When you have jaundice, fatigue, abdominal pain, behavioral changes, tremors, or other symptoms that a health practitioner thinks may be due to Wilson disease or, rarely, to copper deficiency; at intervals when monitoring is recommended
A blood sample drawn from a vein in your arm
Copper is an essential mineral that plays a role in the regulation of iron metabolism, formation of connective tissue, energy production at the cellular level, and the function of the nervous system. It is absorbed from food and liquids by the intestines and then transported to the liver, where it is stored or used to produce a variety of enzymes.
The liver binds copper to a protein to produce ceruloplasmin and then releases it into the bloodstream. About 95% of the copper in the blood is bound to ceruloplasmin. Because of this, the ceruloplasmin test can be used along with one or more copper tests to help diagnose Wilson disease, an inherited disorder that can lead to excess storage of copper in the liver, brain, and other organs.
How is the sample collected for testing?
A blood sample is obtained by inserting a needle into a vein in the arm.
Is any test preparation needed to ensure the quality of the sample?
No test preparation is needed.
How is it used?
Ceruloplasmin testing is used primarily, along with blood and/or urine copper tests, to help diagnose Wilson disease, a rare inherited disorder associated with excess storage of copper in the liver, brain, and other organs, and with decreased levels of ceruloplasmin.
Copper is an essential mineral that performs vital roles in the body. About 95% of the copper in the blood is bound to ceruloplasmin. Only a small amount of copper is normally present in the blood in a free (unbound) state. For more information, read the "What is being tested?" section.
When is it ordered?
A ceruloplasmin test may be ordered alone or along with blood and 24-hour urine copper tests when someone has signs and symptoms that a health practitioner suspects may be due to Wilson disease, such as:
- Nausea, abdominal pain
- Behavioral changes
- Difficulty walking and/or swallowing
Rarely, ceruloplasmin may also be ordered along with copper tests when a health practitioner suspects that someone has a copper deficiency. Ceruloplasmin may be ordered periodically to monitor those with excess or deficient copper and periodically to evaluate the effectiveness of treatment.
What does the test result mean?
Ceruloplasmin levels are not diagnostic of a specific condition and are usually evaluated along with copper tests.
Test results may include:
Test Wilson Disease Copper Toxicity Menkes Disease (Kinky Hair Syndrome) Copper Deficiency Copper, blood Low but may be normal High Low Low Copper, serum free High High Low Low Ceruloplasmin Low but may be normal High Low Low Copper, urine Very high High Low Low Copper, liver/hepatic* Positive but, depending on the site sampled, may be negative High or normal Low Low
*Excess copper in the liver is often unevenly distributed and may not be detected in a sample.
- Decreased ceruloplasmin and blood copper concentrations and increased urine copper levels may indicate Wilson disease.
- About 5% of people with Wilson disease who have neurological symptoms will have normal ceruloplasmin levels as will up to 40% of those with hepatic symptoms, especially if they are acutely ill.
- If ceruloplasmin and urine and/or blood copper concentrations are low, then the person tested may have a copper deficiency.
- Anything that interferes with the supply of copper or with the body's ability to metabolize copper has the potential to affect blood ceruloplasmin and copper concentrations.
Is there anything else I should know?
Ceruloplasmin may be increased in a variety of circumstances where the test is not used as a clinical tool. However, these conditions can affect interpretation of the test and the ability to recognize Wilson disease or copper deficiency. These may include the following:
- Ceruloplasmin is an acute phase reactant. It is frequently elevated when someone has inflammation, severe infection, tissue damage, and may be increased with some cancers.
- It may be increased during pregnancy and with the use of estrogen, oral contraceptives, and medications such as carbamazepine, phenobarbital, and valproic acid.
Should everyone have a ceruloplasmin test?
Ceruloplasmin is not a routine test. Unless your healthcare provider suspects that you have Wilson disease or a problem with your copper metabolism, it is unlikely that you will ever have this test performed.
Can I have the ceruloplasmin test done in my healthcare provider's office?
Do I need to have a liver biopsy?