Incidental pancytopenia in the setting of urolithiasis: severe copper deficiency without classic risk factors

Pancytopenia is a significant haematological finding with a broad differential, ranging from benign conditions to life-threatening malignancies. Copper deficiency is a recognised but uncommon cause of non-clonal cytopenias. We report a case of copper deficiency in a woman in her 80s who presented with urolithiasis and was found to have acute pancytopenia. A thorough evaluation identified undetectable copper levels despite the absence of classic risk factors such as gastrointestinal surgery, malabsorptive disorders or zinc supplementation. Our patient's copper deficiency was most likely multifactorial arising from insufficient dietary intake and chronic mild gastrointestinal dysfunction. Emerging evidence suggests that hypocupremia may be more common than previously appreciated, and clinicians should consider copper deficiency in the differential diagnosis of pancytopenia.