A preterm infant maintained on prolonged unsupplemented parenteral nutrition develops a microcytic anemia that fails to respond to oral iron, along with persistent neutropenia. Radiographs show osteoporosis with metaphyseal spur formation. Serum ceruloplasmin is low.
- A Copper deficiency ✓
- B Iron refractory iron deficiency anemia
- C Transient erythroblastopenia of childhood
- D Menkes disease
Correct answer: A. Copper deficiency
Explanation
Acquired copper deficiency occurs in premature infants and children on prolonged parenteral nutrition or exclusive cow milk feeding. It produces a microcytic hypochromic anemia unresponsive to iron, neutropenia, and skeletal changes including osteoporosis and metaphyseal cupping with spur formation. Low serum copper and ceruloplasmin confirm it. Menkes disease shares low copper levels but presents in infancy with kinky hair, seizures, and neurodegeneration rather than a nutrition-related course, and TECA lacks the neutropenia and skeletal findings.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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