Ceruloplasmin test: what the result means

Ceruloplasmin is a protein made in the liver, and most of the copper present in the blood binds to it. It not only carries copper but also takes part in iron metabolism and acts as an antioxidant. A ceruloplasmin test is most often done together with the amount of copper in the blood or urine, when a disorder of copper metabolism is suspected — especially Wilson’s disease, a rare inherited disorder. Because of it the body cannot remove excess copper, so it builds up in the liver and in other organs. Ceruloplasmin is also an acute-phase protein — its level in the blood can rise temporarily during an infectious illness, with inflammation or with tissue damage, so a single raised result cannot be adequately assessed without clinical context. A low ceruloplasmin together with a low copper level and characteristic symptoms is one of several tests used to diagnose Wilson’s disease.

• When Wilson’s disease is suspected — most often together with a test for the amount of copper in the blood or urine
• When there is unexplained liver disease, especially at a younger age
• When neurological or psychiatric symptoms appear without a clear cause (tremor, difficulty with speech or coordination, changes in behaviour)
• When an eye examination finds a Kayser-Fleischer ring (a copper-stained rim of the iris)
• When a disorder of copper or iron metabolism is suspected and other tests are unclear
• To monitor the course of treatment of already diagnosed Wilson’s disease

A raised ceruloplasmin is most often associated with inflammation or infection, because it is an acute-phase protein. Other causes are pregnancy, the use of hormonal contraceptives or oestrogens, some cancers (breast cancer, lymphoma), rheumatoid arthritis, heart disease and hyperthyroidism. The result should be discussed with a doctor together with other tests.

What can raise ceruloplasmin

• An acute or chronic infection, inflammation or tissue damage — ceruloplasmin rises as an acute-phase protein
• Pregnancy
• The use of hormonal contraceptives or oestrogens
• Cancers — breast cancer, lymphoma
• Rheumatoid arthritis
• Heart disease, including a heart attack
• Hyperthyroidism (an overactive thyroid)

What is usually assessed alongside a raised result

• Whether there was any infection, inflammation or tissue damage at the time of the test
• Whether hormonal contraceptives or oestrogen preparations are being taken, or whether there is a pregnancy
• Liver and thyroid markers, if further questions arise
• When to repeat the test, so that the change over time can be seen

A low ceruloplasmin is one of the markers used to suspect Wilson’s disease — an inherited disorder of copper metabolism. Other causes are chronic liver disease, intestinal absorption disorders, an inadequate diet, Menkes syndrome and nephrotic syndrome. The result is always assessed together with the amount of copper in the blood or urine.

What can lower ceruloplasmin

• Wilson’s disease — an inherited disorder of copper building up in the body
• Chronic liver disease
• Intestinal absorption disorders (malabsorption)
• An inadequate diet associated with copper deficiency
• Menkes syndrome
• Nephrotic syndrome

What is usually assessed alongside a low result

• The amount of copper in the blood and urine — together with ceruloplasmin it helps to assess copper metabolism
• Liver markers and, if needed, an eye examination for a Kayser-Fleischer ring
• Family history of inherited disorders of copper metabolism
• A further consultation with a doctor about the possible diagnosis of Wilson’s disease