Abstract
The patient was an 83-year-old man with the short bowel syndrome associated with a 20-cm-long residual segment of the jejunum after surgery for superior mesenteric artery embolism. The patient had been unable to eat orally, being maintained on total parenteral home nutrition for over five and a half years, and developed severe macrocytic, normochromic anemia and neutropenia. Upper gastrointestinal endoscopy/colonoscopy and bone marrow examination revealed no abnormal findings. Hematologic examination revealed markedly reduced serum zinc and copper levels, and the patient was diagnosed as having anemia and neutropenia caused by zinc and copper deficiency. As excessive zinc administration was considered to be the cause of it was considered that excessive zinc administration might impair copper absorption, zinc was given orally, while copper was administered by the parenteral route. After a month, the anemia and neutropenia improved, along with improvement of both the serum zinc and copper levels. Regular examinations of the blood for trace elements is necessary in patients receiving long-term home parenteral nutrition.
