# A Case of a Hemodialysis Patient With Myelodysplastic Neoplasm-Like Anemia Due to Hypozincemia Treatment

## TL;DR

A hemodialysis patient with anemia and low zinc levels showed improvement after copper supplementation, highlighting the link between zinc treatment and copper deficiency.

## Contribution

This case highlights the importance of monitoring copper levels in hemodialysis patients receiving zinc supplementation.

## Key findings

- Discontinuation of zinc acetate and copper replacement therapy improved anemia and hypocopperemia.
- Low copper levels were linked to hematopoietic issues resembling myelodysplastic neoplasm.
- Zinc supplementation can lead to copper deficiency in hemodialysis patients.

## Abstract

A 50-year-old woman had been on maintenance hemodialysis and used an erythropoiesis-stimulating agent for renal anemia. She developed anemia of unknown cause, and hypozincemia was observed; zinc acetate hydrate was started. However, the improvement was temporary. Leukopenia and macrocytic anemia were observed since the same period, and bone marrow examination revealed abnormal blood cell morphology resembling that of a myelodysplastic neoplasm. She also showed significant hypocopperemia, and we suspected a hematopoietic disorder due to copper deficiency. Zinc acetate hydrate was discontinued, and copper replacement therapy was started. After three weeks, anemia and hypocopperemia improved. Zinc supplementation is sometimes given to hemodialysis patients, but it is important to measure blood copper regularly as zinc supplementation can cause hypocopperemia.