Ceruloplasmin
Ceruloplasmin is a copper-binding glycoprotein made by the liver. It carries about 90% of blood copper and is an acute-phase reactant (rises with inflammation). The main clinical use of ceruloplasmin is to screen for Wilson's disease — a treatable but potentially fatal genetic disorder of copper handling. Low ceruloplasmin with high urine copper in a young person with neurological, psychiatric, or liver symptoms should prompt urgent genetic and specialist evaluation.
Reference Ranges
Male
20 – 60
mg/dL
Female
20 – 60
mg/dL
Child
20 – 60
mg/dL
Reference ranges may vary by laboratory. Always compare with the range printed on your lab report.
What Low Levels Mean
Low ceruloplasmin is the hallmark of Wilson's disease — but only 90–95% of Wilson's patients have low levels. Other causes: advanced liver failure (reduced synthesis), severe malnutrition, nephrotic syndrome (urinary loss), Menkes disease (X-linked copper deficiency in infants), and very rare aceruloplasminemia. Wilson's workup also includes 24-hour urine copper, serum copper, and ophthalmologic exam for Kayser-Fleischer rings.
What High Levels Mean
Elevated ceruloplasmin is usually non-specific — it rises with inflammation, pregnancy, oral contraceptives and other estrogens, lymphoma, rheumatoid arthritis, and acute infection. Isolated high ceruloplasmin rarely changes clinical management. In the context of Wilson's workup, high ceruloplasmin makes Wilson's less likely but does not exclude it — heterozygous carriers and some Wilson's patients can have normal or even elevated levels.
Frequently Asked Questions
When should Wilson's disease be considered?
Any patient under 40 with unexplained liver disease, tremor, dystonia, Parkinsonism, behavioral or psychiatric changes, or a combination of hepatic and neurological features. Family history of early-onset neurological disease or liver failure also raises suspicion. Early diagnosis matters enormously — treatment with penicillamine, trientine, or zinc is highly effective if started before irreversible damage.
What is the full workup for Wilson's disease?
Ceruloplasmin, serum copper, 24-hour urinary copper, ophthalmologic slit-lamp exam for Kayser-Fleischer rings, liver enzymes, and liver biopsy for hepatic copper quantification in uncertain cases. ATP7B gene sequencing confirms the diagnosis. Screening of first-degree relatives is essential — presymptomatic treatment prevents disease.
Does normal ceruloplasmin rule out Wilson's disease?
Not entirely. Up to 10% of confirmed Wilson's patients have normal ceruloplasmin, especially during inflammation (which raises ceruloplasmin as an acute-phase reactant). If clinical suspicion is strong, full workup including 24-hour urine copper and ATP7B sequencing is needed regardless of ceruloplasmin level.
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mg/dLThis information is for educational purposes only and should not replace professional medical advice. Always consult your doctor for interpretation of your test results.
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