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.

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.

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. 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.