An 18-month-old child with severe protein energy malnutrition has a hypochromic microcytic anemia that fails to respond to three months of adequate oral iron therapy. Repeat CBC now also shows a total leukocyte count of 2,400/mm3 with absolute neutrophil count of 300/mm3. X-ray shows osteoporosis. What is the most likely cause?
- A Refractory iron deficiency anemia
- B Lead poisoning
- C Copper deficiency ✓
- D Congenital dyserythropoietic anemia
Correct answer: C. Copper deficiency
Explanation
Copper deficiency in PEM classically produces a microcytic hypochromic anemia unresponsive to iron together with neutropenia, and radiological osteoporosis with metaphyseal changes. Copper is a cofactor for hephaestin and ceruloplasmin, which mediate iron transport out of enterocytes and macrophages, explaining the iron-refractory picture. Lead poisoning causes basophilic stippling and abdominal or neurological features rather than isolated neutropenia with osteoporosis.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.