Wasa M, Satani M, Tanano H, Nezu R, Takagi Y, Okada A
Department of Pediatric Surgery, Osaka University Medical School, Japan.
JPEN J Parenter Enteral Nutr. 1994 Mar-Apr;18(2):190-2. doi: 10.1177/0148607194018002190.
Anemia and neutropenia are commonly observed hematologic changes in patients with copper (Cu) deficiency, but thrombocytopenia is rarely found. A-69-year-old patient with postoperative small-bowel obstruction underwent laparotomy three times. Because of persistent obstruction, nasoduodenal suction was continued and total parenteral nutrition was instituted. Fifteen months after the initiation of total parenteral nutrition, the patient gradually developed pancytopenia (red blood cell count 222 x 10(4)/mm3, neutrophil count 1254/mm3, and platelet count 9.2 x 10(4)/mm3). The serum Cu level was 10 micrograms/dL and the serum ceruloplasmin level was less than 5 mg/dL. After 2 weeks of Cu supplementation in a daily dose of 20 mumol, the serum Cu level increased to 81 micrograms/dL and the serum ceruloplasmin level to 20 mg/dL. Hematologic values showed a dramatic response: red blood cell count increased to 362 x 10(4)/mm3, neutrophil count to 4819/mm3, and platelet count to 22.1 x 10(4)/mm3. The improvement of pancytopenia could be attributed to Cu supplementation. This is the first case report of Cu deficiency with pancytopenia during total parenteral nutrition.
贫血和中性粒细胞减少是铜（Cu）缺乏患者常见的血液学变化，但血小板减少很少见。一名69岁的术后小肠梗阻患者接受了三次剖腹手术。由于持续梗阻，持续进行鼻十二指肠抽吸并开始全胃肠外营养。全胃肠外营养开始15个月后，患者逐渐出现全血细胞减少（红细胞计数222×10⁴/mm³，中性粒细胞计数1254/mm³，血小板计数9.2×10⁴/mm³）。血清铜水平为10微克/分升，血清铜蓝蛋白水平低于5毫克/分升。每日补充20微摩尔铜2周后，血清铜水平升至81微克/分升，血清铜蓝蛋白水平升至20毫克/分升。血液学指标显示出显著反应：红细胞计数增至362×10⁴/mm³，中性粒细胞计数增至4819/mm³，血小板计数增至22.1×10⁴/mm³。全血细胞减少的改善可归因于铜补充。这是全胃肠外营养期间铜缺乏伴全血细胞减少的首例病例报告。
