Formal Name
Ceruloplasmin, serum
This article was last reviewed on
This article waslast modified on
May 25, 2018.
At a Glance
Why Get Tested?

To measure the amount of ceruloplasmin in the blood; to help diagnose Wilson disease; sometimes to help identify conditions associated with copper deficiencies

When To Get Tested?

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

Sample Required?

A blood sample drawn from a vein in your arm

Test Preparation Needed?

None

You may be able to find your test results on your laboratory's website or patient portal. However, you are currently at Lab Tests Online. You may have been directed here by your lab's website in order to provide you with background information about the test(s) you had performed. You will need to return to your lab's website or portal, or contact your healthcare practitioner in order to obtain your test results.

Lab Tests Online is an award-winning patient education website offering information on laboratory tests. The content on the site, which has been reviewed by laboratory scientists and other medical professionals, provides general explanations of what results might mean for each test listed on the site, such as what a high or low value might suggest to your healthcare practitioner about your health or medical condition.

The reference ranges for your tests can be found on your laboratory report. They are typically found to the right of your results.

If you do not have your lab report, consult your healthcare provider or the laboratory that performed the test(s) to obtain the reference range.

Laboratory test results are not meaningful by themselves. Their meaning comes from comparison to reference ranges. Reference ranges are the values expected for a healthy person. They are sometimes called "normal" values. By comparing your test results with reference values, you and your healthcare provider can see if any of your test results fall outside the range of expected values. Values that are outside expected ranges can provide clues to help identify possible conditions or diseases.

While accuracy of laboratory testing has significantly evolved over the past few decades, some lab-to-lab variability can occur due to differences in testing equipment, chemical reagents, and techniques. This is a reason why so few reference ranges are provided on this site. It is important to know that you must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

For more information, please read the article Reference Ranges and What They Mean.

What is being tested?

Ceruloplasmin is a copper-containing enzyme that plays a role in the body's iron metabolism. This test measures the amount of ceruloplasmin in the blood.

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.

Accordion Title
Common Questions
  • 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.

    Rarely, a ceruloplasmin test may be ordered with a copper test to help diagnose abnormalities in copper metabolism, copper deficiencies, or the rare inherited disorder Menkes kinky hair syndrome.

  • 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:

    • Anemia
    • Nausea, abdominal pain
    • Jaundice
    • Fatigue
    • Behavioral changes
    • Tremors
    • Difficulty walking and/or swallowing
    • Dystonia

    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?

    No. It is a specialized test that is not offered by every laboratory. Your blood sample may need to be sent to a reference laboratory.

  • Do I need to have a liver biopsy?
    If Wilson disease is strongly suspected based upon blood, urine, and imaging test results, a liver biopsy may be performed to evaluate hepatic copper content and the extent of liver damage.
View Sources

Sources Used in Current Review

(Updated 2014 July 23). Wilson Disease. National Institute of Diabetes and Digestive and Kidney Diseases [On-line information]. Available online at http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/wilson-disease/Pages/facts.aspx through http://www.niddk.nih.gov. Accessed December 2014.

Dugdale, D. (Updated 2013 February 2).Ceruloplasmin. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003662.htm through http://www.nlm.nih.gov. Accessed December 2014.

Strathmann, F. et. al. (Updated 2014 November). Wilson Disease. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/WilsonDz.html?client_ID=LTD through http://www.arupconsult.com. Accessed December 2014.

(© 1995–2014). Ceruloplasmin, Serum. Mayo Clinic Mayo Medical Laboratories [On-line information]. Available online at http://www.mayomedicallaboratories.com/test-catalog/Overview/8364 through http://www.mayomedicallaboratories.com. Accessed December 2014.

Johnson, L. (Revised 2013 April). Copper Deficiency and Toxicity. Merck Manual Professional Edition [On-line information]. Available online through http://www.merckmanuals.com. Accessed December 2014.

Gilroy, R. (Updated 2014 May 2). Wilson Disease. Medscape Drugs & Diseases [On-line information]. Available online at http://emedicine.medscape.com/article/183456-overview through http://emedicine.medscape.com. Accessed December 2014.

Lorincz, M. (2012). Recognition and Treatment of Neurologic Wilson's Disease. Medscape Multispecialty from Semin Neurol. 2012;32(5):538-543 [On-line information]. Available online at http://www.medscape.com/viewarticle/805129 through http://www.medscape.com. Accessed December 2014.

Sources Used in Previous Reviews

Clarke, W. and Dufour, D. R., Editors (2006). Contemporary Practice in Clinical Chemistry, AACC Press, Washington, DC. Christenson, R., Chapter 17, Proteins: Analysis and Interpretation in Serum, Urine, and Cerebrospinal Fluid. Pp. 197 - 210.

Cox, D. and Roberts, E. (2006 January 24). Wilson Disease. GeneReviews [On-line information]. Available online through http://www.genetests.org. Accessed on 7/17/07.

Thomas, Clayton L., Editor (1997). Taber's Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition]. Pp. 353.

(2007 January). Wilson's Disease Remains Difficult to Diagnose. Medscape from Reuters Health, from Gut 2007;56:115-120. [On-line information]. Available online at http://www.medscape.com/viewarticle/550386 through http://www.medscape.com. Accessed on 7/27/07.

Das, S. and Ray, K. (2006 October 13). Wilson's Disease: An Update. Medscape from Nature Clinical Practice Neurology [On-line information]. Available online at http://www.medscape.com/viewarticle/543866 through http://www.medscape.com. Accessed on 7/27/07.

Van Voorhees, B. (2007 January 22). Ceruloplasmin. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003662.htm. Accessed on 7/27/07.

Wu, A. (2006). Tietz Clinical Guide to Laboratory Tests, Fourth Edition. Saunders Elsevier, St. Louis, Missouri. Pp. 230 - 233.

Dugdale, D. (Updated 2009 February 23). Ceruloplasmin. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003662.htm. Accessed November 2010.

(© 1995-2010). Unit Code 8364: Ceruloplasmin, Serum. Mayo Clinic, Mayo Medical Laboratories [On-line information]. Available online at http://www.mayomedicallaboratories.com/test-catalog/Overview/8364 through http://www.mayomedicallaboratories.com. Accessed November 2010.

McMillin, G. and Roberts, W. (Updated 2010 May). Wilson Disease. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/WilsonDz.html?client_ID=LTD#tabs=0 through http://www.arupconsult.com. Accessed November 2010.

Mak, C. et. al. (2008 June 12). Diagnostic Accuracy of Serum Ceruloplasmin in Wilson Disease: Determination of Sensitivity and Specificity by ROC Curve Analysis among ATP7B-Genotyped Subjects. Clinical Chemistry. 2008;54:1356-1362 [On-line information]. Available online at http://www.clinchem.org/cgi/content/full/54/8/1356 through http://www.clinchem.org. Accessed November 2010.

Johnson, L. (Revised 2008 August). Copper. Merck Manual for Healthcare Professionals [On-line information]. Available online at http://www.merckmanuals.com/professional/sec01/ch005/ch005c.html?qt=wilson disease&alt=sh#sec01-ch005-ch005c-534 through http://www.merckmanuals.com. Accessed November 2010.

Wu, A. (© 2006). Tietz Clinical Guide to Laboratory Tests, 4th Edition: Saunders Elsevier, St. Louis, MO. Pp 230 - 233.

Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Burtis CA, Ashwood ER, Bruns DE, eds. St. Louis: Elsevier Saunders; 2006, Pp. 556 - 559.

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