From the Guidelines
Copper deficiency should be treated with oral copper supplements, typically in the form of copper gluconate or copper sulfate, at a dose of 4-8 mg/day, as recommended by the most recent guideline 1. When treating copper deficiency, it is essential to consider the severity of the deficit and the presence of symptoms such as anemia, neutropenia, or neurological problems.
- The treatment dose and duration should be individualized based on the patient's response to therapy and blood test results.
- Blood concentrations <12 mmol/L and high CRP >20 mg/L indicate a likely deficiency, and copper administration can be considered 1.
- With values < 8 mmol/L with or without elevated CRP, repletion should be indicated 1.
- Common symptoms of copper deficiency include anemia, neutropenia, bone abnormalities, and neurological problems that can mimic B12 deficiency.
- Risk factors for copper deficiency include gastric bypass surgery, zinc excess, malabsorption syndromes, and prolonged parenteral nutrition without copper supplementation, as noted in a previous study 1.
- Dietary sources of copper, such as organ meats, shellfish, nuts, seeds, and chocolate, can complement supplementation.
- If neurological symptoms are present, higher initial doses may be needed, and some symptoms may be irreversible despite treatment.
From the Research
Causes of Copper Deficiency
- Copper deficiency can be caused by various factors, including hereditary and acquired origins, with the latter being the most frequent 2
- Acquired copper deficiency can occur due to reduced absorption after bariatric bypass surgery, zinc supplementation, myelodysplastic syndrome, use of parenteral nutrition, and chronic tube feeding 3, 2
- Changing nutrition patterns and certain treatments, such as prolonged continuous renal replacement therapy, can also contribute to copper deficiency 2
Clinical Manifestations
- Copper deficiency can affect all organs and systems, particularly the hematologic and neurologic systems 2
- Clinical manifestations of copper deficiency include hematologic abnormalities, such as anemia, neutropenia, and leukopenia, as well as myeloneuropathy 3, 2
- Other systems that can be affected by copper deficiency include the cardiovascular, cutaneous, and immune systems 2
Diagnosis and Treatment
- Diagnosis of copper deficiency is made by measuring serum copper, serum ceruloplasmin, and 24-h urine copper levels 4
- Treatment of copper deficiency anemia involves oral or intravenous copper replacement in the form of copper gluconate, copper sulfate, or copper chloride 4
- Hematological manifestations of copper deficiency are fully reversible with copper supplementation over a 4- to 12-week period, while neurological manifestations are only partially reversible 4