Anemia and
neutropenia caused by
copper deficiency is a well-known consequence of long term
total parenteral nutrition in the literature. We present 6 bed-ridden elderly patients who developed
anemia and
neutropenia after receiving
enteral nutrition for a long time (mean: 3.3 years) In all 6 patients, serum
copper and
ceruloplasmin level were very low, and the mean of their hematological data were as follows: WBC 2,200/microliters, neutrophil 554/microliters,
hemoglobin 8.1 g/dl, platelet 260 x 10(3)/microliters, respectively. The bone marrow examination showed cytoplasmic vacuolization of both myeloid and erythroid precursors, and maturation arrest of granulopoiesis. Then,
copper sulfate was administrated by enteral tube to 6 patients, and the improvement of
anemia and
neutropenia was observed within a month. A 82-year-old woman who received
enteral nutrition for 3.5 years with sever
anemia (Hb 3.7 g/dl) and
neutropenia (neutrophil 350/microliters), showed a marked improvement in hematological data (Hb 8.0 g/dl, neutrophil 4, 092/microliters, respectively) after two months by administering the
copper supplementation. The exact cause of the
anemia and
neutropenia in
copper deficiency is unclear, but it is suggested that the decreased activity of
enzyme containing
copper may be related. Hematological abnormalities due to
copper deficiency should be cared during long term
enteral nutrition with long termed bed-ridden elderly patients.