Which bone marrow finding is associated with copper deficiency?

Which bone marrow finding is associated with copper deficiency?

• A. Auer rods in myeloblasts
• B. Hypersegmented neutrophils in peripheral smear
• C. Vacuoles in RBC precursors and ringed sideroblasts
• D. Increased megakaryocytes with schistocytes

Answer: (C)

Copper is essential for proper iron handling in developing blood cells. When copper is deficient, enzymes like ceruloplasmin cannot oxidize iron efficiently, so iron can’t be mobilized and incorporated into hemoglobin. This leads to iron piling up in the mitochondria of erythroid precursors, producing ring sideroblasts, and the erythroid cells can show cytoplasmic vacuolations as part of dyserythropoiesis. That combination—vacuolated erythroid precursors with ring sideroblasts in the bone marrow—is the hallmark copper-deficiency marrow finding. Auer rods in myeloblasts indicate acute myeloid leukemia, hypersegmented neutrophils point to megaloblastic anemia from B12/folate deficiency, and increased megakaryocytes with schistocytes are features of thrombotic microangiopathies or related processes—not copper deficiency.

Copper is essential for proper iron handling in developing blood cells. When copper is deficient, enzymes like ceruloplasmin cannot oxidize iron efficiently, so iron can’t be mobilized and incorporated into hemoglobin. This leads to iron piling up in the mitochondria of erythroid precursors, producing ring sideroblasts, and the erythroid cells can show cytoplasmic vacuolations as part of dyserythropoiesis. That combination—vacuolated erythroid precursors with ring sideroblasts in the bone marrow—is the hallmark copper-deficiency marrow finding.

Auer rods in myeloblasts indicate acute myeloid leukemia, hypersegmented neutrophils point to megaloblastic anemia from B12/folate deficiency, and increased megakaryocytes with schistocytes are features of thrombotic microangiopathies or related processes—not copper deficiency.