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Copper-deficiency anemia after esophagectomy: A pitfall of postoperative enteral nutrition through jejunostomy.

Nakagawa M, Nagai K, Minami I, Wakabayashi M, Torigoe J, Kawano T - Int J Surg Case Rep (2014)

Bottom Line: A 73-year-old man presented with pulmonary failure after esophagectomy for esophageal cancer with video-assisted thoracoscopic surgery, and needed long-term artificial ventilator support.Copper-deficiency anemia was detected 3 months postoperatively; therefore, copper supplementation with cocoa powder was performed, and both serum copper and hemoglobin levels subsequently recovered.However, if anemia of unknown origin occurs in such patients, copper-deficiency anemia must be considered among the differential diagnoses.

View Article: PubMed Central - PubMed

Affiliation: Department of Esophagogastric Surgery, Tokyo Medical and Dental University, Tokyo, Japan. Electronic address: m-nakagawa.srg2@tmd.ac.jp.

No MeSH data available.


Related in: MedlinePlus

Postoperative hemoglobin levels. Arrows, transfusions; star, first day of copper supplementation.
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fig0005: Postoperative hemoglobin levels. Arrows, transfusions; star, first day of copper supplementation.

Mentions: Oral intake was impossible due to his deteriorated deglutition ability; therefore, nutritional management started from postoperative day 3 as enteral nutrition with a small amount of standard nutrient solution through the jejunostomy. His general condition improved, and thus the amount of nutrient solution was gradually increased to 1210 kcal of energy and 1.6 mg of copper by 1 month postoperatively. By 3 months postoperatively, inflammatory response had completely disappeared, and no signs of bleeding or deficiency of serum iron, ferritin, folic acid or vitamin 12 were noted. However, the patient was suffering continuous anemia, and required intermittent transfusions (Fig. 1). Serum levels of copper and ceruloplasmin were 7 μg/dl (normal range, 68–128 μg/dl) and 8 mg/dl (normal range, 21–37 mg/dl), respectively. It was considered that copper deficiency was attributable to problems with the nutrition pathway, leading to copper malabsorption despite the seemingly ample copper administration. Copper supplementation using cocoa was then started. Ten grams of commercially available cocoa powder (0.4 mg of copper) was mixed with 100 ml of warm water, and then administered through the jejunostomy once daily in the morning (Fig. 2). No side effects arose from cocoa supplementation, and the 9-Fr nutritional tube did not become clogged by the cocoa/water mixture.


Copper-deficiency anemia after esophagectomy: A pitfall of postoperative enteral nutrition through jejunostomy.

Nakagawa M, Nagai K, Minami I, Wakabayashi M, Torigoe J, Kawano T - Int J Surg Case Rep (2014)

Postoperative hemoglobin levels. Arrows, transfusions; star, first day of copper supplementation.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4066572&req=5

fig0005: Postoperative hemoglobin levels. Arrows, transfusions; star, first day of copper supplementation.
Mentions: Oral intake was impossible due to his deteriorated deglutition ability; therefore, nutritional management started from postoperative day 3 as enteral nutrition with a small amount of standard nutrient solution through the jejunostomy. His general condition improved, and thus the amount of nutrient solution was gradually increased to 1210 kcal of energy and 1.6 mg of copper by 1 month postoperatively. By 3 months postoperatively, inflammatory response had completely disappeared, and no signs of bleeding or deficiency of serum iron, ferritin, folic acid or vitamin 12 were noted. However, the patient was suffering continuous anemia, and required intermittent transfusions (Fig. 1). Serum levels of copper and ceruloplasmin were 7 μg/dl (normal range, 68–128 μg/dl) and 8 mg/dl (normal range, 21–37 mg/dl), respectively. It was considered that copper deficiency was attributable to problems with the nutrition pathway, leading to copper malabsorption despite the seemingly ample copper administration. Copper supplementation using cocoa was then started. Ten grams of commercially available cocoa powder (0.4 mg of copper) was mixed with 100 ml of warm water, and then administered through the jejunostomy once daily in the morning (Fig. 2). No side effects arose from cocoa supplementation, and the 9-Fr nutritional tube did not become clogged by the cocoa/water mixture.

Bottom Line: A 73-year-old man presented with pulmonary failure after esophagectomy for esophageal cancer with video-assisted thoracoscopic surgery, and needed long-term artificial ventilator support.Copper-deficiency anemia was detected 3 months postoperatively; therefore, copper supplementation with cocoa powder was performed, and both serum copper and hemoglobin levels subsequently recovered.However, if anemia of unknown origin occurs in such patients, copper-deficiency anemia must be considered among the differential diagnoses.

View Article: PubMed Central - PubMed

Affiliation: Department of Esophagogastric Surgery, Tokyo Medical and Dental University, Tokyo, Japan. Electronic address: m-nakagawa.srg2@tmd.ac.jp.

No MeSH data available.


Related in: MedlinePlus