Morphologic findings in bone marrow precursor cells in zinc-induced copper deficiency anemia

Damage to the bone marrow elements, as shown by cytoplasmic vacuolization, has been reported in patients with acute alcohol intoxication, drug reactions, nutritional deficiencies, myeloproliferative syndromes, malignant hematologic conditions, some metabolic conditions, and in those treated with chemotherapeutic agents. A case of zinc toxicity with anemia, leukopenia, and cytoplasmic vacuolization of both myeloid and erythroid precursors is described. The patient described was a 30-year-old quadriplegic man who was receiving oral zinc to promote the healing of and prevention of decubitus ulcers. In the gut, dietary zinc interacts with copper in a competitive manner, and high levels of zinc can lead to copper deficiency. Zinc-induced copper deficiency anemia can be morphologically identified in the bone marrow preparations by cytoplasmic vacuolization of both myeloid and erythroid precursor elements.