Zinc-Containing Over-The-Counter Product Causing Sideroblastic Anemia and Neutropenia

Abstract

Sideroblastic anemia is characterized by anemia, granulocytopenia, and bone marrow findings of vacuolated precursors and ringed sideroblasts. Zinc-induced copper deficiency can present as sideroblastic anemia and neutropenia. We report the case of a previously healthy 74-year-old female who presented with newly discovered sideroblastic anemia as a result of an over-the-counter oral vitamin and mineral supplement. Serum analysis revealed increased zinc levels, decreased copper levels, and a decrease in ceruloplasmin. Bone marrow evaluation revealed ringed sideroblasts and cytoplasmic vacuolization in myeloid precursors. She demonstrated improvement in her hematologic profile with discontinuation of the over-the-counter product and administration of oral copper supplementation. This case highlights the importance of sideroblastic anemia recognition and careful medication review, including over-the-counter supplements.

Keywords: copper; neutropenia; sideroblastic anemia; zinc; zinc-induced hypocupremia.

Figure 1. Bone marrow biopsy sample of a 74-year-old female showing a ringed sideroblast on Perls Prussian blue stain (H&E, 50x), i.e., blue color staining the erythroid precursor.

H&E, hematoxylin and eosin

Figure 2. Bone marrow biopsy sample of a 74-year-old female demonstrating cytoplasmic vacuolization of myeloid precursors (H&E, 100x).

H&E, hematoxylin and eosin