From the Guidelines
Low ceruloplasmin and ferritin levels together suggest a potential copper deficiency or Wilson's disease, requiring prompt medical evaluation. For suspected copper deficiency, supplementation with 2-4 mg of elemental copper daily (as copper gluconate or sulfate) may be recommended by your doctor 1. This condition can develop from malabsorption issues, gastric bypass surgery, excessive zinc intake, or prolonged parenteral nutrition. Ceruloplasmin is a copper-carrying protein that also helps convert iron from ferrous to ferric state for transport, explaining why copper deficiency can lead to low ferritin (iron storage) 2. Conversely, in Wilson's disease, low ceruloplasmin occurs with copper overload, requiring different treatment. Do not self-supplement without medical guidance, as copper balance is delicate. A complete workup including serum copper levels, 24-hour urine copper, liver function tests, and possibly genetic testing is essential for accurate diagnosis 3. Treatment depends on the underlying cause and may include addressing malabsorption issues or specific therapy for Wilson's disease if diagnosed.
Some key points to consider:
- Low ceruloplasmin levels can be seen in various conditions, including Wilson's disease, copper deficiency, and certain liver diseases 1.
- Serum ceruloplasmin concentrations are elevated by acute inflammation and in states associated with hyperestrogenemia such as pregnancy and estrogen supplementation 2.
- The normal concentration of ceruloplasmin measured by the enzymatic assay varies among laboratories (with a lower limit between 0.15 and 0.2 g/L) 3.
- Iron deficiency, even without anaemia, can have negative implications for aerobic performance, and iron deficiencies may present as lethargy and reduced performance 4.
- A reasonable time frame for assessment of iron status is once per year in male players and twice per year in female players (more frequently when iron deficiency has been detected in recent monitoring) 4.
It is essential to note that the evidence from the studies 1, 2, 3, 5, 4 suggests that a comprehensive evaluation, including serum copper levels, 24-hour urine copper, liver function tests, and possibly genetic testing, is necessary to determine the underlying cause of low ceruloplasmin and ferritin levels. Prompt medical evaluation and treatment are crucial to prevent long-term complications and improve quality of life.
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
- Low ceruloplasmin is a diagnostic criterion for Wilson's disease.
- Ferritin levels are not directly mentioned in the provided drug labels as a diagnostic criterion for Wilson's disease. The FDA drug label does not answer the question about low ferritin. However, low ceruloplasmin is associated with Wilson's disease, and treatment with penicillamine capsules or zinc acetate may be considered 6, 7.
From the Research
Low Ceruloplasmin and Ferritin
- Low serum ceruloplasmin levels can be associated with Wilson's disease (WD), a rare genetic disorder that affects copper metabolism 8, 9.
- However, low serum ceruloplasmin levels can also occur in patients without WD, particularly those with liver disorders such as viral hepatitis 10.
- In a study of 3040 adult patients attending a liver diseases outpatient clinic, 4.0% had low serum ceruloplasmin levels without WD, and these patients tended to be younger and more likely to have viral hepatitis as the underlying cause of their liver disease 10.
- The optimal cutoff value of serum ceruloplasmin levels for diagnosing WD was found to be 0.13 g/L in a large Chinese cohort, which had a sensitivity of 97.0% and a specificity of 96.1% 11.
- Low ferritin levels are not directly mentioned in the provided studies as a specific concern related to low ceruloplasmin levels, but impaired iron metabolism is associated with cellular copper overload in WD 12.
- The clinical picture of WD is variable and can include hepatic, neuropsychiatric, and other symptoms, which may be influenced by genetic, epigenetic, environmental, and lifestyle factors 12.