Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (841 page)

   Ingestion of oral contraceptives and estrogens

   Pregnancy

Decreased In

   Wilson disease: Mutation interferes with copper transport from intestinal mucosal cytoplasm to Golgi apparatus, where it becomes bound to protein

   Menkes kinky hair syndrome

   Nephrosis (ceruloplasmin lost in urine)

   Acute leukemia in remission

   Some iron deficiency anemias of childhood (that require copper as well as iron therapy)

   Kwashiorkor, chronic diarrhea

   ACTH and corticosteroids

   Limitations

   Serum copper may be elevated with infection, inflammation, stress, RA, with some cancers, medications such as carbamazepine and phenobarbital.

   Concentrations are 2–3 × normal in the third trimester of pregnancy.

   Copper may be lowered with corticosteroids, zinc, malnutrition, and malabsorption.

   Serum specimen should be collected in a trace element-free tube, such as royal blue sterile tube, to avoid contamination.