Ceruloplasmin - plasma or serum

5 mL blood in lithium heparin or plain tube.

150-450 mg/L

Infants <3 months: 50-180 mg/L.

Low levels are found in Wilson's disease but a normal level does not exclude this diagnosis. The molar copper/ceruloplasmin ratio is increased in Wilson’s disease due to increased albumin-bound copper.

Decreased ceruloplasmin levels occur in liver failure and in Menkes’ disease (where the copper/ceruloplasmin ratio is decreased).

Idiopathic hypoceruloplasminaemia occurs as a non-pathogenic genetic variant but aceruloplasminemia causes massive iron overload.

Increased levels may occur in pregnancy and in patients on oestrogen therapy. Levels are increased by estrogens, in an acute phase response and in liver disease and this may mask a deficiency state.

See also Copper - plasma or serum and Copper - urine.