EBM Consult

Lab Test: Ceruloplasmin (Serum) Level

    Lab Test
    • Ceruloplasmin
    • Serum Ceruloplasmin measurement
    • Measurement of Ceruloplasmin in serum for the evaluation and management of copper-related diseases.
    • This test is an acute-phase reactant protein and can indicate an acute illness.  However, its primary use is in the diagnosis of preclinical states of Wilson disease.
    Reference Range
    • Adults:  27-37 mg/dL (270-370 mg/L)
    • Infants, 1 day to 3 months:  5-18 mg/dL (50-180 mg/L)
    • Infants, 6 to 12 months:  33-43 mg/dL (330-430 mg/L)
    • Children, 13 to 36 months:  26-55 mg/dL (260-550 mg/L)
    • Children, 4 to 5 years:  27-56 mg/dL (270-560 mg/L)
    • Children, 6 to 7 years:  24-48 mg/dL (240-480 mg/L)
    • Children, older than 7 years:  20-54 mg/dL (200-540 mg/L)* (PDR)
    • Adults:  23-50 mg/dL (230-500 mg/L)
    • Neonates:  2-13 mg/dL (20 - 130 mg/L)
    Indications & Uses
    • Suspected copper deficiency - In Menke's disease, there is decreased copper absorption from the intestine, causing systemic copper and Ceruloplasmin deficiencies.
    • Suspected Wilson's disease - a low ceruloplasmin level cannot by itself establish the diagnosis of Wilson's disease, although it is generally considered the most useful screening test.
    Clinical Application

    Cp is an alpha2-globulin that binds copper for transport within the bloodstream after it is absorbed from the GI tract.  Patients who are homozygous for Wilson disease make very little Cp, which results in high unbound copper blood levels, which are toxic to tissues.  If this disease is identified before significant copper deposits affect major organs, the ravages of the disease can be avoided.  Early detection is important. 

    Serum ceruloplasmin levels measured immunochemically are almost always higher than levels measured enzymatically because immunologic methods measure the non-copper-bound apoproteins, which has no enzymatic activity, in addition to the copper-bound form.  The oxidase assay has a lower detection limit than the nephelometric assay. 

    Increased levels may indicate:

    • Pregnancy, thyrotoxicosis, cancer, acute inflammatory reaction (e.g., infection, rheumatoid arthritis), biliary cirrhosis, copper intoxication.

    Decreased levels may indicate:

    • Wilson disease, nephrotic syndrome, sprue, Kwashiorkor, starvation, Menkes (kinky hair) syndrome. 
    • Normal infants (6 months) usually are unable to make adequate amounts of acute-phase reactant proteins (alpha2-globulins) until they are 6 months of age.
    Related Tests
    • C-reactive protein - tests acute-phase reactant protein
    • Erythrocyte sedimentation rate - provides the same information as an acute-phase reactant protein
    Drug-Lab Interactions

    • Results increased in:  pregnancy, inflammation, tissue necrosis, trauma. 
    • Drugs that may cause increased levels include birth control pills, estrogen, methadone, phenytoin, and tamoxifen
    Test Tube Needed
    • Red top tube
    • Collect a venous blood sample.
    • Apply pressure or a pressure dressing to the venipuncture site and assess the site for bleeding. 
    • Medical follow-up and genetic counseling are indicated when Wilson disease is confirmed.
    Storage and Handling
    • May store at 4°C for 3 days or at -20°C for up to 4 weeks.
    What To Tell Patient Before & After
    • Explain the procedure to the patient.
    • Tell the patient that no fasting is required.
    • LaGow B et al., eds. PDR Lab Advisor. A Comprehensive Point-of-Care Guide for Over 600 Lab Tests.  First ed. Montvale, NJ: Thomson PDR; 2007.
    • Pagana K, Pagana TJ eds. Mosby's Manual of Diagnostic and Laboratory Tests. 5th Ed.  St. Louis

MESH Terms & Keywords

  • Ceruloplasmin