The CBC count may show:
(1) anemia, which may be hypochromic, normochromic or megaloblastic.
(2) neutropenia
(3) pancytopenia.
Erythroid changes in the bone marrow:
(1) ringed sideroblasts
(2) dyserythropoiesis
(3) failure of anemia to respond to iron or vitamin therapy
(4) vacuolated erythroid precursors
Changes in the white blood cells:
(1) iron-containing plasma cells
(2) vacuolated granulocytic precursors
(3) increase in immature myeloid cells without an excess of blasts
(4) dysmyelopoiesis, hypogranularity and pseudo-Pelger-Huet anomaly are usually absent
Megakaryocytes usually are normal.
Cytogenetic studies are usually normal.
Diagnosis depends on:
(1) recognition of a condition associated with nutritional copper deficiency (see Chapter 12)
(2) presence of other findings of copper deficiency (neurologic findings, lethargy, changes in hair and skin, etc.)
(3) low serum copper concentration
(4) reversal of hematologic abnormalities on copper repletion
