Copper Deficiency in a Japanese Infant on Milk Formula

Abstract

Summary Copper deficiency in human is uncommon. We described a 7-month-old Japanese infant who developed copper deficiency while being fed milk formula alone, and exhibited neutropenia, sideroblastic anemia and bone changes resembling scurvy and osteoporosis. We treated her with oral copper solution. Within 7 days of treatment, neutrophils and reticulocyte counts remarkably increased. Anemia was corrected by 2 weeks after initiation of copper therapy. Bone radiography showed remarkable improvement, and the maturation arrest and cytoplasmic vacuoles in the early myeloid and erythroid series on the bone marrow examination had disappeared after copper therapy. The plasma and erythrocyte copper concentrations, and serum ceruloplasmin levels returned rapidly to normal range. The patient has been doing well after discontinuing copper supplements. Although there has been no report of copper deficiency in Japanese infants nourished with milk formula alone, marginal copper deficiency, which escapes clinical recognition and is spontaneously cured when solid foods are added, may not be so uncommon in Japan. The recommended daily intake of copper cannot be achieved, if a Japanese infant, especially a premature baby, is nourished with milk formula alone. Therefore, Japanese milk formula must be !supplemented with copper.