26 June 2026
: Case report 
A Perfect MDS Mimic: Zinc-Driven Copper Deficiency After Gastric Bypass in a Patient Using Denture Adhesive
Unusual clinical course, Challenging differential diagnosis, Diagnostic / therapeutic accidents
Farzeen Fatma Syed AEF 1*, Ye Lin Son BEF 2, Jessica Amos
EF 1
DOI: 10.12659/AJCR.952171
Am J Case Rep 2026; 27:e952171
Table 1 Hematologic and biochemical laboratory findings during hospitalization.
| Laboratory parameter | Result | Reference range |
|---|---|---|
| White blood cell count | 2.0×10/μL | 4.0–10.0×10/μL |
| Absolute neutrophil count | 980/μL (nadir <500/μL) | 1500–8000/μL |
| Hemoglobin | 5.8 g/dL | 12–16 g/dL |
| Platelets | 232×10/μL (nadir 104×10/μL) | 150–400×10/μL |
| Reticulocyte production index | 0.4 | >2 suggests appropriate response |
| Vitamin B12 | 910 pg/mL | 200–914 pg/mL |
| Folate | 6.8 ng/mL | >4 ng/mL |
| Lactate dehydrogenase | 149 U/L | 120–250 U/L |
| Haptoglobin | 205 mg/dL | 30–200 mg/dL |
| Ferritin | 198.5 ng/mL | 13–150 ng/mL |
| Serum iron | 38 μg/dL | 50–170 μg/dL |
| Total iron-binding capacity | 279 μg/dL | 250–370 μg/dL |
| Transferrin saturation | 14% | 20–50% |
| Serum copper | <10 μg/dL | 77–206 μg/dL |
| Ceruloplasmin | <60 mg/L | 200–600 mg/L |
| Serum zinc | 130 μg/dL | 60–106 μg/dL |
| Values demonstrate severe hypoproliferative anemia and neutropenia in the context of profound copper deficiency and elevated serum zinc levels. | ||