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We report a case of copper deficiency in a woman in her 80s who presented with urolithiasis and was found to have acute pancytopenia. A thorough evaluation identified undetectable copper levels despite the absence of classic risk factors such as gastrointestinal surgery, malabsorptive disorders or zinc supplementation. Our patient\u2019s copper deficiency was most likely multifactorial arising from insufficient dietary intake and chronic mild gastrointestinal dysfunction. Emerging evidence suggests that hypocupremia may be more common than previously appreciated, and clinicians should consider copper deficiency in the differential diagnosis of pancytopenia.<\/jats:p>","DOI":"10.1136\/bcr-2026-272915","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T14:19:35Z","timestamp":1780409975000},"page":"e272915","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Incidental pancytopenia in the setting of urolithiasis: severe copper deficiency without classic risk factors"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5540-019X","authenticated-orcid":false,"given":"Christopher","family":"Leung","sequence":"first","affiliation":[{"name":"Internal Medicine, Georgetown University School of Medicine, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fekadu Belay","family":"Ayalew","sequence":"additional","affiliation":[{"name":"MedStar Washington Hospital Center, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Layla","family":"Heimlich","sequence":"additional","affiliation":[{"name":"MedStar Washington Hospital Center, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin James","family":"Kurth","sequence":"additional","affiliation":[{"name":"MedStar Washington Hospital Center, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"key":"2026060207000977000_19.6.e272915.1","doi-asserted-by":"crossref","first-page":"100235","DOI":"10.1016\/j.clinme.2024.100235","article-title":"Approach to pancytopenia: From blood tests to the bedside","volume":"24","author":"Chew","year":"2024","journal-title":"Clin Med (Northfield)"},{"key":"2026060207000977000_19.6.e272915.2","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.3109\/10428194.2013.821703","article-title":"New onset pancytopenia in adults: a review of underlying pathologies and their associated clinical and laboratory findings","volume":"55","author":"Devitt","year":"2014","journal-title":"Leuk Lymphoma"},{"key":"2026060207000977000_19.6.e272915.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.blre.2018.03.001"},{"key":"2026060207000977000_19.6.e272915.4","doi-asserted-by":"publisher","DOI":"10.1097\/MOH.0b013e32834da9d2"},{"key":"2026060207000977000_19.6.e272915.5","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2559.2006.02547.x"},{"key":"2026060207000977000_19.6.e272915.6","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.g3691","article-title":"Copper deficiency","volume":"348","author":"Chhetri","year":"2014","journal-title":"BMJ"},{"key":"2026060207000977000_19.6.e272915.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtemb.2011.08.146"},{"key":"2026060207000977000_19.6.e272915.8","doi-asserted-by":"crossref","first-page":"1342","DOI":"10.5858\/arpa.2016-0504-CP","article-title":"Initial Diagnostic Workup of Acute Leukemia: Guideline From the College of American Pathologists and the American Society of Hematology","volume":"141","author":"Arber","year":"2017","journal-title":"Arch Pathol Lab Med"},{"key":"2026060207000977000_19.6.e272915.9","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2022.973887","article-title":"Dietary copper intake and the prevalence of kidney stones among adult in the United States: A propensity score matching study","volume":"10","author":"Zhu","year":"2022","journal-title":"Front Public Health"},{"key":"2026060207000977000_19.6.e272915.10","doi-asserted-by":"crossref","first-page":"1534","DOI":"10.1016\/j.juro.2018.01.077","article-title":"Intake of Trace Metals and the Risk of Incident Kidney Stones","volume":"199","author":"Ferraro","year":"2018","journal-title":"J Urol"},{"key":"2026060207000977000_19.6.e272915.11","doi-asserted-by":"crossref","unstructured":"Cheraghian B , Meysam A , Hashemi SJ , et al . n.d. 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