Specimen Collection

Sample stability:

• 8 day at 20-25 ^o C
• 2 weeks at 4-8 ^o C
• 1 year at -20 ^o C

4.5 mL Adult PST Plasma (Preferred)

5 mL Heparin Plasma

4 mL Plain Serum

3.5 mL SST Serum

2 mL Microsample Blood

0.5 mL Micro-PST Plasma

1 mL Paediatric 2xMicro-SST Serum
Reference Intervals

Reference Intervals:

Units: g/L

Male : 0.15-0.30

Female : 0.16-0.45

Uncertainty of measurement: 7%

Turnaround Time: Within 3 hours
Diagnostic Use and Interpretation

Ceruloplasmin is the major copper-containing protein in plasma, and accounts for >95% of plasma copper.

It is decreased in most cases of Wilson's disease. Traditionally 0.20g/L has been used as the diagnostic cut off for Wilson disease, however due to significant inter-assay difference between caeruloplasmin assays, a single cut off cannot be applied to all assays(2). Using our assay (Roche Cobas since 29 Apr 2019), the lower limits of normal are significantly lower compared to other assays, down to 0.15g/L.

A low ceruloplasmin concentration may also be found in nephrotic syndrome, protein-losing enteropathy, malnutrition, or severe liver disease from any cause.

Ceruloplasmin is an acute phase protein; it increases in response to inflammation and infection. It also increases increases in pregnancy, and with oral contraceptive use.

If Wilson's disease is suspected, the following tests should be performed:
- serum ceruloplasmin (low in Wilson's)
- serum copper (low)
- 24 hour urine copper (high)
- liver enzymes (high)
The final confirmatory test is to measure copper in a liver biopsy.

In children, it is difficult to collect accurate 24h urine samples, and it has been reported that the urine copper / zinc ratio in a morning spot urine sample is a useful screening test.

References:
1. Leitner-Ferenc V, Atamaniuk J, Jansen-Skoupy S, Stockelmeier B, Grohs K, Fodinger M. CLSI-Based Validation of Manufacturer-Derived Reference Intervals on the Cobas 8000 Platform. Lab Med. 2017;48(2):e30-e5.
2. Zegers I, Beetham R, Keller T, Sheldon J, Bullock D, MacKenzie F, et al. The importance of commutability of reference materials used as calibrators: the example of ceruloplasmin. Clin Chem. 2013;59(9):1322-9.
3. Wang et al. World J Pediatr 2010, Online First. www.wjpch.com

Contact Information

Emails to chemicalpathologist@adhb.govt.nz will receive priority attention from the on-call chemical pathologist.

If the query concerns a specific patient please include the NHI number in your email.

If email is not a suitable option, please contact the on-call chemical pathologist via Lablink (Auckland City Hospital ext. 22000 or 09-3078995).

Individual chemical pathologists may be contacted but will not be available at all times.

After-hours : contact Lablink (Auckland City Hospital ext. 22000 or 09-3078995) or hospital operator for on duty staff after hours.

Dr Samarina Musaad (Clinical Lead) : SamarinaM@adhb.govt.nz ext. 22402

Dr Cam Kyle: CampbellK@adhb.govt.nz ext 22052

Dr Weldon Chiu: WeldonC@adhb.govt.nz ext. 23427

Dr Campbell Heron: CHeron@adhb.govt.nz ext. 23427

Dr Sakunthala Jayasinghe: Sakunthala@adhb.govt.nz ext. 23427

Last updated at 15:26:00 06/01/2025