Pennies for Your Thoughts: A Case Series of Pancytopenia Due to Zinc-induced Copper Deficiency in the Same Patient

A 47-year-old schizophrenic male presented on three separate occasions with pancytopenia and sideroblastic anemia due to copper deficiency from massive zinc penny ingestion. The poisoning was treated differently on each visit: intravenous (IV) copper plus surgical decontamination and chelation with calcium disodium versenate (CaNa2EDTA); IV copper plus whole bowel irrigation; and IV copper with surgical decontamination only. Serum zinc half-lives were 80.0 hours, 233.2 hours, and 83.9 hours, respectively. Importantly, chelation with CaNa2EDTA did not significantly alter the elimination half-life. This is the first reported case of the same patient being treated on three different occasions with three different regimens for this condition.

[1]  J. Lazarchick.  Update on anemia and neutropenia in copper deficiency , 2012, Current opinion in hematology.

[2]  R. Cruickshank,et al.  Zinc-containing denture adhesive: a potential source of excess zinc resulting in copper deficiency myelopathy , 2011, BDJ.

[3]  L. Afrin,et al.  Fatal Copper Deficiency From Excessive Use of Zinc-Based Denture Adhesive , 2010, The American journal of the medical sciences.

[4]  C. Schiffer,et al.  Zinc toxicity from massive and prolonged coin ingestion in an adult. , 2008, The American journal of the medical sciences.

[5]  S. Dhawan,et al.  Massive penny ingestion: the loot with local and systemic effects. , 2008, The Journal of emergency medicine.

[6]  Arnon Nagler,et al.  Chelatable cellular copper modulates differentiation and self-renewal of cord blood-derived hematopoietic progenitor cells. , 2005, Experimental hematology.

[7]  A. Alao,et al.  An Unusual Foreign Body Ingestion in a Schizophrenic Patient: Case Report , 2005, International journal of psychiatry in medicine.

[8]  M. Willis,et al.  Zinc-induced copper deficiency: a report of three cases initially recognized on bone marrow examination. , 2005, American journal of clinical pathology.

[9]  E. Mair,et al.  Chronic ingestion of a zinc-based penny. , 2003, Pediatrics.

[10]  Anil Kumar,et al.  Case report of sideroblastic anemia caused by ingestion of coins , 2001, American journal of hematology.

[11]  J. Raufman,et al.  Zinc-induced copper deficiency in a coin swallower , 2000, American Journal of Gastroenterology.

[12]  P. Crookes,et al.  Zinc toxicity following massive coin ingestion. , 1997, The American journal of forensic medicine and pathology.

[13]  D. Emery,et al.  Chronic copper intoxication due to ingestion of coins: a report of an unusual case , 1995, Human & experimental toxicology.

[14]  R. Branda,et al.  Copper deficiency and sideroblastic anemia associated with zinc ingestion , 1988, American journal of hematology.

[15]  C. Fleming,et al.  Zinc-induced copper deficiency. , 1988, Gastroenterology.

[16]  M. L. Taff,et al.  Copper toxicity following massive ingestion of coins. , 1987, The American journal of forensic medicine and pathology.