Annals of Hematology

, Volume 97, Issue 9, pp 1527–1534 | Cite as

Copper deficiency anemia: review article

  • Zin W. MyintEmail author
  • Thein H. Oo
  • Kyaw Z. Thein
  • Aung M. Tun
  • Hayder Saeed
Review Article


Copper is a crucial micronutrient needed by animals and humans for proper organ function and metabolic processes such as hemoglobin synthesis, as a neurotransmitter, for iron oxidation, cellular respiration, and antioxidant defense peptide amidation, and in the formation of pigments and connective tissue. Multiple factors, either hereditary or acquired, contribute to the increase in copper deficiency seen clinically over the past decades. The uptake of dietary copper into intestinal cells is via the Ctr1 transporter, located at the apical membrane aspect of intestinal cells and in most tissues. Copper is excreted from enterocytes into the blood via the Cu-ATPase, ATP7A, by trafficking the transporter towards the basolateral membrane. Zinc is another important micronutrient in animals and humans. Although zinc absorption may occur by direct interaction with the Ctr1 transporter, its absorption is slightly different. Copper deficiency affects physiologic systems such as bone marrow hematopoiesis, optic nerve function, and the nervous system in general. Detailed pathophysiology and its related diseases are explained in this manuscript. Diagnosis is made by measuring serum copper, serum ceruloplasmin, and 24-h urine copper levels. Copper deficiency anemia is treated with oral or intravenous copper replacement in the form of copper gluconate, copper sulfate, or copper chloride. Hematological manifestations are fully reversible with copper supplementation over a 4- to 12-week period. However, neurological manifestations are only partially reversible with copper supplementation.


Copper Anemia Neuropathy Optic disease Zinc Gastric-by-pass Myelodysplastic anemia 



The authors thank Heather N. Russell-Simmons and the Markey Cancer Center Research Communications Office for assistance with manuscript preparation.

Compliance with ethical standards

Not applicable.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Zin W. Myint
    • 1
    • 2
    Email author
  • Thein H. Oo
    • 3
  • Kyaw Z. Thein
    • 4
  • Aung M. Tun
    • 5
  • Hayder Saeed
    • 1
    • 2
  1. 1.Division of Hematology and Blood and Marrow TransplantUniversity of KentuckyLexingtonUSA
  2. 2.Markey Cancer CenterUniversity of KentuckyLexingtonUSA
  3. 3.Division of HematologyUniversity of Texas M.D. Anderson Cancer CenterHoustonUSA
  4. 4.Division of HematologyTexas Tech University of Health Sciences CenterLubbockUSA
  5. 5.Division of HematologyBrooklyn Hospital CenterNew YorkUSA

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