sodium-hypochlorite and Leukopenia

A 19-year-old man who developed extensive oesophageal lye (Alkali) stricture and received long-term enteral nutrition (eight months) with a jejunostomy tube developed macrocytic anaemia (Hb: 41 g/L) with leucopenia (white blood cell [WBC]: 3.0 x 10(9)/L). The patient's serum vitamin B12, folate, iron and liver function tests were normal. Bone marrow examination revealed gross erythroid hyperplasia and cytoplasmic vacuolization of erythroid and myeloid elements. Further investigations revealed low serum copper (0.3 micromol/L) and ceruloplasmin concentrations (<30 mg/L) with marginally low normal serum concentration of red cell peroxidase (13 U/gHb), establishing the diagnosis of copper deficiency anaemia. The anaemia and leucopenia responded intermittently to intravenous copper therapy, but the serum copper concentration dropped when intravenous copper therapy was withdrawn. Enteral jejunostomy copper supplementation failed to maintain adequate serum copper concentrations. After stabilizing the general condition of the patient, a pharyngo-gastric anastamosis was performed and normal oral diet commenced, which restored normal serum copper concentration. This case report suggests that copper supplements in the form of copper sulphate are not adequately absorbed when administered through a jejunostomy tube.

Topics: Adult; Anemia, Macrocytic; Ceruloplasmin; Copper; Deficiency Diseases; Enteral Nutrition; Gastroenterostomy; Humans; Injections, Intravenous; Jejunostomy; Leukopenia; Male; Poisoning; Sodium Hypochlorite

Topics: Cellulose; Female; Humans; Kidney Failure, Chronic; Kidneys, Artificial; Leukocyte Count; Leukopenia; Male; Membranes, Artificial; Sodium Hypochlorite

The functional performance (clearance of small molecules, ultrafiltration and blood loss) and biocompatibility (haemodialysis leucopenia) has been studied for disposable flat plate and hollow fibre haemodialysers utilizing Cuprophan membranes on their first use, and compared with that obtained when reusing by a manual and automated technique. The results obtained relating to functional performance remain unchanged with the exception of blood loss which shows an increase compared with first use. Biocompatibility is modified on reuse but only if the membrane has not been exposed to a rinsing process using sodium hypochlorite.

Topics: Humans; Kidneys, Artificial; Leukocyte Count; Leukopenia; Sodium Hypochlorite