P0576 - Pancytopenia Due to Copper and Zinc Deficiency Following Roux-en-Y Gastric Bypass (RYGB): Importance of Nutritional Monitoring and Adherence to Supplementation. a Case Report

José Juan Flores Patiño, MS¹, Fernando Gil Lopez, MD², Claudia Maya Salazar, MD³, Rene Daniel Vera Ibarra, MD³, Karina Hernandez Ayala, MD³, José A. Arizaga Berber, MD⁴, José M. Gastélum Cano, PhD⁵, Diego Delgado Zaldivar, MD¹, Carlos Torruco Sotelo, MD⁶
1Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán, Mexico City, Distrito Federal, Mexico; 2Mayo Clinic, Jacksonville, FL; 3Hospital Médica Sur, Mexico City, Distrito Federal, Mexico; 4Hospital Star Médica San Luis Potosí, San Luis Potosi, San Luis Potosi, Mexico; 5Departamento de Ciencias Químico Biológicas, Universidad de Sonora, Hermosillo, México, Hermosillo, Sonora, Mexico; 6Hospital Médica Sur, Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán, Mexico City, Distrito Federal, Mexico

Introduction: Bariatric surgery is effective for the treatment of severe obesity. Roux-en-Y gastric bypass (RYGB) and gastric banding are the procedures with the best outcomes and highest success rates, including significant and sustained weight loss, diabetes remission, obstructive sleep apnea and cardiovascular risk reduction. However, because of malabsorption, they can lead to micronutrient deficiencies, with prevalence varying depending on the specific micronutrient involved and surgical procedure.

Case Description/

Methods: A 55-year-old woman with hypothyroidism and prior Roux-en-Y gastric bypass (RYGB) performed 10 years before, presented with a 2-year history of chronic diarrhea and abdominal pain. Three weeks before presentation, a 10% bodyweight loss and dyspnea appeared. Physical exam revealed cachexia, edema, and paresthesias. Workup showed macrocytic anemia, leukopenia, mixed liver enzymes elevation, and exocrine pancreatic insufficiency (fecal elastase: 40 µg/g). Endoscopic biopsies revealed chronic gastritis, moderate chronic ileitis, intraepithelial lymphocytosis (no atrophy or malignancy), and mild chronic colitis. Bone marrow biopsy showed mildly hypercellular marrow with dysplastic features and fibrosis. Serum copper and zinc levels confirmed severe deficiencies (copper: 23 µg/dL; ceruloplasmin: 7 mg/dL; zinc: 45 µg/dL). Treatment with IV cuprous histidine and zinc sulfate led to clinical and hematologic improvement. This case highlights trace element deficiencies as an underrecognized complication post-RYGB, contributing to gastrointestinal and hematologic manifestations.

Discussion: Copper and zinc deficiencies are underrecognized and can mimic hematologic, gastrointestinal, and neurologic disorders. Copper is vital for iron metabolism, erythropoiesis, and neurologic function; deficiency may lead to anemia, leukopenia, and neuropathy. Zinc supports porphyrin synthesis and erythropoiesis. Their combined deficiency, as seen in this patient post-RYGB, can present with pancytopenia, diarrhea, and neuropathy. RYGB alters nutrient absorption, especially in the duodenum and proximal jejunum. Despite supplementation guidelines, adherence remains low due to socioeconomic barriers and complex regimens. Standard multivitamins often lack adequate trace elements. Long-term follow-up, personalized supplementation, and monitoring of high-risk patients with GI symptoms are essential. This case highlights the need for greater awareness of late-onset trace element deficiencies post-bariatric surgery.

Disclosures:
José Juan Flores Patiño indicated no relevant financial relationships.
Fernando Gil Lopez indicated no relevant financial relationships.
Claudia Maya Salazar indicated no relevant financial relationships.
Rene Daniel Vera Ibarra indicated no relevant financial relationships.
Karina Hernandez Ayala indicated no relevant financial relationships.
José A. Arizaga Berber indicated no relevant financial relationships.
José M. Gastélum Cano indicated no relevant financial relationships.
Diego Delgado Zaldivar indicated no relevant financial relationships.
Carlos Torruco Sotelo indicated no relevant financial relationships.

José Juan Flores Patiño, MS¹, Fernando Gil Lopez, MD², Claudia Maya Salazar, MD³, Rene Daniel Vera Ibarra, MD³, Karina Hernandez Ayala, MD³, José A. Arizaga Berber, MD⁴, José M. Gastélum Cano, PhD⁵, Diego Delgado Zaldivar, MD¹, Carlos Torruco Sotelo, MD⁶. P0576 - Pancytopenia Due to Copper and Zinc Deficiency Following Roux-en-Y Gastric Bypass (RYGB): Importance of Nutritional Monitoring and Adherence to Supplementation. a Case Report, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.