Copper deficiency, a rare but correctable cause of pancytopenia: a review of literature

Tahir, Nayha; Ashraf, Aqsa; Waqar, Syed Hamza Bin; Rafae, Abdul; Kantamneni, Leela; Sheikh, Taha; Khan, Rafiullah

doi:10.1080/17474086.2022.2142113

Cited by 10 publications

(2 citation statements)

References 88 publications

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“…Therefore, it may be important to supplement zinc intake to reduce the serum copper concentrations of patients. Conversely, because copper plays an important role in many metabolic processes, including cellular respiration, iron oxidation, and hemoglobin synthesis, acquired copper deficiency can lead to abnormalities such as myelodysplasia and pancytopenia [35]. However, there is no effective treatment for hypocupremia other than copper injections and oral treatment [36].…”

Section: Discussionmentioning

confidence: 99%

Co-Administration of Roxadustat and Zinc Stabilizes Both Serum Copper and Zinc Concentrations in Patients Undergoing Hemodialysis

Takahashi

2023

Nutrients

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Patients undergoing hemodialysis often require zinc supplementation owing to hypozincemia, which may reduce serum copper concentrations. However, hypoxia-inducible factor–prolyl hydroxylase inhibitors (HIF-PHIs), which are used to treat renal anemia, have been reported to increase serum copper. Therefore, this study investigates the effectiveness of a combination of HIF-PHIs and zinc for the stabilization of serum copper and zinc concentrations during zinc supplementation for patients undergoing hemodialysis with renal anemia and hypozincemia. The serum zinc and copper concentrations were retrospectively compared over an 8-month period in 20 patients being administered roxadustat (an HIF-PHI) and 20 controls. The changes in concentrations were tracked in participants taking roxadustat who initiated or increased zinc supplementation. The serum zinc concentrations of the participants were significantly higher (p < 0.001) during zinc supplementation, regardless of roxadustat administration. Post-roxadustat, the serum copper concentrations were significantly higher than those pre-roxadustat or in non-roxadustat-treated participants, irrespective of zinc supplementation (p < 0.005). Even post-roxadustat, the serum copper concentrations were significantly lower, with no increase during zinc supplementation (p < 0.040). When zinc supplementation was initiated or increased in participants taking roxadustat, copper and zinc concentrations were normalized. Thus, combining zinc supplementation with roxadustat prevents both an excessive increase in serum copper and a decrease in serum zinc.

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Section: Discussionmentioning

confidence: 99%

Co-Administration of Roxadustat and Zinc Stabilizes Both Serum Copper and Zinc Concentrations in Patients Undergoing Hemodialysis

Takahashi

2023

Nutrients

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“…Besides zinc, copper is also an essential trace element in physiological processes such as the regulation of oxidative stress, catecholamine metabolism, or hematopoiesis [ 22 , 65 ], although zinc supplementation can induce acquired copper deficiency known as zinc-induced copper deficiency (ZICD) [ 66 ]. ZICD can induce severe disorders including ESA hypo-responsive anemia, pseudo-myelodysplastic syndrome, or myelopathy [ 67 , 68 , 69 ], and several cases of ZICD have been reported in hemodialysis patients [ 70 , 71 , 72 ].…”

Section: Zinc Supplementation and Risk Of Copper Deficiency In Ckdmentioning

confidence: 99%

Clinical Significance of Trace Element Zinc in Patients with Chronic Kidney Disease

Fukasawa

Furuya

Kaneko

et al. 2023

JCM

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The trace element zinc is essential for diverse physiological processes in humans. Zinc deficiency can impair growth, skin reproduction, immune function, maintenance of taste, glucose metabolism, and neurological function. Patients with chronic kidney disease (CKD) are susceptible to zinc deficiency, which is associated with erythropoiesis-stimulating agent (ESA) hypo-responsive anemia, nutritional problems, and cardiovascular diseases as well as non-specific symptoms such as dermatitis, prolonged wound healing, taste disturbance, appetite loss, or cognitive decline. Thus, zinc supplementation may be useful for the treatment of its deficiency, although it often causes copper deficiency, which is characterized by several severe disorders including cytopenia and myelopathy. In this review article, we mainly discuss the significant roles of zinc and the association between zinc deficiency and the pathogenesis of complications in patients with CKD.

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Association between biomarkers of zinc and copper status and heart failure: a meta‐analysis

Liu,

Yao,

Chen

et al. 2024

ESC Heart Failure

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AimsPrevious studies have investigated the relationship between heart failure (HF) and levels of zinc and copper, but conflicting results have been reported. This meta‐analysis aims to clarify the role of zinc and copper in HF progression by examining the associations between HF and concentrations of these minerals.Methods and resultsWe utilized STATA 12.0 software to calculate the standard mean difference (SMD) and 95% confidence interval (CI) for serum zinc and copper levels in patients with HF compared with healthy controls (HCs). The meta‐analysis indicated a lower serum zinc level in patients with HF compared with HCs, using a random effects model (SMD = −0.77; 95% CI: −1.01, −0.54; I2 = 61.9%, the P‐value for Q test = 0.002). Additionally, the meta‐analysis showed an increased serum copper level in patients with HF compared with HCs, using a random effects model (SMD = 0.66; 95% CI: 0.09, 1.23; I2 = 93.8%, the P‐value for Q test < 0.001). Meta‐regression analysis indicated that publication year, age, and gender were not responsible for heterogeneity across studies.ConclusionsThis meta‐analysis demonstrates that patients with HF have lower serum zinc and higher copper concentrations compared with healthy subjects. However, the potential of zinc supplementation as a therapy for HF should be approached with caution. The heterogeneity among the included studies was found to be high. It is recommended that further well‐designed large sample studies be conducted to validate these findings.

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Copper deficiency, a rare but correctable cause of pancytopenia: a review of literature

Cited by 10 publications

References 88 publications

Co-Administration of Roxadustat and Zinc Stabilizes Both Serum Copper and Zinc Concentrations in Patients Undergoing Hemodialysis

Co-Administration of Roxadustat and Zinc Stabilizes Both Serum Copper and Zinc Concentrations in Patients Undergoing Hemodialysis

Clinical Significance of Trace Element Zinc in Patients with Chronic Kidney Disease

Association between biomarkers of zinc and copper status and heart failure: a meta‐analysis

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