A 56-year-old woman with a complicated medical history presented with nausea, vomiting, neuropathy, and chronic weakness. Complete blood count (Hb 54 g/L, MCV 99 fL, white blood cell count 5.0 X 109/L, neutrophil count 3.5 X 109/L, platelets 374 X 109/L, reticulocyte count 46 X 109/L) showed she was markedly anemic with a normal reticulocyte count. The etiology of the anemia was not evident from a review of the blood smear. A bone marrow examination showed prominent vacuolated erythroblasts (panel A) and vacuolated myeloid precursors (panel B). Ring sideroblasts were also present. Cytogenetics showed a normal karyotype (46, XX). Additional laboratory investigations showed markedly decreased copper 0.6 (11.3-25.2 mumol/L), decreased ceruloplasmin 29 (220-495 mg/L), and elevated zinc 18.7 (9.2-18.5 umol/L). Review of her medications showed long-term oral zinc gluconate therapy. Longer-term follow-up showed normalization of anemia with oral copper supplementation, but the neurologic defects persisted.
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机译：一个56岁的女性，具有恶心，呕吐，神经病和慢性弱点的复杂病史。完全血统计数（HB 54 g / L，MCV 99 FL，白细胞计数5.0 x 109 / L，中性粒细胞计数3.5 x 109 / L，血小板374 x 109 / L，网状细胞计数46 x 109 / l）显示她是具有正常的网状细胞计数明显贫血。从血液涂片的审查中，贫血的病因并不明显。骨髓检查显示出突出的真空红细胞（面板A）和真空的骨髓前体（面板B）。还存在环状唾液细胞。细胞源显示出正常的核型（46，XX）。额外的实验室研究表明铜0.6（11.3-25.2毫米醇/升）显着降低，刺激率下降29（220-495mg / L）和升高的锌18.7（9.2-18.5μmol/ l）。审查她的药物表现出长期口腔葡萄糖酸锌疗法。长期随访显示贫血与口服铜补充的正常化，但神经系统缺陷持续存在。
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