Diagnosis of copper deficiency

diagnosis of copper deficiency

Hypocupraemia should be suspected in a person with characteristic neurological and/or haematological abnormalities (particularly patients with risk factors).

• neurological manifestations include: myelopathy, myeloneuropathy, and peripheral neuropathy.
• characteristically patient may complain of lower limb paraesthesias and gait disorder with sensory ataxia or spasticity or both.

The following investigations can be carried out in the primary care:

• full blood count
  • anaemia
    • commonest finding
    • can be microcytic, macrocytic, or normocytic
  • leucopenia
  • thrombocytopenia - is infrequent
• serum copper
• vitamin B12 - may sometimes co-exist with copper deficiency
• zinc – if zinc excess is suspected

Specialist neurological investigations may include:

• MRI
• neurophysiology

Note:

• copper deficiency may result in a myelodysplastic syndrome or vitamin B12 deficiency like picture
• a low threshold should be maintained for measuring serum copper in unexplained and refractory cytopenias or myeloneuropathy, especially in patients who have undergone upper GI tract surgical procedures, excess zinc exposure or malabsorption
  • according to American bariatric surgery clinical practice guidelines recommendations, post-bariatric surgery patients with anaemia, neutropenia, myeloneuropathy, and impaired wound healing should be investigated for copper deficiency

Reference:

• (1) Chhetri SK et al. Copper deficiency. BMJ. 2014;348:g3691