Question 1

What is Wilson's disease and how is copper testing used to diagnose it?

Accepted Answer

Wilson disease is a rare inherited disorder that prevents the body from getting rid of extra copper, and while a small amount of copper from food is needed to stay healthy, too much copper is poisonous. With Wilson disease, copper builds up in the liver and releases directly into the bloodstream, causing damage to the brain, kidneys, and eyes, with symptoms usually starting between ages 5 and 35. Although serum copper levels are usually ordered to work up possible cases of Wilson's disease, serum copper alone is of only limited value, and additional tests like ceruloplasmin and urine copper are typically needed.

Question 2

Can medications or supplements affect copper test results?

Accepted Answer

Diet, medication, and nutritional supplements may introduce interfering substances, so patients should be encouraged to discontinue nutritional supplements, vitamins, minerals, and nonessential over-the-counter medications upon the advice of their physician. Serum copper may be reduced by use of corticosteroids and zinc, while serum copper may be elevated with copper supplementation. It's particularly important to note that zinc supplements can significantly lower copper levels and should be discussed with a healthcare provider.

Question 3

What are the symptoms of copper deficiency?

Accepted Answer

Based on studies in animals and humans, the effects of copper deficiency include anemia, hypopigmentation, hypercholesterolemia, connective tissue disorders, osteoporosis and other bone defects, abnormal lipid metabolism, ataxia, and increased risk of infection. Copper deficiency can lead to problems with connective tissue, muscle weakness, anemia, low white blood cell count, neurological problems, and paleness. However, copper deficiency is uncommon in humans since most diets contain adequate copper.

Question 4

Why are special collection tubes required for copper testing?

Accepted Answer

Elevated results may be due to skin or collection-related contamination, including the use of a noncertified metal-free collection/transport tube, so if contamination concerns exist due to elevated levels of serum copper, confirmation with a second specimen collected in a certified metal-free tube is recommended. Regular blood collection tubes may contain trace amounts of copper that could falsely elevate test results. Royal blue tubes (no additive), royal blue (K2EDTA), or royal blue (NaHep) are required because these are specifically manufactured to be free of copper contamination.

Question 5

How do pregnancy and oral contraceptives affect copper levels?

Accepted Answer

In females, elevated copper may be caused by oral contraceptives and pregnancy, with concentrations elevated up to 3 times normal during the third trimester. Serum ceruloplasmin is an acute-phase reactant type protein, and since it binds a large portion of serum copper, both serum copper and ceruloplasmin increase under the influence of estrogen. This means that women taking birth control pills or who are pregnant will typically have higher copper levels, which is considered normal in these circumstances. Healthcare providers take these factors into account when interpreting results.

Question 6

What foods are high in copper and could affect my test results?

Accepted Answer

Individuals normally get copper through foods in their diet, such as liver and other organ meats, seafood, beans, and whole grains. Copper is found in many food sources such as seeds, organ meats, nuts, seafood, and liver. While dietary copper intake doesn't typically need to be restricted before testing, excessive consumption of copper-rich foods or copper supplements could potentially affect results. Because a normal diet has plenty of copper, copper deficiency is unlikely except in certain cases, making dietary copper toxicity from food sources uncommon.

Copper (Serum)