After 8 months of home total parenteral nutrition, a patient develops a normocytic anaemia with neutropenia and a sensorimotor neuropathy. Serum ceruloplasmin is low. Which intervention addresses the underlying cause?

• A Add copper to the parenteral nutrition regimen ✓
• B Increase the selenium dose
• C Add vitamin B12 injections
• D Reduce the zinc content of the regimen

Explanation

Long-term parenteral nutrition without adequate trace elements causes copper deficiency, producing anaemia and neutropenia (copper is a cofactor for caeruloplasmin and cytochrome oxidase) plus a demyelinating neuropathy resembling B12 deficiency. Low ceruloplasmin confirms it. Excess zinc actually induces copper deficiency by blocking intestinal absorption, so simply reducing zinc without adding copper does not correct established depletion.

Reference: Williams Hematology, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.