Diagnostic algorithms for Wilson's disease (WD) recommend the determination of serum ceruloplasmin in addition to the slit-lamp examination required to identify Kayser-Fleischer rings as clues in order to decide on or decline further testing, while measurements of total serum copper and/or ceruloplasmin-unbound ("free") copper are of value in monitoring pharmacotherapy [1,2]. The direct measurement of "free" copper is, however, difficult and not routinely available [3], To overcome this issue, equations have been proposed for assessing "free" copper fraction in serum; however, they can produce biologically implausible negative results in a significant number of patients [4]. The use of copper/ceruloplasmin ratio (Cu:Cp) has been proposed to overcome such problems [5].
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