Copper and Iron Status in Myelodysplastic Syndromes.

Introduction: Copper is an essential mineral found in many tissues. It is involved in iron incorporation into hemoglobin, hemolytic syndromes, while copper deficiency provokes iron overload and induces dysplastic changes to erythrocytes. On the other hand, there are references that iron overload can result in mild copper deficiency. There seems to be equivocal relationship between these two elements.

Aim: The aim of this study is to determine copper and iron status in myelodysplastic patients and to investigate if copper deficiency correlates with the type of myelodysplastic syndrome.

Materials and methods: We studied 52 patients with myelodysplastic syndrome, 29 men and 23 women(mean age 67,05± years). No other simultaneous disease was confirmed which could contribute to copper disorders. Patients were categorized in two groups. Group A, composed of 21 patients frequently transfused(approximately once monthly), suffering from RAEB, RAEB-t AND CMML. Group B included 31 patients, who either didn’t often need transfusion, or responded to erythropoietin, suffering from RA and RARS. Copper, iron and ferritin levels measurments were performed. Copper was measured by flame atomic absorption spectrometry (normal range: 0,8–1,3mg/l).

Results:

• Nine patients of group A revealed copper deficiency(mean value 0,66±0,06mg/L). Mean copper value was 0,8±0,11mg/L for that group. All of them had elevated iron levels (average:602,23±160,46μg/dl) and high ferritin levels(average:1769±693,85ng/ml)

• All group B patients were found to have normal copper levels(Mean value was 1,15±0,09), indicating a statistically significant difference compared to group A patients(p<0,0001). Iron and ferritin levels were within normal range(average105,22±28,63 and 82,9±28,42 respectively)

Conclusions: Copper levels, in multitransfused patients with poor prognosis myelodysplastic syndrome and iron overload, are significantly lower than in oligotransfused ones with good prognosis who consequently present normal iron burden.