Unusual Anemias

What happens to Hoplias malabaricus fed on live prey (Astyanax altiparanae) previously exposed to copper? A multiple biomarker approach

Copper waterborne toxicity is well understood in aquatic organisms. However, the dietary copper effects are much less known, especially in tropical fish. The toxicity of copper via the trophic route could be influenced by the composition of the food, and diets naturally impregnated with copper seem to have greater toxicity at lower concentrations than artificially impregnated ones. Thus, our objective was to investigate the effects of copper on juveniles of the Neotropical fish Hoplias malabaricus fed on live prey (Astyanax altiparanae) previously exposed to the metal (20 µg L ^- 1) for 96 h. The prey fish were given to H. malabaricus every 96 h, totaling 10 doses at the end of the experiment. Thus, after 40 days fish were killed and tissues were sampled. Blood showed to be the only tissue in which copper accumulated. Anemia was found and there was damage to the DNA of erythrocytes. Furthermore, ionic imbalances were observed in plasma. There was an increase in the concentration of Na⁺ and Cl^- and a decrease in Ca²⁺, which were associated with increased copper uptake in the gastrointestinal tract of fish fed on copper exposed prey. All the antioxidant enzymes evaluated in the gills showed decreased activity compared to the control group. Copper seems to have interfered in the energy metabolism of H. malabaricus, since a lower condition factor and feed conversion efficiency rate were observed in fish fed with copper diet. The present study confirms the trophic route as an important copper toxicity pathway for H. malabaricus and reinforces the idea that metal toxicity can be increased when it is naturally impregnated in the prey tissues, even if the prey has been exposed to the metal only for a short period of time.

Clinical Manifestations of Copper Deficiency: A Case Report and Review of the Literature

BACKGROUND

Copper is a mineral that is absorbed in the stomach, duodenum, and jejunum. Gastric bypass surgery, gastrectomy, and short-bowel syndrome commonly lead to copper malabsorption. Copper deficiency primarily presents with hematological and neurological sequelae, including macrocytic anemia and myelopathy. Although hematological disturbances often correct with copper supplementation, neurological manifestations of copper deficiency may be irreversible. We present the case of copper deficiency secondary to malabsorption and management strategies to prevent irreversible neurological sequelae.

PRESENTATION

A 48-year-old female with a history of hypothyroidism, ischemic stroke, and Crohn's disease, complicated by subtotal colectomy and small-bowel resections, was admitted for fatigue and progressive neurological deficiencies. Her vital signs were stable, and physical examination was remarkable for weakness of both upper and lower extremities, ataxia, and upper extremities paresthesia. Computed tomography scan of the head without contrast was unremarkable. Magnetic resonance imaging enterography revealed a focal area of narrowing of the remaining small bowel. Copper level was low at 39 µg/dL. After 5 days of intravenous replacement using trace element within parenteral nutrition, her copper level corrected to 81 µg/dL. Her ataxia improved after intravenous copper supplementation and did not recur.

CONCLUSIONS

Our patient presented with copper deficiency secondary to malabsoprtion. This case highlights the importance of copper testing in the bariatric surgery population and in patients with short-bowel syndrome. Given the irreversible nature of neurological symptoms when compared with the expense of nutrition supplements, routine copper testing should be considered in patients with malabsorptive states or altered anatomy, regardless of initial presentation.

Hematologic Manifestations of Nutritional Deficiencies: Early Recognition is Essential to Prevent Serious Complications

Nutritional deficiencies, including deficiencies of vitamin B12, copper, and vitamin C, may result in cytopenias and hematologic symptoms. Early recognition of these deficiencies is imperative for prompt treatment and improvement in hematologic and other manifestations. We describe 5 cases which illustrate the hematologic manifestations of nutritional deficiencies and challenges to initial diagnosis and management. Supplementation of the deficient vitamin or micronutrient in all of these cases resulted in rapid resolution of cytopenias, hemorrhage, and other associated hematologic symptoms. We also review other nutritional deficiencies that manifest with hematologic symptoms and compile recommendations on treatment and expected time to response.

Is there a standard-of-care for transfusion therapy in thalassemia?

PURPOSE OF REVIEW

Thalassemia is the most common form of inherited anemia, characterized by variable clinical phenotypes. The purpose of this review is to summarize the transfusion support in thalassemia patients and the management of transfusion-related iron overload.

RECENT FINDINGS

The most recent evidence on transfusion strategy and iron chelation therapy in thalassemia arising from clinical trials as well as from recommendation guidelines are critically discussed.

SUMMARY

Enhancements in the global care of thalassemia, resulting from the combination of an appropriate transfusion approach and iron chelation therapy, have produced a significant improvement in the quality of life and, finally, in the prognosis of patients affected by this inherited hematologic disorder.