Test Catalog

Test ID: CERS    
Ceruloplasmin, Serum

Useful For Suggests clinical disorders or settings where the test may be helpful

Investigation of patients with possible Wilson disease

Testing Algorithm Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

See Wilson Disease Testing Algorithm in Special Instructions.

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Ceruloplasmin is a positive acute-phase reactant and a copper-binding protein that accounts for over 95% of serum copper in normal adults. Ceruloplasmin is measured primarily to assist with a diagnosis of Wilson disease. Other indications include Menkes disease, dietary copper insufficiency, and risk of cardiovascular disease.


Wilson disease is a rare inherited disorder of copper transport that results in low serum copper and ceruloplasmin and accumulation of copper in various tissues. The pathological accumulation of copper in the liver, brain, cornea, and kidney causes cirrhosis, neuropsychiatric symptoms, Kayser-Fleischer rings, and hematuria/proteinuria, respectively. See Wilson Disease Testing Algorithm in Special Instructions for appropriate use of clinical findings, serum biomarkers, genetic tests, and tissue biopsies when working up suspected cases.


Menkes disease is an X-linked disorder in which dietary copper is absorbed from the gastrointestinal tract but cannot be transported, so copper is not available to the liver for incorporation into ceruloplasmin.


Dietary ceruloplasmin deficiency may be due to inadequate dietary copper intake, long-term parenteral nutrition without copper supplementation, malabsorption, penicillamine therapy, or a combination of these.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.


0-8 weeks: 7.4-23.7 mg/dL

9 weeks-5 months: 13.5-32.9 mg/dL

6-11 months: 13.7-38.9 mg/dL

12 months-7 years: 21.7-43.3 mg/dL

8-13 years: 20.5-40.2 mg/dL

14-17 years: 17.0-34.8 mg/dL

> or =18 years: 19.0-31.0 mg/dL



0-8 weeks: 7.4-23.7 mg/dL

9 weeks-5 months: 13.5-32.9 mg/dL

6-11 months: 13.7-38.9 mg/dL

12 months-7 years: 21.7-43.3 mg/dL

8-13 years: 20.5-40.2 mg/dL

14-17 years: 20.8-43.2 mg/dL

> or = 18 years: 20.0-51.0 mg/dL

Interpretation Provides information to assist in interpretation of the test results

Low concentrations of ceruloplasmin are consistent with Wilson disease and warrant further investigation according to the recommended algorithm; see Wilson Disease Testing Algorithm in Special Instructions.


Ceruloplasmin is a positive acute-phase reactant. Increases in serum ceruloplasmin have been reported during pregnancy, in women taking oral contraceptives, in hepatitis, pneumonia, tuberculosis, rheumatoid arthritis, myocardial infarction, various forms of anemia, and many obscure neurological disorders.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Ceruloplasmin is a positive acute-phase reactant; therefore, levels are elevated in cases of inflammation (as in chronic hepatitis or active infection). Consequently, ceruloplasmin levels are not always extremely low in patients with Wilson disease.


Values vary considerably from patient to patient and may be in the normal range in some patients with Wilson disease (indicating a different primary defect).


Birth control pills and pregnancy increase ceruloplasmin levels.

Clinical Reference Recommendations for in-depth reading of a clinical nature

1. Wilson Tang WH, Wu Y, Hartiala J, et al: Clinical and genetic association of serum ceruloplasmin with cardiovascular risk. Arterioscler Thromb Vasc Biol. 2012 Feb;32(2):516-522

2. Dadu RT, Dodge R, Nambi V, et al: Ceruloplasmin and heart failure in the Atherosclerosis Risk in Communities study. Circ Heart Fail. 2013 Sep 1;6(5):936-943

3. Cox DW, Tumer Z, Roberts EA: Copper transport disorders: Wilson's disease and Menkes disease. Inborn Metabolic Disease. Fernandes J, Sandubray JM, VandenBerghe F, eds. Springer-Verlag; 2000:385-391

4. Sontakke AN, More U: Changes in serum ceruloplasmin levels with commonly used methods of contraception. Indian J Clin Biochem. 2004 Jan:19(1):102-104

5. Schilsky ML: Wilson disease: Diagnosis, treatment, and follow-up. Clin Liver Dis. 2017 Nov;21(4):755-767

6. Hermann W: Classification and differential diagnosis of Wilson's disease. Ann Transl Med. 2019 Apr;7(Suppl 2):S63

Special Instructions Library of PDFs including pertinent information and forms related to the test