Copper deficiency mimicking myelodysplastic syndrome

Copper is an essential element for all living organisms, because it has key activities in the metabolic enzymes such as cytochrome oxidase and superoxide dismutase, and in the proteins essential for iron homeostasis such as ceruloplasmin and hephaestin. In humans, the daily copper requirement is low, therefore copper deficiency is not so frequently a condition. However, we should be aware that copper deficiency can cause hematological abnormalities and sometimes it may masquerade as a myelodysplastic syndrome (MDS). Copper deficiency is mainly associated with the conditions, such as gastric and bariatric surgery, parenteral hyperalimentation, enteroparthies with loss of proteins, hypoproteinemic status such as celiac disease, complications due to therapy with high doses of zinc and penicillamine, and chronic use of proton pump inhibitors. Copper deficiency can be associated with hyperzinchemia; in some cases, this condition could be a consequence of possible use of zinc based denture adhesives creams. The copper deficiency may also be the result of an inherited disorder, such as the Menkes disease. Copper deficiency and cytopenia