Department of Nephrology and Dialysis, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan.
Ikeda Clinic Osaka, 1-5-4 Katamachi, Miyakojima-ku, Osaka, 534-0025, Japan.
CEN Case Rep. 2024 Dec;13(6):440-444. doi: 10.1007/s13730-024-00862-6. Epub 2024 Mar 23.
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.
锌缺乏可导致味觉障碍和皮炎，以及贫血。由于大约一半的透析患者存在锌缺乏，因此在促红细胞生成素刺激剂（ESA）反应低下性贫血的情况下，应考虑补锌。我们报告了一例慢性透析患者因标准剂量补锌而导致铜缺乏性贫血的病例。该患者为 70 岁女性，因糖尿病肾病接受维持性血液透析 8 年。每周接受达贝泊汀 30μg 治疗肾性贫血，Hb 维持在 12-14g/dL。患者无味觉障碍。4 个月前发现锌缺乏（44μg/dL）后，开始每天服用 50mg 醋酸锌（Nobelzin®），这是标准剂量。出乎意料的是，她的贫血缓慢进展，伴有巨幼细胞性和粒细胞减少。当时她的血小板计数没有下降。实验室检查显示血清铜（<4μg/dL）和铜蓝蛋白（<2mg/dL）显著降低，尽管血清锌在正常范围内（125μg/dL）。我们停止了醋酸锌的使用，并开始了铜补充治疗，包括可可，为期 1 个月。她的贫血和粒细胞减少症随着血清铜和铜蓝蛋白的增加而迅速恢复。铜补充还改善了转铁蛋白饱和度和铁蛋白评估的铁状态。在锌补充期间，临床医生应监测贫血透析患者的锌和铜状态，因为两者对正常造血都很重要。
