Ceruloplasmin Test

Ceruloplasmin is a protein synthesised by your liver. It stores the mineral copper in the liver and carries it around your body, from the liver to other organs via the bloodstream. Ceruloplasmin carries about 65% to 90% of the total copper found in the blood.

Copper is essential for various processes in your body. It helps build strong bones, produces energy and makes melanin. Your liver transfers the copper from your blood into ceruloplasmin proteins. This copper-containing ceruloplasmin is then released into your blood plasma. The copper is carried around by ceruloplasmin in the blood to all other tissues in your body. A deficiency or excess of copper in your body can be fatal for you.

The Ceruloplasmin Test measures the levels of the copper-containing protein, ceruloplasmin, in blood. This Ceruloplasmin Test helps diagnose Wilson disease and other conditions caused by a copper deficiency or copper toxicity.

Wilson disease is a rare form of genetic disorder that stops your body from getting rid of excess copper. The liver is unable to send excess copper into your bowel for excretion. Instead, the excess copper gets accumulated in your liver and overflows into the bloodstream. This excess copper then builds up in your brain, corneas, liver, kidneys, bones and near the thyroid. If left untreated, copper poisoning from Wilson disease can be fatal.

People with Wilson disease should avoid foods rich in copper like liver, shellfish, nuts, mushrooms and chocolate.

The Ceruloplasmin Test is advised in people who complain of the following symptoms like:

• Trouble while speaking or swallowing
• Tremors
• Lack of coordination
• Stiff muscles
• Changes in behaviour
• Swollen liver or spleen
• Yellowing of the skin and eyes (jaundice)
• Fluid build-up in the legs and belly
• Extreme tiredness
• Lots of bruising
• Anaemia
• Low platelet levels
• Low white blood cell counts
• Slow blood clotting
• Osteoporosis and arthritis
• High amounts of amino acids, protein, uric acid and carbohydrates in the urine

​​Studies show that Ceruloplasmin Test levels of more than 20 mg/dL help rule out Wilson disease. However, low levels of ceruloplasmin may be seen in 45% of Indian children without Wilson Disease. The Ceruloplasmin Test helps diagnose Wilson disease in 93% of cases when ceruloplasmin levels are < 10 mg/dL and in 100% cases with ceruloplasmin levels of < 5 mg/dL.

Wilson Disease, Conditions associated with copper deficiencies

The Ceruloplasmin Test measures the level of ceruloplasmin in the blood. Ceruloplasmin is a protein that carries copper from the liver to all other parts of your body. Copper helps build bones, produce energy and produce melanin (a substance that gives your body colour). In the absence of ceruloplasmin, copper cannot be carried around in the blood, resulting in copper toxicity in the body.

The Ceruloplasmin Test is prescribed for adults of both genders.

This test is prescribed in the following cases:

Symptoms of Wilson disease  

If you experience the following symptoms, your doctor may advise you to get the Ceruloplasmin Test done.

• Anaemia
• Jaundice (yellowing of the skin and eyes)
• Nausea
• Abdominal pain
• Trouble swallowing and/or speaking
• Tremors
• Trouble walking
• Changes in behaviour
• Involuntary muscle contractions that are persistent and cause repetitive or twisting motions (dystonia)
• Diarrhoea and vomiting
• Dark brown rings around your eyes (iris and cornea) (Kayser-Fleischer rings).
• High levels of amino acids in your urine
• Haemolytic anaemia
• Low copper levels in your blood
• High copper levels (> 40 mcg per day) in your 24-hour urine sample

Symptoms of copper deficiency

If you experience any of the following symptoms, your doctor may advise Ceruloplasmin Test.

• Pale skin
• Osteoporosis, a condition that causes weak bones and makes them prone to fractures.
• Abnormally low levels of white blood cells.
• Fatigue
• Tingling in hands and feet.

Symptoms of Menkes Syndrome

If your child has any of the following symptoms during infancy, your doctor may advise getting the Ceruloplasmin Test done.

• Brittle hair
• Sparse hair
• Tangled hair
• Feeding difficulties
• Failure to grow
• Developmental delays
• Lack of muscle tone
• Seizures

Your doctor may repeat the Ceruloplasmin Test based on your diagnosis and symptoms. If you start your treatment for excess or deficiency of copper in your blood, then the Ceruloplasmin Test may be repeated every 3-4 months to check if the treatment is working. Regular monitoring and testing allow your doctor to check the prognosis of your disease and how you are responding to the treatment.

In addition, follow-up tests of Ceruloplasmin Test help provide detailed information about the severity of the disease and how the disease has progressed over time.

Before the Test

The Ceruloplasmin Test requires a blood sample. It does not require any special preparation. However, if you are getting other blood tests done along with the Ceruloplasmin Test, you may be asked to not eat or drink anything for 10-12 hours based on the tests like lipid profile, etc. This test does not require any preparation from your end.

During the Test

It is a simple blood test that will get over in 5-10 minutes. You do not need to prepare for the test in any way.

After the Test

There are no restrictions after the Ceruloplasmin Test. Therefore, you can resume regular activity after the test.

The parameters included in the Ceruloplasmin Test are the measures of the levels of ceruloplasmin, a copper-containing protein, in the blood. If your doctor orders for other tests like liver function tests, genetic testing, MRI scan or a CT scan, then you may get to see all parameters of your liver function.

The Ceruloplasmin Test results are usually reported in milligrams per deciliter (mg/dL). If you have gotten other liver function tests done, you will get the reports of all parameters.

The Ceruloplasmin Test results give you a report of the abnormal levels of ceruloplasmin in the blood.

The normal values and reference ranges of the test may vary from lab to lab. Please refer to the ranges mentioned in the report and consult a doctor to understand the interpretation of lab reports.

Low ceruloplasmin levels indicate that your body is unable to use or eliminate copper properly. This can be seen in people with:

• Wilson disease
• Menkes syndrome - a disease where your body cells are able to absorb copper but are unable to release it.
• Liver disorders
• Liver failure
• Liver cirrhosis
• Malnutrition
• Malabsorption - a condition where your body has difficulty in absorbing nutrients and other substances from your intestines.
• Kidney disease
• Nephrotic syndrome - a condition that leads to increased protein in the urine, low protein in the blood and increased triglyceride and cholesterol levels.

High ceruloplasmin levels can be seen in people with:

• Heart disorders
• Rheumatoid arthritis
• Leukaemia
• Hodgkin lymphoma
• Serious infections
• Breast cancer
• Overactive thyroid
• Primary biliary cholangitis (damaged liver bile ducts)
• Systemic lupus erythematosus (SLE)

The Ceruloplasmin Test results can be affected due to:

• Pregnancy
• Oestrogen therapy
• Birth control pills
• Infections causing inflammation
• Injury
• Trauma

Based on your Ceruloplasmin Test results, the doctor may require some other tests from the liver profile to confirm the clinical diagnosis.