Health Consequences of Decreased Copper Levels
Copper deficiency causes serious and potentially irreversible hematologic and neurologic complications, with anemia and myeloneuropathy being the most clinically significant manifestations that require prompt recognition and treatment. 1
Hematologic Manifestations
Copper deficiency produces multiple blood abnormalities that develop over weeks and are generally fully reversible with copper supplementation over 4-12 weeks 2:
- Microcytic anemia - occurs due to impaired iron metabolism, as copper is essential for iron oxidation and hemoglobin synthesis 1
- Neutropenia - can be severe and increases infection risk 1
- Thrombocytopenia - may occur as part of multilineage cytopenia 3
- Bone marrow dysplasia - can mimic myelodysplastic syndrome (MDS) with refractory cytopenia and multilineage dysplasia on bone marrow examination 3
The hematologic features respond promptly and completely to copper replacement, with 93% of cytopenias resolving with treatment 3.
Neurologic Manifestations
The neurological complications are the most devastating consequence of copper deficiency because they are only partially reversible, even with appropriate copper supplementation 2, 4:
Myeloneuropathy (Copper Deficiency Myelopathy)
- Spastic gait with prominent sensory ataxia - the most common neurological presentation 4
- Progressive walking difficulties and paraesthesia 3
- Spastic paraparesis with or without sensory neuropathy 3
- Dorsal column dysfunction - similar to subacute combined degeneration seen in vitamin B12 deficiency 4
The neurological syndrome may present without hematologic manifestations, making diagnosis more challenging 4. Only 25% of patients show improvement in neurological function with copper replacement, while 33% deteriorate and 42% remain unchanged despite treatment 3.
Cardiovascular Manifestations
- Cardiac arrhythmias - rare acute symptom of severe deficiency 1
- Cardiovascular system dysfunction - copper is essential for blood pressure control 1
Other Systemic Effects
Connective Tissue and Skeletal
- Osteoporosis - copper is essential for collagen and elastin synthesis via lysyl oxidase 1
- Delayed wound healing - impaired connective tissue maturation 1
Dermatologic
- Hair depigmentation - copper is essential for melanin synthesis 1
Metabolic and Endocrine
Immune System
- Immune dysfunction - copper plays a role in immune function 1
High-Risk Populations
Copper deficiency is observed in specific clinical contexts 1:
- Post-bariatric surgery patients - particularly after gastric bypass 1, 5
- Prolonged parenteral nutrition without adequate copper (standard PN provides 0.5-1.2 mg/day) 1
- Continuous renal replacement therapy 1, 5
- Major burns 1
- Excessive zinc ingestion - zinc interferes with copper absorption; maintain 8-15 mg zinc to 1 mg copper ratio 1, 3
- Prior gastric surgery or malabsorption syndromes 4
Diagnostic Considerations
Symptoms require several weeks to develop and are not readily recognized 1. The key diagnostic pitfall is that copper deficiency can mimic other conditions:
- Resembles vitamin B12 deficiency - both cause myelopathy with dorsal column involvement 4
- Mimics myelodysplastic syndrome - bone marrow findings can be indistinguishable 3
- May coexist with vitamin B12 deficiency - check both when investigating unexplained anemia or neurological symptoms 1, 4
Treatment Urgency
Early identification is critical to prevent irreversible neurological injury 3, 5. While hematologic manifestations resolve completely with treatment, neurological damage is often permanent. Treatment requires copper 4-8 mg/day for deficiency, which is 4-8 times the usual nutritional recommendations 1, 5.
For unexplained anemia, fatigue, or neurological symptoms (particularly myelopathy), investigate copper levels alongside other nutritional deficiencies 1. When both zinc and copper are low, consider two Forceval daily for 3 months and recheck levels; with severe copper deficiency, refer for specialist advice 1.