What is the significance of a low ceruloplasmin level of 13.6 mg/dL, with a reference range of 16.0-31.0 mg/dL, as reported by Laboratory Corporation of America (Lab Corp)?

From the Guidelines

Your low ceruloplasmin level of 13.6 mg/dL requires immediate follow-up with your healthcare provider for further evaluation, as it may indicate Wilson's disease or other underlying conditions. This result is below the normal range of 16.0-31.0 mg/dL, and according to the practice guideline on Wilson disease published in Hepatology in 2003 1, modestly subnormal levels suggest that further evaluation is necessary. Low ceruloplasmin levels can be associated with various conditions, including:

• Wilson's disease, a genetic disorder that causes copper to accumulate in the liver, brain, and other organs
• Protein malnutrition
• Severe liver disease
• Protein-losing enteropathy
• Certain genetic conditions

Your doctor will likely recommend additional tests to determine the cause, which may include:

• 24-hour urine copper collection
• Serum copper levels
• Liver function tests
• Possibly genetic testing for Wilson's disease, as serum ceruloplasmin within the normal range does not exclude the diagnosis 1. If Wilson's disease is suspected, treatment typically involves copper-chelating medications and dietary copper restriction. It is essential to consult with your healthcare provider before making any changes to your diet or starting supplements. Ceruloplasmin is a copper-carrying protein produced by the liver, and proper diagnosis of the underlying cause is crucial for appropriate treatment.

From the FDA Drug Label

The diagnosis, if suspected on the basis of family or individual history or physical examination, can be confirmed if the plasma copper-protein ceruloplasmin** is less than 20 mg/dL

• The patient's ceruloplasmin level is 13.6 mg/dL, which is less than 20 mg/dL.
• This suggests that the patient may have Wilson's disease, but further testing, such as a liver biopsy or Kayser-Fleischer rings, is needed to confirm the diagnosis 2.

From the Research

Ceruloplasmin Levels

• The patient's ceruloplasmin level is 13.6 mg/dL, which is below the normal range of 16.0-31.0 mg/dL 3, 4, 5.
• Low ceruloplasmin levels can be associated with Wilson's disease, a genetic disorder characterized by copper accumulation in the body 3, 4, 6, 7.
• However, low ceruloplasmin levels can also occur in patients without Wilson's disease, particularly those with liver disorders such as viral hepatitis 5.
• In patients with low ceruloplasmin levels, further testing such as urinary copper excretion and genetic analysis may be necessary to confirm a diagnosis of Wilson's disease 4, 6.

Diagnostic Considerations

• The patient's low ceruloplasmin level may be indicative of Wilson's disease, but other causes of low ceruloplasmin levels should also be considered 5.
• The diagnosis of Wilson's disease is typically confirmed by a combination of low ceruloplasmin levels, elevated urinary copper excretion, and genetic analysis 4, 6.
• In some cases, low ceruloplasmin levels may be associated with other liver disorders, such as alcoholic liver disease 6.

Treatment Options

• If the patient is diagnosed with Wilson's disease, treatment options may include chelation therapy with penicillamine or trientine, or zinc supplementation 3, 4, 7.
• The goal of treatment is to reduce the accumulation of copper in the body and prevent further liver damage 3, 4.
• In patients with Wilson's disease, regular monitoring of ceruloplasmin levels and urinary copper excretion is necessary to adjust treatment and prevent complications 4.