Copper
- Description
- Copper by ICP-MS
- Clinical details
- Copper is now well established as an essential trace element. The majority of copper in the circulation is bound to caeruloplasmin which is synthesised in the liver, and binds 6-8 atoms of copper per molecule. Caeruloplasmin is an acute phase protein and can increase greatly in response to infection, injury, chronic inflammatory conditions or steroid hormones (including pregnancy, the OC pill and HRT). Copper deficiency presents as a microcytic hypochromic anaemia with marked neutropenia. Frank dietary copper deficiency is uncommon but subclinical copper deficiency may be more widespread than was first thought. The rare sex linked recessive disorder Menke's 'steely hair' disease is characterised by a failure of intestinal copper absorption due to a defect in the gene coding for the intestinal copper transporter ATP7A. Wilson disease (hepatolenticular degeneration) is an autosomal recessive disorder due to defects in the gene coding for the copper transporter (ATP7B) in other cells. Copper a especially the brain. Children and adolescents presenting with a variety of hepatic symptoms often associated with a normocytic anaemia should be investigated for Wilson disease. The classical presentation in adults is of progressive neurological symptoms and characteristic copper deposits in the corneas (Kayser-Fleischer rings). Chronic poisoning with copper or inherited disorder (Wilson disease) accumulates in the liver and other tissues, leads to gross hepatic copper overload with severe liver disease in young children. Indian childhood cirrhosis has been ascribed to storage of drinking water/milk in copper vessels and there have been several cases of copper poisoning from well water.
- Reference range
For serum/plasma; copper: 0-4 months old- 1.4 -7.2 µmol/L, 4-6 months old - 3.9-17.3 µmol/L, 7-12 months old - 7.9-20.5 µmol/L, Adults & children > 1 year old - 12-25 µmol/L, Pregnancy : 27-40 µmol/L
24H urine: Normal adult : <0.95 µmol/24 h
Suggestive of Wilson's Disease : >1.57 µmol/24h,
Adults post penicillamine: <12 µmol/24h, Wilson's Disease- Post penicillamine: >25 µmol/24h
Random Urine: Male- 16.4-47.0 nmol/mmol creatine, Female-19.6-76.2 nmol/mmol creatinine,
Liver Biopsy: 20-50 µg/g Dry Weight
- Synonyms
- Copper, serum/plasma, biopsy, urine
- Testing site
- Synnovis : Reference Services : King's College Hospital
- Laboratory
- Trace Elements
- Sample type and volume required
- 1ml plasma/serum from Trace element free (royal blue top tube). 20 ml urine (Portion of 24 hour collection [acid-washed bottle] in sterile universal, record total volume on sample tube or request form). Random urine collection in 25ml Sterilin Universal containers. Liver biopsy
- Call in advance
- No
- Special sample instructions
Separate serum/plasma as soon as possible after collection. Transfer to metal-free aliquot tube.Do not transfer serum/plasma in tube with black O-ring.
For Liver biopsy- At least one centimetre of liver tissue sample is required. Sample should be transferred from biopsy needle without delay. If the specimen is to be divided (e.g. piece required for histology) a new/clean scalpel should be used. A clean Sterilin universal container is acceptable. The tissue sample should not be placed in Formalin or saline, as this can lead to contamination or leaching out of certain elements.If a sample embedded in paraffin wax is available, and there is no possible way of getting a fresh liver sample, then the embedded sample can be utilised (provided there is enough tissue) to estimate liver Copper concentration. There is however, a potential risk of contamination during the de-waxing procedure.
- Storage and transport
- Stable at 4°C. Send by overnight first class post. Keep liver tissue samples in paraffin wax blocks at room temperature.
- Turnaround time
- 7 working days for serum/plasma copper. 10 working days for urine. 10 working days for liver biopsy.
- Contacts
Toxicology Department at King’s Hospital
Phone: 020 3299 5881
Email: kch-tr.toxicology@nhs.net
King’s College Hospital
Bessemer Wing – 3rd Floor
Denmark Hill
London SE5 9RSTrace Elements Laboratory at King’s College Hospital
Phone: 020 3299 3008
Email: kishor.raja@nhs.net
King’s College Hospital
Bessemer Wing – Top Floor
Denmark Hill
London SE5 9RS