Copper deficiency anemia due to zinc supplementation in a chronic hemodialysis patient.

Autor: Watanabe T; Department of Nephrology and Dialysis, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan. tsukamoto5017@gmail.com., Yonemoto S; Ikeda Clinic Osaka, 1-5-4 Katamachi, Miyakojima-ku, Osaka, 534-0025, Japan., Ikeda Y; Ikeda Clinic Osaka, 1-5-4 Katamachi, Miyakojima-ku, Osaka, 534-0025, Japan., Kawaguchi K; Department of Gastroenterology, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan., Tsukamoto T; Department of Nephrology and Dialysis, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan.
Jazyk: angličtina
Zdroj: CEN case reports [CEN Case Rep] 2024 Dec; Vol. 13 (6), pp. 440-444. Date of Electronic Publication: 2024 Mar 23.
DOI: 10.1007/s13730-024-00862-6
Abstrakt: Zinc deficiency causes dysgeusia and dermatitis as well as anemia. As approximately half of dialysis patients have zinc deficiency, zinc supplementation should be considered in case of erythropoiesis-stimulating agent (ESA)-hyporesponsive anemia. We report a case of a chronic dialysis patient with copper deficiency anemia caused by standard-dose zinc supplementation. The patient was a 70-year-old woman who had received maintenance hemodialysis for 8 years due to diabetic nephropathy. She had been treated with weekly administration of darbepoetin 30 μg for renal anemia, which resulted in Hb 12 to 14 g/dL. She had no dysgeusia. When zinc deficiency (44 μg/dL) had been identified 4 months earlier, 50 mg daily zinc acetate hydrate (Nobelzin®), which is the standard dose, was started. Unexpectedly, her anemia progressed slowly with macrocytosis together with granulocytopenia. Her platelet count did not decrease at that time. Laboratory tests revealed a marked decrease of serum copper (< 4 μg/dL) and ceruloplasmin (< 2 mg/dL), although serum zinc was within the normal limit (125 μg/dL). We discontinued zinc acetate and started copper supplementation including cocoa for 1 month. Her anemia and granulocytopenia were dramatically restored coincident with the increase in both serum copper and ceruloplasmin. Copper supplementation also improved her iron status as assessed by transferrin saturation and ferritin. Clinicians should monitor both zinc and copper status in anemic dialysis patients during zinc supplementation, as both are important to drive normal hematopoiesis.
Competing Interests: Declarations. Conflict of interest: The authors declare that they have no conflict of interests. Ethical approval and consent to participate: The ethical committee of Kitano Hospital approved this case report. Consent for publication: Informed consent was obtained from the patient in this case report.
(© 2024. The Author(s), under exclusive licence to Japanese Society of Nephrology.)
Databáze: MEDLINE
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