Copper (Cu) Test

Copper is required for the normal functioning of the human body indirectly. Copper is incorporated with body enzymes as an essential mineral. These Enzymes responsible for maintaining iron metabolism need this mineral to work properly. It also helps in energy manufacturing within cells, the development of connective tissue, melanin formation and regulating functions of the nervous system.

The average adult’s body has about 50 - 120 mg of copper stored in it. Around 95% of it is found bound to ceruloplasmin and is found in the blood. The remaining 5% is bound with other albumin-like proteins. The liver plays an important role in maintaining the copper levels in the body. It stores some amount of this mineral, binds the rest to protein and flushes the excess into the bile, which gets removed as either stool or urine.

Excess or deficiency of copper can affect all the above-mentioned functions of the body and, if not treated on time, can cause severe manifestations of diseases. This is why when a person shows symptoms like fatigue, abdominal pain, tremors or any other behavioural change, they are advised to take the copper test. A blood or urine sample is taken to check if a person has any copper deficiency or excessiveness. If test results show higher copper levels than normal, doctors may conduct a liver biopsy to confirm any abnormality in the patient's body.

Doctors recommend copper testing when a person has Wilson disease, a rare genetic disorder that may cause excess deposition of copper in the brain, liver, eyes, etc. Patients with jaundice are also recommended for this test. In India, it has been observed that 29% to 34% of the population (mostly consisting of pregnant women and tribal groups) face copper deficiency.

Other names of Copper Test

• Copper plasma test
• Copper serum test
• Urine Copper
• Blood Copper
• Free Copper
• Hepatic Copper

What does the copper test detect or measure and who is this prescribed for?

The test is prescribed to detect a copper deficiency or excess and specifically Wilson's disease.

A person can experience the below-mentioned symptoms when having a higher level of copper (excess copper storage or copper poisoning) in the body:

• Anaemia
• Nausea
• Abdominal pain
• Jaundice (yellowing of skin and eyes)
• Fatigue
• Behavioural changes such as feeling anxious or irritable
• Tremors
• Difficulty in walking
• Dystonia (continuous involuntary muscle contractions causing consistent or twisting movements)
• Diarrhoea and vomiting
• Problems in swallowing or speaking
• Kayser-Fleischer rings (brown rings in the eyes)

Symptoms of a lower level of copper (Copper deficiency) in the body are as follows:

• Unusually lower neutrophils (a type of white blood cell)
• Osteoporosis
• Anaemia
• Delayed or slow growth in children
• Abnormal neurological symptoms

The symptoms mentioned above aren’t inclusive, hence, they may include other related symptoms which are connected to a copper imbalance in the opinion of the doctor.

The copper test, amongst other tests, is prescribed by the consulting doctor to individuals having or suffering from any of the symptoms mentioned above.

Once the individual is diagnosed with copper deficiency or copper toxicity, the doctor will order further tests as the copper imbalance doesn’t determine any specific disease. Copper imbalance in the body is an indication of a need for further investigation of the category of the disease. After running other related tests and analysing the test reports, the doctor will start the medication.

During the treatment, the doctor may order other related tests to monitor the person’s health and regulate the dosage. The doctor will determine the medication and continue the treatment or modify the current dosage based on the test results.

Copper normal ranges are given below:

During pregnancy and due to the intake of oral contraceptives, both ceruloplasmin and copper levels increase.

• Low blood copper levels with high urine copper concentration, low ceruloplasmin and increased hepatic copper are generally indications of Wilson disease. But, whether you’re Wilson’s disease positive/negative depends upon further tests and not specifically on the copper test.
• Increased blood and urine copper levels with normal or increased ceruloplasmin levels may indicate copper toxicity. This interpretation of the copper test means that your body has excess copper. It may also be an indicator of conditions that decrease copper excretion, such as chronic liver disease or acute hepatitis.
• Low levels of blood and urine copper concentrations and high ceruloplasmin levels may indicate copper deficiency.
• If a person is on medications - bind copper (chelators) for Wilson disease or copper toxicity, then their 24-hour urine copper levels may be high until body copper stores decrease.
• If the person is taking medicines for managing copper deficiency and his/her ceruloplasmin and total copper levels rise, then such a condition is associated with the normal response to the treatment.

The copper test’s results depend on the analysis of a blood or 24-hour urine sample. Initially, a blood sample is taken; however, a 24-hour urine test might be done depending on the observations and advice of the Doctor.

Test Preparation

There is no fasting or any other specific preparation required for the copper test. The blood sample is collected usually from the person's forearm vein. A 24-hour urine sample may also be collected with or without the blood sample. Precaution must be taken to not contaminate the sample.

The copper test procedure of collection of a sample may last for 5 minutes. The second test is ordered to confirm the results or findings of the first test. The concerned doctor may ask you to repeat the urine or blood copper test if the test results of the first or previous test are higher than expected.

For further diagnoses or investigations, healthcare experts may run a liver biopsy.

Test inclusions: What parameters are included?

The parameter included under the copper test is the total quantity of copper present in the blood, urine or liver (hepatic).

The results of the copper test show the level of copper in the blood, liver or urine. The test primarily diagnoses Wilson’s disease and sometimes excess copper storage or copper poisoning. The copper test report expresses the result in high/low form. The test diagnoses the disease based on the copper values in blood or (and) urine and ceruloplasmin levels.

A low range of ceruloplasmin may mean that your body is unable to use or eliminate excess copper. Higher ceruloplasmin level than the normal range is a sign of a serious infection, heart disease, rheumatoid arthritis, leukaemia, Hodgkin lymphoma, etc. However, ceruloplasmin level also increases during pregnancy or due to the use of birth control pills

How frequently should you take this test?

If the copper test results are abnormally higher, the healthcare expert can conduct a second test. Depending on the doctors' advice, one or more of the copper tests may be prescribed a period after the medication has been started.

And if the copper test reports confirm copper deficiency or excess, further tests can be ordered by the doctor for further diagnosis.

Wilson disease, Copper deficiency or excess, Menkes kinky hair syndrome