2026 Volume 38 Issue 2 Pages 78-85
An elderly patient with rheumatoid arthritis developed two-lineage blood cell abnormalities（neutropenia, anemia）, but the cause was unknown on bone marrow aspiration, and the abnormalities recurred even after the immunosuppressant was discontinued and reduced. She visited a hematology department, where abnormally low serum copper levels, high zinc levels, and vitamin B12 deficiency were noted. In this case, it was thought that long-term administration of a zinc-containing preparation（polaprezinc）was a strong factor in copper deficiency. Even with a relatively low dose of zinc-containing preparation like polaprezinc, copper deficiency can become apparent when combined with other factors such as nutritional background, advanced age, and chronic inflammation, leading to severe cytopenia. By discontinuing zinc-containing preparations, encouraging intake of copper-containing foods（for example, cocoa and semi-digested enteral nutritional supplement）and supplementing with vitamin B12, correction of these abnormalities led to improvement of the two-lineage abnormalities gradually within three months. When blood cell abnormalities are present in patients with rheumatoid arthritis, trace elements（copper, zinc）should also be examined. And it is considered important to actually monitor serum zinc and copper levels regularly when administering zinc preparations. To our knowledge, this is the first report of a patient with rheumatoid arthritis who developed cytopenias due to copper deficiency.
