, 8 tweets, 6 min read Read on Twitter

Are we trying to diagnosis Wilson Disease or ... do we just like to say ceruloplasmin?

Please join me for the last #tweetorial in a series on diagnostic tests for liver disease #livertwitter #meded
Interpret the following in the context of my COI:

Every time a ceruloplasmin is sent on a 70 year old, a part of my spleen infarcts.
Ceruloplasmin tests 4 Wilson Disease

What's that?
1⃣Prevalence 1/55,000. Avg age @ dx: 11
2⃣Mutated ATP7B gene⬇️Copper export from liver &⬇️cerulo formation
3⃣Copper gets everywhere (ie KF rings), damages liver &🧠
4⃣Diagnostic algorithm 4 liver disease of unknown cause
Ceruloplasmin test performance liver disease
(positive = under 20mg/dL)

1⃣In ~3K consec pts, 17(0.6%) have Cerulo<20 & 1 had WD
2⃣In our study, of 5K pts, 448(8%) were <20, 8 had WD

3⃣35% normal cerulo in tru WD
4⃣When WD present w/liver diz in adults~50% r normal
What are we doing??
1⃣Guidance: Look 4 WD in unknown liver diz, esp 3-55 yrs, w/o liver failure
2⃣But we r testing everyone @ the same⏲️as common diseases!
3⃣A pop-up alert ⬇️⬇️orders 4 cerulo...
4⃣Then when ppl DO order cerulo, it's⬆️likely 2 be ordered appropriately
But don't just take my word for it!

1⃣"Ceruloplasmin's test characteristics cannot meaningfully change diagnostic certainty when applied to all comers with liver disease."
- Thomas Bayes
2⃣"It's positive? Huh. Weird. Why did we get it?"
- Most ordering clinicians
In summary, be the best ceruloplasmin tester u can be!

🚫Test 4 rare disease in population w/common ones (i.e. NASH/HCV/ALD)
🚫Test wrong population (e.g. elderly)
🚫stop with cerulo if u really want 2 diagnose Wilson Disease
Thank you for reading! I hope you enjoyed. This concludes a #tweetorial on ceruloplasmin.
I wanted to promote our paper (w/@lstrnad5 & @RobShmerling)
on reducing the burden of false positives @MayoProceedings

Consider a read: mayoclinicproceedings.org/article/S0025-…
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