Copper plays an important role in proper functioning of numerous enzymatic systems. An acquired deficiency can be diagnosed when certain clinical findings are noted in a patient with a predisposing clinical condition.


Copper is important in several enzymes, including:

(1) cytochrome C oxidase

(2) amine oxidase

(3) lysyl oxidase

(4) tyrosinase

(5) superoxide dismutase

(6) ceruloplasmin

(7) S-adenosylhomocysteine hydrolase

(8) dopamine beta-hydroxylase

(9) Factor V

(10) ascorbate oxidase


Clinical states associated with copper malnutrition:

(1) TPN without copper supplementation

(2) malabsorption states

(3) inflammatory bowel disease

(4) protein malnutrition

(5) high oral doses of zinc or iron

(6) premature infants

(7) malnourished infants

(8) nephrotic syndrome

(9) chronic infection or inflammation

(10) pregnancy

(11) hepatitis or cirrhosis

(12) cancer



• Patients with protein malnutrition, nephrotic syndrome and malabsorption may have low serum copper levels yet adequate copper stores.


Clinical findings in a deficiency state:

(1) pancytopenia, with a hypochromic, normochromic or megaloblastic anemia unresponsive to iron

(2) kinky hair

(3) skeletal demineralization with osteoporosis and defects in metaphysis

(4) myocardial disease, which may be fatal

(5) delayed wound healing

(6) depigmentation with loss of hair and skin color

(7) lethargy and neurologic disturbances


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