Clinicopathological Analysis of Hematological Disorders in Tube-Fed Patients with Copper Deficiency
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概要
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Object Anemia and leukopenia caused by copper deficiency are well-documented consequences of long-term total parenteral nutrition. We measured the serum copper levels of bed-ridden patients receiving enteral feeding, and evaluated optical and ultrastructural features of bone marrow before and after copper supplementation.Patients and Methods Serum samples were obtained from 15 bed-ridden elderly patients receiving tube feeding (TF) and 10 age-matched bed-ridden patients who took food orally (CO), and the copper ceruloplasmin concentration of each sample was measured. Bone marrow samples were obtained from patients who exhibited copper deficiency and leukopenia and/or anemia before and after the copper supplementation, for use in light and electron microscopic analysis.Results The tube-fed patients had significantly lower mean serum copper and ceruloplasmin concentrations than the control patients. Seven of the 15 tube-fed patients had reduced serum copper concentrations and leukopenia. Six of those 7 patients also had anemia. Copper sulfate was administered to those 7 patients by enteral tube;their copper concentration, anemia and leukopenia improved within 1 month after they were administered copper sulfate. In the bone marrow examination before copper supplementation, light microscopy showed cytoplasmic vacuolization in both myeloid and erythroid precursors, and electron microscopy showed electron-dense deposits in mitochondria and cytoplasm of erythroid and myeloid cells. After copper supplementation, these pathological changes disappeared.Conclusions Bicytopenia is likely to occur in tube-fed patients with copper deficiency. Copper deficiency appears to be associated with cytoplasmic vacuolization and electron-dense deposits in mitochondria in erythroid and myeloid cells.
- 日本内科学会,The Japanese Society of Internal Medicineの論文
著者
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Kohno Shigeru
佐世保市立総合病院
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Mizuta Yohei
Second Department of Internal Medicine, Nagasaki University School of Medicine
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Isomoto Hajime
Second Department of Internal Medicine, Nagasaki University School of Medicine
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Shikuwa Saburo
Second Department of Internal Medicine, Nagasaki University School of Medicine
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Omagari Katsuhisa
Second Department of Internal Medicine, Nagasaki University School of Medicine
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Kohno Shigeru
Second Department of Internal Medicine, Nagasaki University School of Medicine
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Chen Chun_Chuan
Second Department of Internal Medicine, Nagasaki University School of Medicine
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Takeshima Fuminao
Department of General Medicine, Nagasaki University School of Medicine
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Miyazaki Takashige
Second Department of Internal Medicine, Nagasaki University School of Medicine
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Murase Kunihiko
Second Department of Internal Medicine, Nagasaki University School of Medicine
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Ohtani Hiroshi
First Department of Pathology, Nagasaki University School of Medicine
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Ozono Yoshiyuki
Department of General Medicine, Nagasaki University School of Medicine
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Isomoto Hajime
Second Department Of Internal Medicine Nagasaki University School Of Medicine
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Mizuta Yohei
Second Department Of Internal Medicine Nagasaki University School Of Medicine
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Murase Kunihiko
Second Department Of Internal Medicine Nagasaki University School Of Medicine
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Omagari Katsuhisa
Second Department Of Internal Medicine Department Of Translational Medical Sciences Nagasaki Univers
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Miyazaki Takashige
Second Department Of Internal Medicine Nagasaki University School Of Medicine
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Kohno Shigeru
Second Dep. Of Internal Medicine Nagasaki Univ. Graduate School Of Biomedical Sciences Nagasaki Univ
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Shikuwa Saburo
Second Department Of Internal Medicine Nagasaki University School Of Medicine
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Ohtani Hiroshi
First Department Of Internal Medicine Fukushima Medical College
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Takeshima Fuminao
Department Of Gastroenterology And Hepatology Graduate School Of Biomedical Sciences Nagasaki Univer
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Chen Chun
Second Department of Internal Medicine, Nagasaki University School of Medicine
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