Neurologic complications of copper deficiency are myelopathy with or without peripheral neuropathy. Other changes may include leukopenia and occasional neutropenia. More importantly, Copper deficiency can lead to persistent IDA despite aggressive replacement due to impaired iron metabolism, transport, and absorption. The main hematologic alteration is anemia, which is often microcytic and hypochromic but may vary due to copper’s intricate involvement in erythropoiesis. Still, copper levels are not as routinely monitored in the post-operative phase. Malabsorption due to gastric bypass surgery has become an increasingly recognized cause. Rapid replacement with oral copper supplementation later improved her symptoms considerably.Ĭopper deficiency is relatively rare and is mostly seen in malnourishment cases. Further workup revealed a severe copper deficiency, along with unchanged microcytic anemia. She had persistent burning pain in both feet, lethargy, weight loss, and pagophagia for ice. A few months later, her symptoms continued to deteriorate significantly despite aggressive supplemental iron therapy. Initial workup revealed profound iron deficiency anemia (IDA), and treatment was started with parenteral and oral replacement. She had a past medical history of obesity with Roux-en-Y gastric bypass surgery six months ago. University of Florida Health at Jacksonville General Medicine, Jacksonville, FLĬopper deficiency is a commonly forgotten cause of anemia and myeloneuropathy, especially in malabsorption cases such as gastric bypass.Ī 37-year-old lady presents to the clinic due to generalized fatigue, weakness, and bilateral foot pain. 1 Recalcitrant iron deficiency anemia and neuropathy as a facade of copper deficiency
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