Reference Values for Ceruloplasmin in Pregnancy

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Reference values — Ceruloplasmin (serum)

Ceruloplasmin is a copper-binding α2-globulin and acute-phase reactant. Levels rise in pregnancy due to estrogen-mediated hepatic synthesis.

Units Nonpregnant Adult 1st Trimester 2nd Trimester 3rd Trimester
mg/dL 25 – 63 30 – 49 40 – 53 43 – 78
mg/L 250 – 630 300 – 490 400 – 530 430 – 780

Pregnancy physiology

Estrogen increases hepatic synthesis of ceruloplasmin, producing a 40–70% rise compared with the nonpregnant state. As an acute-phase reactant, ceruloplasmin also rises with inflammation, infection, or malignancy.

Causes of elevated ceruloplasmin
  • Pregnancy (physiologic)
  • Estrogen exposure (OCPs, HRT)
  • Malignancy (solid tumors, leukemias, lymphomas)
  • Chronic liver disease / biliary disorders
  • Autoimmune disease (SLE, RA)
  • Infection / inflammatory states
  • Copper overload
Causes of decreased ceruloplasmin
  • Wilson disease
  • Menkes disease
  • Severe liver dysfunction
  • Nephrotic syndrome
  • Protein-losing enteropathy
  • Severe malnutrition or malabsorption

Low ceruloplasmin should prompt evaluation of copper metabolism and hepatic function.

References

  1. Abbassi-Ghanavati M, Greer LG, Cunningham FG. Pregnancy and laboratory studies: a reference table for clinicians. Obstet Gynecol. 2009;114:1326–31.
  2. Wallach J. Interpretation of Diagnostic Tests. 8th ed. LWW; 2007.
  3. Fischbach FT, Dunning MB. Manual of Laboratory and Diagnostic Tests. 7th ed. LWW; 2004.