Ceruloplasmin

CPT: 82390
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Test Details

Use

Decreased in most instances of Wilson's disease (hepatolenticular degeneration); hence, ceruloplasmin is used in evaluation of chronic active hepatitis, cirrhosis, and other liver disease. In Wilson's disease, there is decreased ability to incorporate copper into apoceruloplasmin. As a result, free copper levels in plasma and in tissue, especially liver and brain, are greatly increased.

Should be considered in cases of central nervous system disease of obscure etiology. Neurological symptoms include problems of coördination.

Ceruloplasmin is low in Menkes kinky hair syndrome (In Menkes syndrome the defect is secondary to poor absorption and utilization of dietary copper.) and with protein loss such as the nephrotic syndromes, malabsorption, and with some cases of advanced liver disease in which decreases of serum proteins have occurred.

Ceruloplasmin is high in a variety of neoplastic and inflammatory states, since it behaves as an acute phase reactant, although levels rise more slowly than “acute phase reactants.” Increases are described with carcinomas, leukemias, Hodgkin's disease, primary biliary cirrhosis, and with SLE and rheumatoid arthritis. High levels occur in pregnancy, with estrogens, and with oral contraceptive use when the agent contains estrogen as well as progesterone. Increased with copper intoxication.

Limitations

A normal ceruloplasmin does not rule out Wilson's disease. Serum copper should be measured in addition.

Methodology

Immunologic

Reference Interval

See table.

Male

Range (mg/dL)

0 to 30 d

Not established

1 to 6 m

11.0−31.0

7 m to 12 y

18.0−35.0

>12 y

16.0−31.0

Female

Range (mg/dL)

0 to 30 d

Not established

1 to 6 m

11.0−31.0

>6 m

19.0−39.0

Additional Information

Ceruloplasmin is an α2-globulin containing copper. About 70% or more of total serum copper is associated with ceruloplasmin, 7% with a high MW protein, transcuprein, 19% with albumin, and 2% with amino acids.1

Laboratory parameters of Wilson's disease include decreased serum ceruloplasmin, decreased serum copper concentration, increased 24-hour urine copper excretion, increased liver copper concentration, and abnormal liver function studies. Demonstration of failure to incorporate radiolabeled copper into ceruloplasmin is the definitive test for Wilson's disease. Liver and CNS manifestations of Wilson's disease need not both be present. Kayser-Fleischer rings are extremely helpful findings.

Excessive therapeutic zinc may lead to block of intestinal absorption of copper and a copper deficiency syndrome characterized by hypochromic microcytic anemia with leukopenia/neutropenia and zero level of ceruloplasmin. A prolonged period of time may be required to eliminate the excess zinc, overcome the block of intestinal copper absorption and obtain increase in serum copper and ceruloplasmin levels.2

Specimen Requirements

Specimen

Serum (preferred) or plasma

Volume

1 mL

Minimum Volume

0.1 mL

Container

Red-top tube, gel-barrier tube, or green-top (heparin) tube

Collection

Draw blood in gel-barrier tube (preferred). Separate serum or plasma from cells within 45 minutes of collection. Transfer separated serum or plasma to a plastic transport tube.

Storage Instructions

Refrigerate

Stability Requirements

Temperature

Period

Room temperature

7 days

Refrigerated

14 days

Frozen

14 days

Freeze/thaw cycles

Stable x3

Causes for Rejection

Hemolyzed specimen; specimen with improper identification

Clinical Information

Footnotes

1. Barrow L, Tanner MS. Copper distribution among serum proteins in pediatric liver disorders and malignancies. Eur J Clin Invest. 1988 Dec; 18(6):555-560. 3147183
2. Hoffman HN II, Phyliky RL, Fleming CR. Zinc-induced copper deficiency. Gastroenterology. 1988 Feb; 94(2):508-512. 3335323

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
001560 Ceruloplasmin 2064-4 001560 Ceruloplasmin mg/dL 2064-4

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