{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:37:07Z","timestamp":1787315827290,"version":"build-2736575974"},"reference-count":93,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Hematol. Rep.","Hematology Reports"],"abstract":"<jats:p>Zinc is an essential micronutrient involved in many physiological processes in the human body, including immune system regulation, cellular survival, neurologic function, and erythropoiesis. Zinc deficiency can result in a wide range of clinical manifestations, including impaired immune function, dermatologic findings, and decreased growth. Anemia has been reported as a hematologic manifestation of zinc deficiency and may be underrecognized in clinical practice. This narrative review examines the pathophysiology of zinc deficiency-associated anemia, highlighting zinc\u2019s role in erythropoiesis, heme biosynthesis, and red blood cell stability. It also outlines populations at increased risk for zinc deficiency, including patients with chronic kidney disease, sickle cell disease, malabsorptive disorders, chronic proton pump inhibitor use, and older adults. Emerging evidence suggests that zinc deficiency-associated anemia may represent a potentially modifiable contributor to anemia in selected at-risk populations, although the strength of evidence varies across clinical settings and study designs. Assessment of zinc status may be considered in patients with unexplained or refractory anemia and additional risk factors for deficiency. Further prospective studies are needed to clarify the role of zinc deficiency in anemia and define appropriate screening, supplementation, and monitoring strategies.<\/jats:p>","DOI":"10.3390\/hematolrep18040060","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T11:37:34Z","timestamp":1787312254000},"page":"60","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Narrative Review of Zinc Deficiency-Associated Anemia"],"prefix":"10.3390","volume":"18","author":[{"given":"Karina","family":"Basmajian","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Arrowhead Regional Medical Center, Colton, CA 92324, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9038-8752","authenticated-orcid":false,"given":"Aren","family":"Dermarderosian","sequence":"additional","affiliation":[{"name":"University of California, Davis, School of Medicine, Sacramento, CA 95817, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan Jeffrey","family":"Thoreson","sequence":"additional","affiliation":[{"name":"Southern Methodist University, Dallas, TX 75205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4503-2543","authenticated-orcid":false,"given":"Joshua","family":"Adams","sequence":"additional","affiliation":[{"name":"California University of Science of Medicine, Colton, CA 92324, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9651-9681","authenticated-orcid":false,"given":"Camron","family":"Farjami","sequence":"additional","affiliation":[{"name":"Palos Verdes Peninsula High School, Rolling Hills Estates, CA 90274, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9501-9226","authenticated-orcid":false,"given":"Austin","family":"Yang","sequence":"additional","affiliation":[{"name":"University of California, Berkeley, Berkeley, CA 94720, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elham","family":"Akhtari","sequence":"additional","affiliation":[{"name":"Department of Traditional Medicine, School of Persian Medicine, Iran University of Medical Sciences, Tehran 1449614535, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soha","family":"Araji","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Sharp Healthcare, San Diego, CA 92110, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziad","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Hematology\/Oncology, Arrowhead Regional Medical Center, Colton, CA 92324, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siamak","family":"Saadat","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Hematology\/Oncology, Arrowhead Regional Medical Center, Colton, CA 92324, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarkis","family":"Arabian","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Pulmonology\/Critical Care, Arrowhead Regional Medical Center, Colton, CA 92324, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Tansy","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Hematology\/Oncology, Arrowhead Regional Medical Center, Colton, CA 92324, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Knutzen","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Hematology\/Oncology, Arrowhead Regional Medical Center, Colton, CA 92324, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mojtaba","family":"Akhtari","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Transplantation, Cellular Therapy, and Hematological Malignancies, Loma Linda University School of Medicine, Loma Linda University Medical Center, Loma Linda, CA 92354, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1177\/0884533615570376","article-title":"Zinc: Physiology, deficiency, and parenteral nutrition","volume":"30","author":"Livingstone","year":"2015","journal-title":"Nutr. Clin. Pract."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"6843","DOI":"10.1073\/pnas.0502257102","article-title":"Interleukin-6 regulates the zinc transporter Zip14 in liver and contributes to the hypozincemia of the acute-phase response","volume":"102","author":"Liuzzi","year":"2005","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3137","DOI":"10.1073\/pnas.87.8.3137","article-title":"Interleukin 6 regulates metallothionein gene expression and zinc metabolism in hepatocyte monolayer cultures","volume":"87","author":"Schroeder","year":"1990","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1642","DOI":"10.1128\/MCB.17.3.1642","article-title":"Erythroid-cell-specific properties of transcription factor GATA-1 revealed by phenotypic rescue of a gene-targeted cell line","volume":"17","author":"Weiss","year":"1997","journal-title":"Mol. Cell. Biol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1002\/cbf.947","article-title":"Effect of vitamin C and zinc on osmotic fragility and lipid peroxidation in zinc-deficient haemodialysis patients","volume":"20","author":"Candan","year":"2002","journal-title":"Cell Biochem. Funct."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Kim, J., Lee, J., and Ryu, M.S. (2023). Cellular Zinc Deficiency Impairs Heme Biosynthesis in Developing Erythroid Progenitors. Nutrients, 15, Erratum in Nutrients 2025, 17, 2402. https:\/\/doi.org\/10.3390\/nu17152402.","DOI":"10.3390\/nu17152402"},{"key":"ref_7","unstructured":"Hashmi, M.F., Shaikh, H., and Rout, P. (2026, April 07). Anemia of Chronic Kidney Disease, StatPearls [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK539871\/."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"i18","DOI":"10.1093\/ndtplus\/sfn176","article-title":"Inflammation and its impact on anaemia in chronic kidney disease: From haemoglobin variability to hyporesponsiveness","volume":"2","author":"Stenvinkel","year":"2009","journal-title":"NDT Plus"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2128","DOI":"10.1080\/10408398.2015.1050483","article-title":"New perspectives on the regulation of iron absorption via cellular zinc concentrations in humans","volume":"57","author":"Knez","year":"2017","journal-title":"Crit. Rev. Food Sci. Nutr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"10815589261422251","DOI":"10.1177\/10815589261422251","article-title":"Zinc deficiency and chronic anemia: A retrospective analysis of zinc supplementation in populations with concurrent nutritional and clinical risk factors","volume":"Epub ahead of print","author":"Hagele","year":"2026","journal-title":"J. Investig. Med."},{"key":"ref_11","first-page":"15","article-title":"Study of Zinc Deficiency in Pregnant Women","volume":"33","author":"Salimi","year":"2004","journal-title":"Iran. J. Public Health"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"496","DOI":"10.4291\/wjgp.v5.i4.496","article-title":"Zinc and gastrointestinal disease","volume":"5","author":"Skrovanek","year":"2014","journal-title":"World J. Gastrointest. Pathophysiol."},{"key":"ref_13","first-page":"243","article-title":"Proton Pump Inhibitors Interfere with Zinc Absorption and Zinc Body Stores","volume":"4","author":"Farrell","year":"2011","journal-title":"Gastroenterol. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.jtemb.2014.10.003","article-title":"Genetic causes and gene\u2013nutrient interactions in mammalian zinc deficiencies: Acrodermatitis enteropathica and transient neonatal zinc deficiency as examples","volume":"29","author":"Kasana","year":"2015","journal-title":"J. Trace Elem. Med. Biol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"5246","DOI":"10.1182\/blood-2024-212285","article-title":"Identifying and Treating Zinc Deficiency Anemia in the Elderly","volume":"144","author":"Hagele","year":"2024","journal-title":"Blood"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"5210","DOI":"10.1182\/blood-2024-211692","article-title":"Zinc Deficiency Anemia Associated with Proton Pump Inhibition","volume":"144","author":"Hanson","year":"2024","journal-title":"Blood"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1017\/S1368980008002401","article-title":"Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993\u20132005","volume":"12","author":"McLean","year":"2009","journal-title":"Public Health Nutr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1016\/S2352-3026(23)00160-6","article-title":"Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990\u20132021: Findings from the Global Burden of Disease Study 2021","volume":"10","author":"Gardner","year":"2023","journal-title":"Lancet Haematol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"176","DOI":"10.3945\/an.112.003210","article-title":"Discovery of human zinc deficiency: Its impact on human health and disease","volume":"4","author":"Prasad","year":"2013","journal-title":"Adv. Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"679S","DOI":"10.3945\/ajcn.110.005744","article-title":"Zinc: An essential but elusive nutrient","volume":"94","author":"King","year":"2011","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"676","DOI":"10.3390\/nu4070676","article-title":"Zinc and regulation of inflammatory cytokines: Implications for cardiometabolic disease","volume":"4","author":"Foster","year":"2012","journal-title":"Nutrients"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Wessels, I., Maywald, M., and Rink, L. (2017). Zinc as a gatekeeper of immune function. Nutrients, 9.","DOI":"10.3390\/nu9121286"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"4841","DOI":"10.1073\/pnas.95.9.4841","article-title":"Regulation of the zinc transporter ZnT-1 by dietary zinc","volume":"95","author":"McMahon","year":"1998","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_24","first-page":"30761","article-title":"The acrodermatitis enteropathica gene ZIP4 encodes a metal-transporting protein","volume":"278","author":"Wang","year":"2003","journal-title":"J. Biol. Chem."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Geiser, J., De Lisle, R.C., and Andrews, G.K. (2012). Loss of intestine zinc transporter ZIP4 disrupts the regulation of zinc absorption and leads to rapid wasting in mice. PLoS Genet., 8.","DOI":"10.1371\/journal.pgen.1002766"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1111\/j.1651-2227.1995.tb13580.x","article-title":"Erythrocyte cupric\/zinc superoxide dismutase exhibits reduced activity in preterm and low-birthweight infants at birth","volume":"84","author":"Phylactos","year":"1995","journal-title":"Acta Paediatr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"79","DOI":"10.7150\/ijms.5291","article-title":"Effects of zinc supplementation on plasma copper\/zinc ratios, oxidative stress, and immunological status in hemodialysis patients","volume":"10","author":"Guo","year":"2013","journal-title":"Int. J. Med. Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3204","DOI":"10.1182\/blood-2006-06-027631","article-title":"Interleukin-6 induces hepcidin expression through STAT3","volume":"108","author":"Wrighting","year":"2006","journal-title":"Blood"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"28","DOI":"10.4103\/joah.joah_63_22","article-title":"Correlation of Erythroferrone and Hepcidin Hormones with Iron Status Levels in Patients with Iron Deficiency","volume":"14","author":"Bylappa","year":"2023","journal-title":"J. Appl. Hematol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Kondaiah, P., Yaduvanshi, P.S., Sharp, P.A., and Pullakhandam, R. (2019). Iron and zinc homeostasis and interactions: Does enteric zinc excretion cross-talk with intestinal iron absorption?. Nutrients, 11.","DOI":"10.3390\/nu11081885"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1080\/20009666.2017.1351289","article-title":"Copper deficiency, a new triad: Anemia, leucopenia, and myeloneuropathy","volume":"7","author":"Wazir","year":"2017","journal-title":"J. Community Hosp. Intern. Med. Perspect."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1097\/MOH.0b013e32834da9d2","article-title":"Update on anemia and neutropenia in copper deficiency","volume":"19","author":"Lazarchick","year":"2012","journal-title":"Curr. Opin. Hematol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"S44","DOI":"10.3177\/jnsv.61.S44","article-title":"Overview of Inherited Zinc Deficiency in Infants and Children","volume":"61","author":"Kambe","year":"2015","journal-title":"J. Nutr. Sci. Vitaminol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1352","DOI":"10.1039\/C7MT00162B","article-title":"The role of the zinc transporter SLC30A2\/ZnT2 in transient neonatal zinc deficiency","volume":"9","author":"Golan","year":"2017","journal-title":"Metallomics"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1016\/j.nut.2011.06.002","article-title":"Transient symptomatic zinc deficiency in a breast-fed infant: Relevance of a genetic study","volume":"27","author":"Monia","year":"2011","journal-title":"Nutrition"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1159\/000348261","article-title":"Update on zinc deficiency and excess in clinical pediatric practice","volume":"62","author":"Krebs","year":"2013","journal-title":"Ann. Nutr. Metab."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e3553","DOI":"10.1097\/MD.0000000000003553","article-title":"Acrodermatitis Enteropathica: A Case Report","volume":"95","author":"Nistor","year":"2016","journal-title":"Medicine"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Cui, W., Wang, N., Shi, M., Xu, X., and Jiang, H. (2025). Acrodermatitis enteropathica in the pediatric population: A literature review of real-world studies. Front. Nutr., 12.","DOI":"10.3389\/fnut.2025.1590075"},{"key":"ref_39","first-page":"e3811","article-title":"Association of Zinc Deficiency with Iron Deficiency Anemia and its Symptoms: Results from a Case-control Study","volume":"11","author":"Amer","year":"2019","journal-title":"Cureus"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1832","DOI":"10.1056\/NEJMra1401038","article-title":"Iron-deficiency anemia","volume":"372","author":"Camaschella","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_41","first-page":"205","article-title":"Serum zinc concentration decreases with age and is associated with anemia in middle-aged and elderly people","volume":"58","author":"Idei","year":"2010","journal-title":"Rinsho Byori"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"858S","DOI":"10.3945\/jn.115.220079","article-title":"Biomarkers of Nutrition for Development (BOND)-Zinc Review","volume":"146","author":"King","year":"2015","journal-title":"J. Nutr."},{"key":"ref_43","unstructured":"Baddam, S., Maxfield, L., Shukla, S., and Crane, J.S. (2025). Zinc Deficiency. StatPearls [Internet], StatPearls Publishing."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"17","DOI":"10.5144\/0256-4947.2006.17","article-title":"Zinc and antioxidant vitamin deficiency in patients with severe sickle cell anemia","volume":"26","author":"Hasanato","year":"2006","journal-title":"Ann. Saudi Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1093\/ajcn\/75.2.181","article-title":"Zinc deficiency in patients with sickle cell disease","volume":"75","author":"Prasad","year":"2002","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1093\/clinchem\/21.4.582","article-title":"Zinc deficiency in sickle cell disease","volume":"21","author":"Prasad","year":"1975","journal-title":"Clin. Chem."},{"key":"ref_47","unstructured":"Ofakunrin, A. (2026, April 03). Serum Zinc Status in Sickle Cell Anaemia Children at the Jos University Teaching Hospital, Jos, Nigeria. Available online: https:\/\/www.researchgate.net\/publication\/326212030_Serum_zinc_status_in_sickle_cell_anaemia_children_at_the_Jos_University_Teaching_Hospital_Jos_Nigeria."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"3023","DOI":"10.1182\/bloodadvances.2022008539","article-title":"Zinc for infection prevention in children with sickle cell anemia: A randomized double-blind placebo-controlled trial","volume":"7","author":"Namazzi","year":"2023","journal-title":"Blood Adv."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"2686","DOI":"10.1001\/jama.1979.03300240026019","article-title":"Zinc metabolism in sickle cell anemia","volume":"242","author":"Niell","year":"1979","journal-title":"JAMA"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2798","DOI":"10.4314\/ahs.v19i3.56","article-title":"Serum levels of copper, zinc and disease severity scores in sickle cell disease patients in Benin City, Nigeria","volume":"19","author":"Emokpae","year":"2019","journal-title":"Afr. Health Sci."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"126980","DOI":"10.1016\/j.jtemb.2022.126980","article-title":"Zinc in sickle cell disease: A narrative review","volume":"72","author":"Miranda","year":"2022","journal-title":"J. Trace Elem. Med. Biol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1002\/ajh.22012","article-title":"And the CURAMA Study Group (2011), Oxidative stress in sickle cell disease; pathophysiology and potential implications for disease management","volume":"86","author":"Nur","year":"2011","journal-title":"Am. J. Hematol."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Marreiro, D.D., Cruz, K.J., Morais, J.B., Beserra, J.B., Severo, J.S., and de Oliveira, A.R. (2017). Zinc and Oxidative Stress: Current Mechanisms. Antioxidants, 6.","DOI":"10.3390\/antiox6020024"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.trsl.2008.06.001","article-title":"Zinc supplementation decreases oxidative stress, incidence of infection, and generation of inflammatory cytokines in sickle cell disease patients","volume":"152","author":"Bao","year":"2008","journal-title":"Transl. Res."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"3213","DOI":"10.1007\/s00277-025-06429-4","article-title":"Zinc level and its impact on the phenotype of sickle cell disease","volume":"104","author":"Youssry","year":"2025","journal-title":"Ann. Hematol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"2251","DOI":"10.1093\/jn\/130.9.2251","article-title":"Prenatal Iron Supplements Impair Zinc Absorption in Pregnant Peruvian Women","volume":"130","author":"Zavaleta","year":"2000","journal-title":"J. Nutr."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Agedew, E., Tsegaye, B., Bante, A., Zerihun, E., Aklilu, A., Girma, M., Kerebih, H., Wale, M.Z., and Yirsaw, M.T. (2022). Zinc deficiency and associated factors among pregnant women\u2019s attending antenatal clinics in public health facilities of Konso Zone, Southern Ethiopia. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0270971"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"398","DOI":"10.34067\/KID.0007812021","article-title":"Zinc Deficiency: A Potential Hidden Driver of the Detrimental Cycle of Chronic Kidney Disease and Hypertension","volume":"4","author":"Ume","year":"2023","journal-title":"Kidney360"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1093\/ndt\/gfz065","article-title":"Renal handling of zinc in chronic kidney disease patients and the role of circulating zinc levels in renal function decline","volume":"35","author":"Damianaki","year":"2020","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Chen, Y.H., Feng, H.L., and Jeng, S.S. (2018). Zinc Supplementation Stimulates Red Blood Cell Formation in Rats. Int. J. Mol. Sci., 19.","DOI":"10.3390\/ijms19092824"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"353","DOI":"10.2119\/2008-00033.Prasad","article-title":"Zinc in human health: Effect of zinc on immune cells","volume":"14","author":"Prasad","year":"2008","journal-title":"Mol. Med."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1272","DOI":"10.1093\/ndt\/gfg074","article-title":"Oxidative stress in end-stage renal disease: An emerging threat to patient outcome","volume":"18","author":"Locatelli","year":"2003","journal-title":"Nephrol. Dial. Transpl."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"3783","DOI":"10.3390\/nu7053783","article-title":"Oral zinc supplementation reduces the erythropoietin responsiveness index in patients on hemodialysis","volume":"7","author":"Kobayashi","year":"2015","journal-title":"Nutrients"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"3827","DOI":"10.1182\/blood-2023-183066","article-title":"Hemoglobin Response to Zinc Supplementation in Chronic Kidney Disease in Patients with Zinc Deficiency and Anemia","volume":"142","author":"Hanson","year":"2023","journal-title":"Blood"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1046\/j.1365-2125.2003.02007.x","article-title":"Age-related changes in pharmacokinetics and pharmacodynamics: Basic principles and practical applications","volume":"57","author":"Mangoni","year":"2004","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_66","unstructured":"Ahmed, A., and Clarke, J.O. (2026, April 05). Proton Pump Inhibitors (PPI), StatPearls [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK557385\/."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Zupo, R., Sila, A., Castellana, F., Bringiotti, R., Curlo, M., De Pergola, G., De Nucci, S., Giannelli, G., Mastronardi, M., and Sardone, R. (2022). Prevalence of Zinc Deficiency in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis. Nutrients, 14.","DOI":"10.3390\/nu14194052"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1016\/j.mayocp.2018.11.036","article-title":"Micronutrient Deficiencies Are Common in Contemporary Celiac Disease Despite Lack of Overt Malabsorption Symptoms","volume":"94","author":"Bledsoe","year":"2019","journal-title":"Mayo Clin. Proc."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Soheilipour, F., Ebrahimian, M., Pishgahroudsari, M., Hajian, M., Amirkashani, D., Ordooei, M., Radgoodarzi, M., and Eskandari, D. (2021). The prevalence of zinc deficiency in morbidly obese patients before and after different types of bariatric surgery. BMC Endocr. Disord., 21.","DOI":"10.1186\/s12902-021-00763-0"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1097\/MPG.0b013e31826a105d","article-title":"Vitamin and mineral status in patients with inflammatory bowel disease","volume":"56","author":"Alkhouri","year":"2013","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1660","DOI":"10.1007\/s11695-010-0237-5","article-title":"Zinc deficiency: A frequent and underestimated complication after bariatric surgery","volume":"20","author":"Demarsy","year":"2010","journal-title":"Obes. Surg."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1007\/s12262-024-04082-1","article-title":"Zinc Deficiency After Bariatric Surgery: A Systematic Review and Meta-analysis","volume":"87","author":"Jiao","year":"2025","journal-title":"Indian J. Surg."},{"key":"ref_73","unstructured":"Ganipisetti, V.M., and Naha, S. (2023). Bariatric Surgery Malnutrition Complications. StatPearls [Internet], StatPearls Publishing."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"175","DOI":"10.3324\/haematol.2009.017046","article-title":"Pathogenesis and treatment of anemia in inflammatory bowel disease","volume":"95","author":"Weiss","year":"2010","journal-title":"Haematologica"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"5244","DOI":"10.1182\/blood-2024-212239","article-title":"Secondary Zinc Deficiency and Its Association with Chronic Anemia in Patients with Malnutrition or Prior Bowel Resection","volume":"144","author":"Hagele","year":"2024","journal-title":"Blood"},{"key":"ref_76","first-page":"46","article-title":"Zinc: A Review of Clinical Use and Efficacy","volume":"1","author":"Elgar","year":"2022","journal-title":"Nutr. Med. J."},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Devarshi, P.P., Mao, Q., Grant, R.W., and Mitmesser, S.H. (2024). Comparative Absorption and Bioavailability of Various Chemical Forms of Zinc in Humans: A Narrative Review. Nutrients, 16.","DOI":"10.3390\/nu16244269"},{"key":"ref_78","unstructured":"Office of Dietary Supplements (ODS), and National Institutes of Health (2026, April 05). Zinc\u2014Health Professional Fact Sheet. Provides Foundational Information on Zinc Forms Used in Supplements, Their Presence in OTC Products, and General Tolerability, Available online: https:\/\/ods.od.nih.gov\/factsheets\/Zinc-HealthProfessional\/."},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Fischer, P., Giroux, A., and L\u2019Abb\u00e9, M. The effect of dietary zinc on intestinal copper absorption. Am. J. Clin. Nutr., 34, 1670\u20131675.","DOI":"10.1093\/ajcn\/34.9.1670"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"217","DOI":"10.5045\/br.2016.51.4.217","article-title":"Copper deficiency mimicking myelodysplastic syndrome","volume":"51","year":"2016","journal-title":"Blood Res."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1093\/ajcn\/51.2.225","article-title":"Zinc toxicity","volume":"51","author":"Fosmire","year":"1990","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"2040S","DOI":"10.3945\/ajcn.2009.27230G","article-title":"Methods of assessment of zinc status in humans: A systematic review","volume":"89","author":"Lowe","year":"2009","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"S403","DOI":"10.1177\/15648265070283S303","article-title":"Use of serum zinc concentration as an indicator of population zinc status","volume":"28","author":"Hess","year":"2007","journal-title":"Food Nutr. Bull."},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"International Zinc Nutrition Consultative Group (IZiNCG) (2004). Assessment of the risk of zinc deficiency in populations. Food Nutr. Bull., 25, S130\u2013S162.","DOI":"10.1177\/15648265040251S205"},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"International Zinc Nutrition Consultative Group (IZiNCG) (2004). Overview of zinc nutrition. Food Nutr. Bull., 25, S99\u2013S130.","DOI":"10.1177\/156482650402500115"},{"key":"ref_86","first-page":"e778","article-title":"Methods of assessment of zinc status in humans: An updated review and meta-analysis","volume":"83","author":"Brazier","year":"2024","journal-title":"Nutr. Rev."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"1412","DOI":"10.1093\/jalm\/jfac079","article-title":"Relationship between Plasma Zinc and Red Blood Cell Zinc Levels in Hospitalized Patients","volume":"7","author":"Rodic","year":"2022","journal-title":"J. Appl. Lab. Med."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1146\/annurev.nu.05.070185.002013","article-title":"Clinical manifestations of zinc deficiency","volume":"5","author":"Prasad","year":"1985","journal-title":"Annu. Rev. Nutr."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1344S","DOI":"10.1093\/jn\/130.5.1344S","article-title":"Human zinc deficiency","volume":"130","author":"Hambidge","year":"2000","journal-title":"J. Nutr."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1093\/ajcn\/nqz304","article-title":"Adjusting plasma or serum zinc concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project","volume":"111","author":"McDonald","year":"2020","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"64","DOI":"10.3945\/ajcn.111.023812","article-title":"Quantitative data on the magnitude of the systemic inflammatory response and its effect on micronutrient status based on plasma measurements","volume":"95","author":"Duncan","year":"2012","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1093\/ajcn\/nqy052","article-title":"A comparison of methods for adjusting biomarkers of iron, zinc, and selenium status for the effect of inflammation in an older population: A case for interleukin 6","volume":"107","author":"MacDonell","year":"2018","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_93","unstructured":"(2026, April 12). Zinc Sulfate Injection, Available online: https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=4b528c88-07a0-4dce-84c6-ccd32555bbff."}],"container-title":["Hematology Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2038-8330\/18\/4\/60\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:14:44Z","timestamp":1787314484000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2038-8330\/18\/4\/60"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,21]]},"references-count":93,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["hematolrep18040060"],"URL":"https:\/\/doi.org\/10.3390\/hematolrep18040060","relation":{},"ISSN":["2038-8330"],"issn-type":[{"value":"2038-8330","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,21]]}}}