Reviewer ’s report  
 
Title: Anemia following zinc treatment for  Wilson's disease:a case report and literature review  
 
Version: 1 Date: 16 Mar 2019  
 
Reviewer: Michael Schilsky  
 
Reviewer's report:  
 
Can et al re port on a case of anemia following high dose zinc therapy in a pediatric patient with 
Wilson disease. Reference 23 is used to justify the excessively high dosage of zinc used in this 
patient. Table 2 in this manuscript shows no difference in the efficacy o f conventional dosing 
and "high" dosing of zinc in select pediatric patients. In fact, the conclusion of this paper is that 
there is no difference in outcome for the high and normal zinc dosing.   
Therefore you cannot exclude that the higher dosage of zinc  used in this paper might have been 
the cause of the rapid onset of anemia.  Furthermore, it may have led to the reported GI side 
effects noted.   
 
While the other changes improve the quality of the case report and discussion, the reporting of 
the case in the current manner appears to sanction the use of the high dose zinc regimen, which 
was previously unfounded and may have even been harmful in this instance.  This is a major 
stumbling block for this reviewer with respect to consideration of this manuscrip t as suitable for 
general audiences who may not know the literature as well.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in t he manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of wr itten English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content o f the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any  non-financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on  the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license  (http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Anemia following zinc treatment for  Wilson's disease:a case report and literature review  
 
Version: 1 Date: 16 Mar 2019  
 
Reviewer: Michael Schilsky  
 
Reviewer's report:  
 
Can et al re port on a case of anemia following high dose zinc therapy in a pediatric patient with 
Wilson disease. Reference 23 is used to justify the excessively high dosage of zinc used in this 
patient. Table 2 in this manuscript shows no difference in the efficacy o f conventional dosing 
and "high" dosing of zinc in select pediatric patients. In fact, the conclusion of this paper is that 
there is no difference in outcome for the high and normal zinc dosing.   
Therefore you cannot exclude that the higher dosage of zinc  used in this paper might have been 
the cause of the rapid onset of anemia.  Furthermore, it may have led to the reported GI side 
effects noted.   
 
While the other changes improve the quality of the case report and discussion, the reporting of 
the case in the current manner appears to sanction the use of the high dose zinc regimen, which 
was previously unfounded and may have even been harmful in this instance.  This is a major 
stumbling block for this reviewer with respect to consideration of this manuscrip t as suitable for 
general audiences who may not know the literature as well.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in t he manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of wr itten English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content o f the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any  non-financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on  the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license  (http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Anemia following zinc treatment for  Wilson's disease:a case report and literature review  
 
Version: 1 Date: 16 Mar 2019  
 
Reviewer: Michael Schilsky  
 
Reviewer's report:  
 
Can et al re port on a case of anemia following high dose zinc therapy in a pediatric patient with 
Wilson disease. Reference 23 is used to justify the excessively high dosage of zinc used in this 
patient. Table 2 in this manuscript shows no difference in the efficacy o f conventional dosing 
and "high" dosing of zinc in select pediatric patients. In fact, the conclusion of this paper is that 
there is no difference in outcome for the high and normal zinc dosing.   
Therefore you cannot exclude that the higher dosage of zinc  used in this paper might have been 
the cause of the rapid onset of anemia.  Furthermore, it may have led to the reported GI side 
effects noted.   
 
While the other changes improve the quality of the case report and discussion, the reporting of 
the case in the current manner appears to sanction the use of the high dose zinc regimen, which 
was previously unfounded and may have even been harmful in this instance.  This is a major 
stumbling block for this reviewer with respect to consideration of this manuscrip t as suitable for 
general audiences who may not know the literature as well.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in t he manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of wr itten English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content o f the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any  non-financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on  the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license  (http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant