Abstract
Copper deficiency during enteral nutrition is very rare. In this case, we treated a patient who developed leukocytopenia and anemia caused by copper deficiency during long-term enteral nutrition.
A 67-year-old woman was admitted for treatment of brain damage after cardiopulmonary resuscitation. After one month, her condition improved and she started rehabilitation. As she could not eat spontaneously, she received forced enteral feeding (Fiberen YH(R)). However, She developed leukocytopenia after 15 weeks enteral feeding, and then had anemia for 23 weeks (white blood cell count; WBC 2.5×103μl-1, red blood cell count; RBC 2.68×106·μl-1, hemoglobin; Hb 8.4gdl-1, hematocrit; Ht 25.1% for 24 weeks). Bone marrow was tapped and found to be normal. The plasma copper level was markedly below normal (9μg·dl-1). After 4 weeks of intravenous (0.3mg·day-1) and enteral (6.4mg·day-1) copper supplementation, the plasma copper level increased to 97μg·dl-1 and hematologic values improved dramatically (WBC; 9.0×103μl-1, RBC; 3.95×106μl-1, Hb; 12.0g·dl-1, Ht; 36.0%). In conclusion, the copper deficiency should be considered during not only total parenteral nutrition but also enteral nutrition when hematologic disorder develops.
