Clinical Scorecard: Case Report of Acquired Copper Deficiency Resulting from Revisional Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) and Associated Severe Pancytopenia and Refractory Anemia

At a Glance

Key Highlights

• Copper is absorbed mainly in the stomach and proximal duodenum, sites altered by SADI-S surgery leading to malabsorption.
• Severe copper deficiency post-SADI-S can cause pancytopenia with cellular atypia mimicking other hematologic disorders.
• Timely diagnosis and intravenous copper supplementation can reverse hematologic abnormalities and improve patient outcomes.

Guideline-Based Recommendations

Diagnosis

• Consider copper deficiency in patients with anemia and pancytopenia post-bariatric surgery, especially SADI-S.
• Measure serum copper and ceruloplasmin levels alongside other micronutrients (zinc, selenium, vitamin D, folate).
• Exclude other causes such as vitamin B12 deficiency and celiac disease.

Management

• Administer intravenous copper chloride for severe deficiency and refractory anemia.
• Provide multivitamin and mineral supplementation including copper gluconate, selenium, vitamin D, calcium, iron, and cyanocobalamin.
• Use high-protein diet and consider pancreatic enzyme supplementation if pancreatic insufficiency is suspected.

Monitoring & Follow-up

• Regularly monitor complete blood count, serum copper, ceruloplasmin, and other micronutrient levels postoperatively.
• Assess clinical symptoms such as fatigue, edema, and neurological signs.
• Follow-up labs to confirm resolution of pancytopenia and normalization of hematologic parameters.

Risks

• Malabsorptive bariatric procedures like SADI-S increase risk of multiple micronutrient deficiencies.
• Copper deficiency can be misdiagnosed due to overlapping symptoms with vitamin B12 deficiency.
• Delayed diagnosis may lead to severe hematologic complications including refractory anemia and pancytopenia.

Patient & Prescribing Data

Adult patients post-revisional SADI-S bariatric surgery with symptoms of anemia and pancytopenia

Intravenous copper chloride followed by oral copper gluconate and comprehensive micronutrient supplementation improves hematologic parameters and symptoms

Clinical Best Practices

• Maintain high suspicion for copper deficiency in post-bariatric surgery patients presenting with hematologic abnormalities.
• Implement routine micronutrient screening including copper in long-term follow-up of SADI-S patients.
• Educate patients on adherence to prescribed multivitamin and mineral supplementation postoperatively.
• Use a multidisciplinary approach involving bariatric surgeons, hematologists, and nutritionists for management.

References

• Copper's role in enzymatic reactions and absorption sites
• Nutritional deficiencies post-bariatric surgery including copper
• SADI-S surgical technique and outcomes
• Copper deficiency clinical presentation and diagnosis challenges
• Incidence of copper deficiency after SADI-S