Copper (cuprum; Cu) is an element from the group of heavy or semi-precious metals. Copper is absorbed in the small intestine and stored in the liver; most of it (90-95%) leaves the liver as coeruloplasmin, the rest is bound to albumin and amino acids. Copper plays an important role in many metabolic processes: copper is an integral component of a number of metalloproteins and is essential for their enzyme function. Copper is found primarily in liver, fish, and nuts, as well as in beans.Daily copper intake should be between 2-5 mg. If there is an excess of copper, intoxication (poisoning) can occur. Copper intoxication may cause the following symptoms:
- Hemolysis – destruction of erythrocytes (red blood cells).
- Renal failure
Copper deficiency is rarely observed, but then especially in premature infants and babies. Copper deficiency can lead to the following symptoms:
- Anemia (anemia)
- Connective tissue changes, unspecified
- Bone changes, unspecified
- Neurological disorders, unspecified
- Neutropenia – decrease in a subtype of granulocytes (immune defense cells).
The procedure
Material needed
- Blood serum
- 24 h urine
Preparation of the patient
- Not necessary
Disruptive factors
- Not known
Normal values – blood
Age | Normal value in μg/dl | Normal value in μmol/l |
Preterm infants | 17-44 | 2,7-7,7 |
Until 4 months of age (LM) | 9-46 | 1,4-7,2 |
4TH-6TH LM | 25-110 | 3,9-17,3 |
7-12 LM | 50-130 | 7,9-20,5 |
1-5 years of age (LY) | 80-150 | 12,6-23,6 |
6.-9- LJ | 84-136 | 13,2-21,4 |
10-13 LY | 80-121 | 12,6-19,0 |
14-19 LY | 64-117 | 10,1-18,4 |
Women | 74-122 | 11,6-19,2 |
Men | 79-131 | 12,4-20,6 |
Normal values – urine
Normal value in μg/24 h | 10-60 |
Normal value in μmol/24 h | 0,16-0,94 |
Indications
- Suspected copper poisoning
- Suspicion of copper deficiency (e.g., parenteral nutrition).
- Suspicion of Wilson’s disease
- Suspicion of Menkes syndrome
Interpretation
Interpretation of lowered values
- Alimentary (nutritional)
- Premature infants and babies
- Menkes syndrome – rare inborn error of metabolism (X-linked inheritance) based on copper metabolism disorder (impaired copper absorption by the mucosa cells of the small intestine).
- Wilson’s disease (copper storage disease) – genetic disease leading to copper storage disease (increasing accumulation of copper primarily in the liver, later also in the brain and kidney).
- Nephrotic syndrome – collective term for symptoms that occur in various diseases of the glomerulus (renal corpuscles); symptoms include: Proteinuria (excretion of protein in the urine) with a protein loss of more than 1 g/m²/body surface per day; hypoproteinemia, peripheral edema due to hypalbuminemia of < 2.5 g/dl in serum, hyperlipoproteinemia (lipid metabolism disorder).
Interpretation of elevated values
Urine
- Wilson’s disease (copper storage disease) – genetic disease that leads to copper accumulation in tissues.
Serum
- Acute inflammation, unspecified (secondary to elevation of coeruloplasmin as an acute phase protein).
- Aplastic anemia – form of anemia.
- Hyperthyroidism (hyperthyroidism)
- Hepatopathy (liver disease) – e.g. hepatitis (liver inflammation).
- Leukemia, acute (blood cancer).
- Gravidity in the last trimester (third of pregnancy).
- Therapy with estrogens (female sex hormone) or oral contraceptives.
Further notes
- The normal requirement for copper in women as well as men is 1.0-1.5 mg/d.