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Copper Deficiency in Children With Intestinal Failure: Risk Factors and Influence on Hematological Cytopenias
Heitor Pons Leite1, Paulo Cesar Koch Nogueira1,2, Keilla Mayumi Castelo Branco Uchoa2
1Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil.
Insights
Serum copper levels significantly impact neutrophil and platelet counts in children with intestinal failure. Factors like prolonged parenteral nutrition without copper, cholestasis, and ostomy negatively affect copper status.
Area of Science:
- Pediatric Gastroenterology
- Nutritional Science
- Hematology
Background:
- Children with intestinal failure (IF) often require long-term parenteral nutrition (PN).
- Monitoring micronutrient status, including copper, is crucial in this vulnerable population.
- The relationship between serum copper and hematological parameters in IF requires further elucidation.
Purpose of the Study:
- To determine the influence of serum copper on hemoglobin, neutrophil, and platelet counts in children with IF.
- To identify factors associated with serum copper levels in these patients.
Main Methods:
- Prospective follow-up of children in a pediatric intestinal rehabilitation program receiving home PN.
- Routine monitoring of serum copper and complete blood counts.
- Repeated-measures analyses to assess variable effects on outcomes.
Main Results:
- Serum copper was not associated with hemoglobin levels.
- Increased serum copper correlated with significant increases in neutrophil and platelet counts.
- Low serum copper was observed in over half of the patients, often repeatedly.
Conclusions:
- Serum copper positively influences neutrophil and platelet counts in children with IF.
- Parenteral nutrition duration without copper, cholestasis, and ostomy are associated with lower serum copper levels.
- These findings highlight the importance of adequate copper monitoring and supplementation in pediatric IF.
Background:
We investigated to what extent serum copper influences hemoglobin (Hb), neutrophil, and platelet counts and the factors associated with serum copper in children with intestinal failure (IF) who have their micronutrient status monitored according to a standard protocol.
Methods:
Children with IF admitted to a pediatric intestinal rehabilitation program and receiving home parenteral nutrition (PN) were followed up prospectively. Patients received vitamins and multi-trace elements (TEs) as part of the PN. Copper, iron, zinc, vitamin A, and cobalamin serum levels were routinely monitored at 3-month intervals or monthly when a deficiency was detected. Complete blood counts were performed biweekly. Repeated-measures analyses were used to estimate the effect of explanatory variables on the outcomes.
Results:
Thirteen children with a median time receiving PN of 16.6 months were included. An average of 7 copper measurements per patient were performed; 53.8% of patients had a low serum level at least twice during the follow-up. Eight patients with cholestasis had TEs of PN discontinued. In the multivariable analysis, copper was not associated with Hb levels; an increase of 10 µg/dL in serum copper resulted in an increase of 240/mm3 (95% confidence interval [CI], 18.0-30.1) neutrophils and of 8429/mm3 (95% CI, 466-1219) platelets (P < .001). Time of PN without copper, direct bilirubin levels, and ostomy were associated with lower serum copper.
Conclusion:
The increase in serum copper was associated with significant increases in neutrophil and platelet counts. Time without copper in PN, cholestasis, and having an ostomy negatively influenced copper status.
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