Ceruloplasmin, Acute Phase Protein

Acute-phase protein (Acute Phase Reactants)

• Acute-phase protein is raised in inflammatory conditions.
• When there is an increase in a protein called positive acute-phase protein.
  • In the case of a decrease in the acute phase protein, is called negative phase protein.
• The acute phase proteins (positive) are protein whose concentration increases in the plasma and after the disease episode is over then it decreases and may become normal.

Ceruloplasmin

Sample

• This test is done in the serum.
• The test is done with a fresh sample.
• Can store the sample for 3 days at 4 °C.
• For 4 weeks can store at -20 °C.

Precaution

1. Avoid hemolyzed or lipemic serum.
2. Ceruloplasmin is affected by infection and liver function.
3. Birth control pills increase ceruloplasmin and pregnancy.

Indications

1. This is done to diagnose Willson’s disease.
2. To diagnose an accumulation of copper in the liver, eye, and other organs.

Pathophysiology

1. This is a major copper-carrying protein in the blood.

2. Ceruloplasmin is  α2- globulin, and glycoprotein (7.5% carbohydrate) which is made by the liver.
3. Ceruloplasmin which contains 95%of the total copper and gives it a blue color.
   1. 95% of the copper is bound to Ceruloplasmin.   
   2. Its molecular mass is 134,000.
   3. This is an acute-phase protein and it has enzymatic activity (peroxidase activity).

    Ceruloplasmin can leads to:

1. Ceruloplasmin reduces the number of WBCs attachment to the endothelium.
2. In one of the experiments, it was found that ceruloplasmin may act as an anti-inflammatory agent by reducing the number of PMNs attaching to endothelium and by acting as an extracellular scavenger of superoxide.
3. This is a decrease in Wilson’s disease.
   1. There is decreased ceruloplasmin and blood copper concentration, with increased urine copper level, indicate Wilson’s disease.
   2. This is an increase in acute and chronic inflammation.

Normal

• One day to 3 months    =  5 to 18 mg/dL
• > 7 years                         =  20 to 54 mg/dL
• Adult                              =  18 to 45 mg/dL
• Critical value  =  <20mg/dL is abnormal.
• Another source gives this normal value:
  • Male = 36.0 ± 5.6 mg/dL (2.38 ± 0.37 µmol/L).
  • Female = 40.9  ±  6.8 mg/dL (2.71  ± o.45 µmol/L).
• Source 4
  • 25 to 63 mg/dL  (250 to 630 mg/L) by nephelometry.

Increased level of ceruloplasmin is seen in:

1. The latter half of the pregnancy.
2. Acute and chronic infection.
3. In myocardial infarction.
4. Thyrotoxicosis.
5. Leukemia and cancers.
6. In liver cirrhosis.

Wilson’ disease

1. This is rarely inherited autosomal recessive abnormality.
2. Age: This is seen in young adults, adolescents, and both sexes.
3. Sign and symptom:
   1. There is increasing rigidity.
   2. The patient will have spasticity.
   3. This patient develops difficulty in swallowing and speaking.
4. Pathophysiology: All the tissues will have a high content of the copper.
   1. There is especially more copper in the liver and brain.
   2. In the liver copper concentration is 5 to 30 times more than normal tissues.
   3. The plasma ceruloplasmin level is low because of the copper deposition in the liver.
   4. Most of the patients develop cirrhosis.

5. Diagnosis: There is decreased ceruloplasmin.
   1. Increased urine copper.

 

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