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Copper Level

Last updated May 18, 2018

Approved by: Krish Tangella MD, MBA, FCAP

Image of Copper metabolism in normal and abnormal (affected by Wilson’s disease). Copper Level Testing is primarily used to help diagnose Wilson disease.

What are the other Names for this Test? (Equivalent Terms)

  • 24-Hour Urine Copper
  • Hepatic Copper Level on a Tissue Biopsy
  • Non-Ceruloplasmin-Bound Copper in Blood

What is Copper Level Test? (Background Information)

  • Copper: Among the important minerals that body requires, Copper is one among them.  It incorporates into enzymes that play a vital role in body's regulation of iron, ATP production, melanin pigment formation, connective tissue formation, brain and nervous system function
  • Deficiency and excesses of Copper are rare in the human body under most circumstances; hence, a routine testing for Copper is usually not recommended
  • Copper metabolism: Copper absorption takes place from the intestine. Since, Copper is toxic in nature, it binds itself to a plasma protein to become non-toxic and some of this is transported to liver for storage. The rest of the Copper binds to a protein called Apoceruloplasmin, which is then referred to as the enzyme Ceruloplasmin. Most of the Copper found in blood is due to this enzyme. Any excess Copper is excreted by liver, along with other wastes in the feces and through urine
  • Copper source: Foods that include Copper are chocolates, dried fruits, shellfish, mushrooms, whole grains, and liver. Water we drink has Copper in it, if it flows through Copper pipes; also foods cooked or stored in Copper dishes gain some of the mineral Copper. A regular diet complements the body's Copper needs. It is advisable to consult one’s physician before starting to change diet or use dietary supplements
  • Copper testing: The amount of Copper circulating in the body fluids like blood, urine is measured to determine if there is Wilson’s disease and/or deficient or excess amount of Copper. Its level may temporarily increase in individuals with infection or inflammation that are not associated with Copper

What are the Clinical Indications for performing the Copper Level Test?

Individuals in the following category may be prescribed testing for Copper:

  • To confirm and monitor a metabolic disorder called Wilson’s disease. This inherited disorder can accumulate excess Copper in brain, liver, and a few other organs, and lead to tissue damage. The symptoms and signs presented are abdominal pain, behavioral changes, jaundice, tremors, difficulty walking, fatigue, nausea, and dystonia
  • Those suffering from Copper poisoning due to acute/chronic exposure. Some of the symptoms are reduced urine production or stoppage, when kidneys are involved. Any obstruction in Copper excretion and metabolism, or liver disease, also presents some of the above symptoms
  • Those with a deficiency of Copper: Individuals suffering from severe malabsorption due to cystic fibrosis and Celiac disease. Formulas made from cow milk may also cause Copper deficiency in infants. Neutropenia, microcytic anemia, and osteoporosis, are some of the other symptoms
  • Menkes kinky hair syndrome due to Copper deficiency affects brain and liver of infants and is a rare genetic X-linked condition. The affected individuals are usually males with clinical symptoms of unusually brittle kinky hair, seizures, slow development, abnormality in brain growth, etc.

How is the Specimen Collected for Copper Level Test?

Sample required: Blood, urine, liver sample (occasionally)


  • Insertion of needle into a vein (arm) for blood
  • A sample from 24-hour urine collection
  • Sometimes, a physician may perform a liver biopsy

Preparation required: None

Note: Each of the tests provides supportive information. The healthcare provider determines which of the tests (blood, urine) are needed to evaluate the condition.

What is the Significance of the Copper Level Test Result?

  • Decreased blood Copper level and decreased Ceruloplasmin level with elevated urine of copper and  increased level of  Copper in liver tissue are observed in Wilson’s disease
  • Reduced Ceruloplasmin level in blood and Copper concentration in blood and urine might indicate Copper deficiency
  • Elevated Copper concentration in blood and urine along with normal to elevated Ceruloplasmin levels are associated certain metabolic conditions such as liver disease or might indicate an excessive exposure to Copper. Chronic exposure conditions may also indicate an increased Copper in liver tissue
  • Chelators are medicines that are used for treating elevated Copper storage increase levels in 24-hour urine test.  Blood and urine levels return to normalcy when body Copper storage reduces

The laboratory test results are NOT to be interpreted as results of a "stand-alone" test. The test results have to be interpreted after correlating with suitable clinical findings and additional supplemental tests/information. Your healthcare providers will explain the meaning of your tests results, based on the overall clinical scenario.

Additional and Relevant Useful Information:

  • Certain cancers and rheumatoid arthritis are known to increase blood Copper level
  • Severe exposure of copper can cause intense vomiting and diarrhea. It can also cause significant liver and kidney damage. You are advised to consult your physician immediately, in these cases
  • Test results for Copper show increased levels in pregnant women, patients with dilated cardiomyopathy, and on those who suffered a myocardial infarction
  • Medicines, such as Gadoversetamide are known to affect the Copper test results.
  • In all cases copper test results must be carefully evaluated and abnormal results investigated. Ceruloplasmin is an acute phase reactant which means that it can be elevated, whenever body undergoes stress due to infection or inflammation. Thus, interpretations are sometimes complicated

Certain medications that you may be currently taking may influence the outcome of the test. Hence, it is important to inform your healthcare provider, the complete list of medications (including any herbal supplements) you are currently taking. This will help the healthcare provider interpret your test results more accurately and avoid unnecessary chances of a misdiagnosis.

References and Information Sources used for the Article:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Sept. 7, 2013
Last updated: May 18, 2018