2014 Volume 47 Issue 1 Pages 85-90
An 82-year-old man undergoing hemodialysis for 8 years was admitted to Kitasato University Hospital for pneumonia and pancytopenia with ESA hyporesponsiveness in July 2009. He had undergone partial gastrectomy for gastric carcinoma in 1994, and had been taking a zinc-containing medicine for the stomach for 31 months until admission. Complete blood cell counts showed 2,800/μL of white blood cells, 7.4 g/dL of hemoglobin with normocytosis and 8.2×104/μL of platelets. His serum data showed 2 μg/dL for copper (normal range : 68-128), 5 mg/dL for ceruloplasmin (normal range : 21-37), 140 μg/dL for zinc (normal range : 70-110), 23 μg/dL for Fe, 1,471 ng/mL for ferritin and 20.9 mg/dL for CRP. Bone marrow aspiration revealed refractory anemia with ringed sideroblasts of myelodysplastic syndrome (MDS). We diagnosed the case as copper deficiency-induced pancytopenia and ESA hyporesponsiveness related to zinc excess. Intravenous and oral administrations of copper supplements removed the pancytopenia and ameliorated the ESA responsiveness by 3 months of treatment.
