Wahab Ahsan, Mushtaq Kamran, Khan Aqsa, Khakwani Muhammad Shahzeb Khan, Masood Adeel, Henderson Jeremey, Malik Faizan
Hospital Medicine/Internal Medicine, Baptist Medical Center South, Montgomery, AL, USA.
Hospital Medicine/Internal Medicine, Northeast Internal Medicine Associates, LaGrange, IN, USA.
J Community Hosp Intern Med Perspect. 2021 Nov 15;11(6):843-846. doi: 10.1080/20009666.2021.1983319. eCollection 2021.
According to one estimate, zinc supplementation is widely used in the USA by almost 37% of the elderly population above age 71. Zinc has perceived benefits of immune system enhancement without realizing the harmful effects when used in excess. One of its under-recognized side effects is hypocupremia or copper deficiency due to excessive gastrointestinal losses as excessive zinc in the gut competes with copper for absorption. If severe, hypocupremia can cause hematologic changes (anemia, leukopenia/neutropenia, thrombocytopenia, and pancytopenia) with and without neurological deficits. Since zinc-induced hypocupremia is an overlooked entity, there is a lag of 12 months between the onset of symptoms and diagnosis. Most patients usually undergo a series of costly and sometimes invasive tests such as bone marrow biopsies during this lag time. Once diagnosed, the treatment is as simple as discontinuation of zinc and oral copper supplements. Here, we present a case report of zinc-induced hypocupremia and pancytopenia in an 81-year-old lady who was taking zinc supplements for macular degeneration. The patient presented with leukopenia with neutropenia, thrombocytopenia, and moderate anemia. This case report aims to educate clinicians since this is an easily missed entity and likely more prevalent than known due to widely used zinc supplementation.
据一项估计，在美国，71岁以上的老年人口中近37%广泛使用锌补充剂。锌被认为有增强免疫系统的益处，但人们没有意识到过量使用时的有害影响。其未被充分认识的副作用之一是低铜血症或铜缺乏，这是由于肠道中过量的锌与铜竞争吸收，导致胃肠道过度流失。如果情况严重，低铜血症可导致血液学变化（贫血、白细胞减少/中性粒细胞减少、血小板减少和全血细胞减少），伴或不伴有神经功能缺损。由于锌诱导的低铜血症是一个被忽视的问题，症状出现与诊断之间存在12个月的延迟。在此延迟期间，大多数患者通常会接受一系列昂贵且有时具有侵入性的检查，如骨髓活检。一旦确诊，治疗很简单，只需停止服用锌补充剂并口服铜补充剂。在此，我们报告一例81岁女性因服用锌补充剂治疗黄斑变性而导致锌诱导的低铜血症和全血细胞减少的病例。该患者表现为白细胞减少伴中性粒细胞减少、血小板减少和中度贫血。本病例报告旨在教育临床医生，因为这是一个容易被漏诊的问题，而且由于锌补充剂的广泛使用，其实际发生率可能比已知的更高。
