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Hyperregenerative macrocytic anaemia: the role of copper and zinc
  1. Patrick Hofmann,
  2. Claudia Buetikofer and
  3. Esther Bächli
  1. Internal Medicine, Hospital Uster, Uster, Switzerland
  1. Correspondence to Dr. Patrick Hofmann; hofmannpatrick{at}


In a patient with a history of bariatric surgery, severe copper deficiency presenting with macrocytic hyperregenerative anaemia was diagnosed. Besides the impaired intestinal absorption due to a short bowel syndrome, the enteral zinc supplementation competitively decreased the intestinal copper uptake. Once the zinc supplementation was stopped, enteral copper replacement ensued and normalised haemoglobin levels with decreasing median corpuscular volume were observed during follow-up visits.

  • nutrition
  • malnutrition
  • haematology (incl blood transfusion)

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  • Contributors PH: Involved in patient care, design and drafting the article. CB: Involved in patient care, design, drafting and critical review of the manuscript. EB: Involved in patient care, design, drafting and critical review of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer-reviewed.