Ceruloplasmin

What is ceruloplasmin?

Copper is a trace element you need for the enzymes that build in iron, make energy, build connective tissue and insulate nerves. Free copper is toxic, so your liver packs it up: it makes ceruloplasmin, loads six copper atoms onto it and sends it into your blood that way. About ninety percent of the copper in your blood is bound to this protein. Ceruloplasmin also does work of its own on the way: it converts iron into the form transferrin can pick up, and it captures radicals. That is why a copper value says nothing without ceruloplasmin alongside. If the liver makes less ceruloplasmin, total copper falls along while nothing is wrong with the store; if it makes more, with inflammation, the pill or a pregnancy, copper rises along without there being more copper. The two together show whether a change is about copper or about its transport, and the difference between the two, the free copper, is the value that counts in the rare Wilson's disease, in which copper piles up in the liver and brain. Your report shows ceruloplasmin in g/L. Normal is about 0.20 to 0.60 g/L, and the three labs publishing the value hold exactly the same band, which is rare on this site. A low value is the side to take seriously; a high one is usually inflammation.

Why is ceruloplasmin relevant?

Ceruloplasmin is a value you rarely need, and that makes the difference in two situations. The first is a copper deficiency, which develops insidiously in anyone who takes a lot of zinc for years, after stomach surgery or with a bowel disease, and which gives anaemia, few white cells and tingling and weakness in the legs that look like a B12 deficiency. A low copper with a low ceruloplasmin is then the answer, and stopping zinc or topping up copper the solution. The second is Wilson's disease, rare and inherited, in which the liver cannot excrete copper and it piles up in the liver, brain and eyes. It begins between the fifth and fortieth year with liver symptoms, trembling, stiffness or changes in mood and behaviour, and a low ceruloplasmin is the first clue. The disease is very treatable if it is found in time, and that is the reason a low ceruloplasmin in a young person with deviating liver values is not waved away. For anyone who is healthy, the value is mainly a footnote to copper: a high copper beside a high ceruloplasmin and a high CRP is inflammation, and a high copper on the pill is the pill. Without ceruloplasmin alongside you read copper wrongly.

Ceruloplasmin reference ranges

This is one of the few tests in this library where the labs publishing it hold exactly the same limits, so there is little to differ here. More important than the band is the company: always read ceruloplasmin beside copper, because without each other the two cannot be read, and beside CRP, because inflammation, the pill and a pregnancy lift the value without anything changing about your copper.

Ceruloplasmin high or low: what it means

A low value means your liver makes less ceruloplasmin, and the question is why. From common to rare: less production in the liver, through a copper deficiency with a bowel disease, after stomach surgery, with tube feeding or with severe malnutrition, or through a liver that makes less protein as a whole; a lot of zinc, from supplements or denture cream, which blocks the absorption of copper in the gut; and rarely Wilson's disease, in which a low ceruloplasmin goes with a low total copper, a high free copper and a lot of copper in the urine. A low ceruloplasmin with anaemia, few white cells or tingling in the legs is a copper deficiency until proven otherwise. A high value is almost always the acute phase. With an infection or an inflammation your liver makes more ceruloplasmin, like CRP, and then the copper in your blood rises along without there being more copper. The pill and a pregnancy lift the value through oestrogen, up to double, and that is not a finding. A high value without inflammation, pill or pregnancy is rare and belongs with a liver disease or a malignancy that drives the acute phase. What you do about it: with a low ceruloplasmin from zinc you stop the zinc supplement, and copper recovers in weeks to months; with a copper deficiency from the gut you top up copper under supervision, because too much is toxic. Copper from food sits in organ meat, shellfish, nuts, seeds, cocoa and whole grains. With a suspicion of Wilson's, investigation of free copper, copper in the urine and the eyes follows, and the treatment binds the copper away. With a high value from inflammation or the pill you need do nothing; measure again after recovery or without the pill if you want to know your copper. Set ceruloplasmin beside copper, because without each other they cannot be read, beside CRP, which says whether a high value is inflammation, and with a low value beside haemoglobin, white cells and zinc.

How does a ceruloplasmin blood test work?

Referral

Not needed. You can have ceruloplasmin measured yourself, always together with copper; apart from each other they say little.

Fasting

Not needed; the value does not move with food.

When

Not during or just after an infection, because inflammation lifts the value. Anyone on the pill knows the value sits higher.

The draw

One tube of blood from a vein in your arm. Copper and CRP come from the same draw, and with a low value haemoglobin, white cells and zinc.

Repeating

With a low value after three months without zinc or with copper topped up. With a high value after recovery from the inflammation, or without the pill. Otherwise not.

Where to draw

You can draw at 250+ locations near you, no referral needed. See the locations

Educational information only, not medical advice. Consult a healthcare professional for clinical decisions.