Copper Deficiency Anemia Due to Low-Calorie, Blended Enteral Diet: Case Report

Published:September 07, 2022DOI:


      Copper deficiency is an uncommon cause of hematologic abnormalities in children that is often overlooked or misdiagnosed. When found, specific recommendations on dose, duration, or frequency of copper repletion are lacking in the current literature. This report describes the case of a 4-year-old boy who presented to a university medical center in the midwestern United States with persistent macrocytic anemia found to be caused by copper deficiency secondary to a low-calorie, blended enteral diet. Intravenous copper supplementation was initiated at 40 μg/kg/d for a total of 6 days, followed by enteral supplementation of 2 mg cupric oxide. This repletion regimen ultimately improved the patient’s copper deficiency and resolved anemia within 1 month.
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        • Myint Z.W.
        • Oo T.H.
        • Thein K.Z.
        • Tun A.M.
        • Saeed H.
        Copper deficiency anemia: Review article.
        Ann Hematol. 2018; 97: 1527-1534
        • Balamurugan K.
        • Schaffner W.
        Copper homeostasis in eukaryotes: Teetering on a tightrope.
        Biochim Biophys Acta. 2006; 1765: 737-746
        • Lazarchick J.
        Update on anemia and neutropenia in copper deficiency.
        Curr Opin Hematol. 2012; 19: 58-60
        • Halfdanarson T.R.
        • Kumar N.
        • Li C.Y.
        • Phyliky R.L.
        • Hogan W.J.
        Hematological manifestations of copper deficiency: A retrospective review.
        Eur J Haematol. 2008; 80: 523-531
        • Tsugutoshi A.
        Copper deficiency and the clinical practice.
        JMAJ. 2004; 47: 365-370
      1. National Nutrient Database for Standard Reference. Release 28, Copper Cu (mcg) content of selected foods per common measure. US Department of Agriculture. Accessed August 18, 2020.

      2. Copper. In: Institute of Medicine (US) Panel on Micronutrients. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. National Academies Press; 2001:224-257. Accessed August 18, 2020.

        • Close A.
        • Malec L.
        Copper deficiency.
        Blood. 2017; 130: 4742
        • Chin A.
        Copper deficiency anemia and neutropenia due to ketogenic diet.
        Pediatrics. 2018; 141e20173286
        • Chhetri S.K.
        • Mills R.J.
        • Shaunak S.
        • Emsley H.C.
        Copper deficiency.
        Br Med J. 2014; 348: 3691
        • Beer S.
        • Rich S.
        • Bunting K.D.
        • Spoede E.
        • Canada N.
        • Turybury K.
        Texas Children’s Hospital Pediatric Nutrition Reference Guide.
        11th ed. Texas Children’s Hospital, 2016
        • National Reference Laboratory
        Arup Laboratories.
        Date accessed: December 10, 2019
        • Wazir S.M.
        • Ghobrial I.
        Copper deficiency, a new triad: Anemia, leucopenia, and myeloneuropathy.
        J Community Hosp Intern Med Perspect. 2017; 7: 265-268


      S. Mandli is a clinical dietitian, UW Health Kids, Madison, Wisconsin