A 15-month-old preterm infant on prolonged total parenteral nutrition develops progressive pallor and recurrent infections. CBC shows Hb 8.0 g/dL, MCV 72 fL, and absolute neutrophil count 300 cells/mm3. The anemia does not respond to oral iron. X-ray shows osteoporosis with a healed fracture. Which of the following is the MOST likely deficiency?

• A Selenium deficiency
• B Iron refractory iron deficiency anemia (IRIDA)
• C Transient erythroblastopenia of childhood
• D Copper deficiency ✓

Explanation

Acquired copper deficiency, seen in prematurity, prolonged parenteral nutrition, and excess zinc intake, causes a microcytic hypochromic anemia unresponsive to iron together with neutropenia and skeletal changes of osteoporosis with fractures. Neutropenia is the discriminating finding, since IRIDA and transient erythroblastopenia do not produce it. Low serum ceruloplasmin and copper levels confirm the diagnosis, and copper supplementation reverses all findings.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.