “punched out” cytoplasmic vacuoles as do some of the granulocytic precursors. There are 20% ringed sideroblasts. By morphology, there is 1% marrow blasts; flow cytometry shows 2.5% blasts.

These findings suggesting copper deficiency are relayed to the hematologist. The patient’s copper level is <10ug/uL (normal: 70-145ug/dL). The patient notes he has been taking large doses of zinc supplements. He is told to discontinue the zinc and copper supplements that are prescribed. Within a month his blood counts have rectified. The patient has no neuropathy.

The marrow findings of vacuolated erythroid and granulocytic precursors with increased ringed sideroblasts in a patient with an anemia, neutropenia and normal platelet count should be considered copper deficiency until otherwise proven. Copper deficiency is an uncommon disorder not generally considered in individuals with cytopenias. Copper is important in heme iron incorporation; its role in granulopoiesis is less well understood. In addition to anemia and neutropenia, prolonged copper deficiency can lead to an irreversible demyelinating neuropathy making timely diagnosis critical. Common causes include: dietary deficiency, hypoproteinemic states such as celiac disease and sprue, Menkes syndrome and excess zinc ingestion (supplements or psychogenic coin consumption). The mechanism of the latter appears to be mediated through copper malabsorption in the small bowel.

Reference
Am J Clin Pathol 123:125-131, 2005

The ProPath Hematopathology Team

Craig E. Litz, M.D., FCAP Director, Hematopathology
Board-certified in Anatomic and Clinical Pathology and Hematopathology by the American Board of Pathology

Dongkun Jack Chang, M.D.
Board-certified in Anatomic and Clinical Pathology and Hematopathology by the American Board of Pathology

Carrie Chenault, M.D., FCAP ProPath Medical Director
Board-certified in Anatomic and Clinical Pathology and Hematopathology by the American Board of Pathology

Crystal Montgomery-Goecker, M.D.
Board-certified in Anatomic and Clinical Pathology and Hematopathology by the American Board of Pathology

John M. Peters, M.D., Ph.D.
Board-certified in Anatomic and Clinical Pathology and Hematopathology by the American Board of Pathology

 

About ProPath Hematopathology
ProPath Hematopathology provides customized service for clients including, but not limited to, preparation of extra bone marrow biopsy histology sections for hematologist examination, easy access to a hematopathologist, training and help with bone marrow biopsy procedures, and immunohistochemical staining for various antigens.

About ProPath
ProPath is a physician-owned medical practice and laboratory offering expert anatomic pathology, esoteric testing, and full-service clinical pathology. Our team of board-certified pathologists have subspecialty training and expertise in virtually every aspect of anatomic pathology. Our team also includes Ph.D. scientists with expertise in Cytogenetics, Molecular Diagnostics, and Flow Cytometry.

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