First Case Report of Acquired Copper Deficiency Following Revisional Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) Leading to Severe Pancytopenia with Refractory Anemia - Report - MDSpire
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First Case Report of Acquired Copper Deficiency Following Revisional Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) Leading to Severe Pancytopenia with Refractory Anemia
Severe Copper Deficiency and Pancytopenia After Revisional SADI-S Surgery
Overview
A 37-year-old female developed severe copper deficiency resulting in pancytopenia and refractory anemia following revisional single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S). Despite adherence to multivitamin and mineral supplementation, she presented with significant hematologic abnormalities that improved with targeted copper and micronutrient repletion.
Background
Copper is an essential trace element absorbed mainly in the stomach and proximal duodenum, acting as a cofactor in enzymatic reactions critical for hematologic and neurologic function. Bariatric surgeries, including SADI-S, alter gastrointestinal anatomy and can predispose patients to micronutrient deficiencies such as copper deficiency. Copper deficiency is rare but can mimic vitamin B12 deficiency and cause severe hematologic manifestations including anemia and pancytopenia. Reports of malnutrition outcomes after SADI-S are limited, with copper deficiency documented in approximately 12% of patients at one year postoperatively.
Data Highlights
Parameter
Normal Range
Patient Value
White Blood Cell Count (WBC)
4–10 × 10³/µL
Low (Leucopenia)
Hemoglobin (Hb)
12–15 g/dL
Microcytic hypochromic anemia
Platelets (Plt)
150–400 × 10³/µL
Thrombocytopenia
Ceruloplasmin
20–60 mg/dL
Low
Copper
Not specified
Severe deficiency
Zinc
10.1–16.8 µmol/L
Low
Selenium
70–150 ng/mL
Low
Vitamin D
35–80 ng/mL
Low
Folate
10.4–42.4 nmol/L
Low (4.98 nmol/L)
Vitamin B12
133–675 pmol/L
High
Key Findings
The patient developed severe pancytopenia with cellular atypia 11 months after revisional SADI-S surgery despite reported adherence to supplementation.
Laboratory evaluation revealed severe copper deficiency along with deficiencies in zinc, selenium, vitamin D, and folate, but elevated vitamin B12 levels.
Peripheral blood smear confirmed pancytopenia with cellular atypia, and hemoglobin electrophoresis was normal.
Initial transfusion of packed red blood cells resulted in transient hematologic improvement, but sustained recovery occurred only after intravenous copper chloride supplementation.
Following targeted micronutrient therapy, the patient showed normalization of serum copper levels, resolution of leukopenia, neutropenia, thrombocytopenia, and improvement in anemia.
This case represents possibly the first reported severe copper deficiency causing profound hematologic abnormalities post-SADI-S surgery.
Clinical Implications
Clinicians should maintain a high index of suspicion for copper deficiency in patients presenting with unexplained anemia and pancytopenia after bariatric procedures such as SADI-S, even when patients report adherence to supplementation. Early diagnosis and prompt intravenous copper repletion can reverse hematologic abnormalities and improve patient outcomes. Routine monitoring of trace elements including copper is advisable in post-bariatric surgery follow-up to prevent severe deficiency complications.
Conclusion
Severe copper deficiency is a rare but serious complication following revisional SADI-S surgery that can cause profound hematologic abnormalities including pancytopenia and refractory anemia. Awareness and early intervention with appropriate micronutrient supplementation are critical to prevent morbidity.
References
Copper's role in enzymatic reactions and absorption sites [1,2,3]
Nutritional deficiencies post-bariatric surgery and SADI-S outcomes [5,6,7,9,10]
Clinical presentation and diagnosis challenges of copper deficiency [8]
