Copper deficiency is extremely rare, and there is no evidence that copper ever need be added to a normal diet. Even in clinical states associated with hypocupremia (sprue, celiac disease, and nephrotic syndrome), effects of copper deficiency usually are not demonstrable. Anemia due to copper deficiency has been described in individuals who have undergone intestinal bypass surgery, in those who are receiving parenteral nutrition, in malnourished infants, and in patients ingesting excessive amounts of zinc. While an inherited disorder affecting copper transport (Menkes' disease) is associated with reduced activity of several copper-dependent enzymes, this disease is not associated with hematological abnormalities.
The outstanding findings in copper deficiency are leukopenia, particularly granulocytopenia, and anemia; the anemia is not always microcytic. When a low plasma copper concentration is determined in the presence of leukopenia and anemia, a therapeutic trial with copper is appropriate. Daily doses up to 0.1 mg/kg of cupric sulfate have been given by mouth, or 1-2 mg/day may be added to the solution of nutrients for parenteral administration.
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