Does copper supplementation help with pancytopenia (a condition characterized by a reduction in the number of red and white blood cells, and platelets)?

From the Guidelines

Copper supplementation should be considered in patients with pancytopenia if plasma concentrations are <12 mmol/L and high CRP >20 mg/L, indicating a likely deficiency, as stated in the espen micronutrient guideline 1. Pancytopenia is a medical condition characterized by a reduction in all three blood cell types: red blood cells, white blood cells, and platelets. While copper deficiency is a rare cause of pancytopenia, when it is the underlying cause, copper supplementation can be effective.

Key Points to Consider

• Copper is essential for hematopoiesis (blood cell formation) because it's required for proper iron metabolism and the function of enzymes involved in blood cell development.
• Typical copper supplementation for deficiency includes oral copper gluconate or copper sulfate at doses of 2-4 mg elemental copper daily, or intravenous copper if the deficiency is severe or absorption issues exist.
• Treatment duration depends on the severity of deficiency and response to therapy, typically continuing for several months with regular blood monitoring.
• A proper diagnosis of the underlying cause of pancytopenia is crucial before starting any treatment, as most cases have other causes such as bone marrow disorders, medications, infections, or autoimmune conditions, which would require different treatments.

Monitoring and Supplementation

• Plasma Cu and ceruloplasmin should be monitored in patients on long-term parenteral nutrition, especially if they develop PN-associated liver disease or if they have high gastrointestinal fluid losses 1.
• Copper-Zn superoxide dismutase (SOD) activity in erythrocytes seems to be a more sensitive indicator of Cu deficiency than plasma concentration of Cu or ceruloplasmin 1.
• Parenteral Cu requirements are estimated to be 40 mg/kg per day Cu for preterm infants and 20 mg/kg per day for term infants and children 1.

From the Research

Copper Supplementation and Pancytopenia

• Copper deficiency has been identified as a cause of pancytopenia in some cases, as seen in a 2014 study where a 15-year-old girl developed pancytopenia with myelodysplasia due to copper deficiency after undergoing allogeneic bone marrow transplantation 2.
• Another study from 2008 reported a series of cases of bi-lineage cytopenia associated with copper deficiency, highlighting the importance of considering copper deficiency in the differential diagnosis of reversible causes of bone marrow failure syndromes, including myelodysplastic syndrome 3.
• However, other studies have identified different underlying causes of pancytopenia, such as vitamin B12 deficiency 4, megaloblastic anemia, nutritional anemia, aplastic anemia, hypersplenism, sepsis, and leukemia 5, 6.
• The role of copper supplementation in treating pancytopenia is not explicitly stated in these studies, but it can be inferred that addressing copper deficiency may help alleviate pancytopenia symptoms in cases where copper deficiency is the underlying cause 2, 3.

Underlying Causes of Pancytopenia

• Various studies have identified a range of underlying causes of pancytopenia, including:
  • Vitamin B12 deficiency 4
  • Megaloblastic anemia 5, 6
  • Nutritional anemia 5
  • Aplastic anemia 5, 6
  • Hypersplenism 5
  • Sepsis 5
  • Leukemia 5, 6
  • Copper deficiency 2, 3

Diagnosis and Treatment

• Accurate diagnosis of the underlying cause of pancytopenia is crucial for effective treatment 4, 5, 6.
• Copper deficiency should be considered in the differential diagnosis of reversible causes of bone marrow failure syndromes, including myelodysplastic syndrome 3.
• Addressing the underlying cause of pancytopenia, such as vitamin B12 deficiency or copper deficiency, may help alleviate symptoms and improve patient outcomes 2, 4, 3.