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HelpTest Code LBCS Labile Bound Copper, Serum
Ordering Guidance
If CUS1 / Copper, Serum is ordered with this test, it will be canceled, as copper testing will be automatically added as a part of this test order.
Specimen Required
Patient Preparation: High concentrations of gadolinium and iodine are known to potentially interfere with most inductively coupled plasma mass spectrometry-based metal tests. If either gadolinium- or iodine-containing contrast media has been administered, a specimen should not be collected for at least 96 hours.
Supplies:
-Metal Free Specimen Vial (T173)
-Metal Free B-D Tube (No Additive), 6 mL (T184)
Collection Container/Tube: 6-mL Plain, royal blue-top Vacutainer plastic trace element blood collection tube
Submission Container/Tube: 7-mL Metal-free, screw-capped, polypropylene vial
Specimen Volume: 0.75 mL serum
Collection Instructions:
1. For complete instructions, see Metals Analysis Specimen Collection and Transport.
2. Allow the specimen to clot for 30 minutes; then centrifuge the specimen to separate serum from the cellular fraction.
3. Remove the stopper. Carefully pour specimen into metal-free, polypropylene vial, avoiding transfer of the cellular components of blood. Do not insert a pipet into the serum to accomplish transfer, and do not ream the specimen with a wooden stick to assist with serum transfer.
4. Freeze sample on dry ice immediately after pouring off the serum.
Useful For
May be useful in the evaluation of copper-related disorders, including Wilson disease
Additional Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| CUS1 | Copper, S | Yes | Yes |
Testing Algorithm
After a labile-bound copper serum result is obtained, a total copper serum test will be performed at an additional charge. The labile-bound copper concentration will be divided by the total copper concentration to calculate the labile-bound copper fraction result.
Special Instructions
Method Name
Inductively Coupled Plasma Mass Spectrometry (ICP-MS)
Reporting Name
Labile Bound Copper, SSpecimen Type
SerumSpecimen Minimum Volume
Serum: 0.5 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum | Frozen | 28 days | METAL FREE |
Reference Values
Labile Bound Copper: <105 ng/mL
Labile Bound Copper Fraction:
Males: <10.5 %
Females: <8.1 %
Copper, Total:
0-2 months: 40-140 mcg/dL
3-6 months: 40-160 mcg/dL
7-9 months: 40-170 mcg/dL
10-12 months: 80-170 mcg/dL
13 months-10 years: 80-180 mcg/dL
11-17 years: 75-145 mcg/dL
Males:
≥18 years: 73-129 mcg/dL
Females:
≥18 years: 77-206 mcg/dL
Interpretation
This test measures the labile bound copper (LBC) in serum and calculates the fraction (%) of LBC to total copper (LBC fraction).
Serum copper results below the normal range and LBC fractions above the normal range are associated with Wilson disease. Abnormal total copper and LBC fraction may also be associated with a variety of other copper-related disorders (see Clinical Information).
Clinical Reference
1. Woimant F, Djebrani-Oussedik N, Poujois A. New tools for Wilson's disease diagnosis: exchangeable copper fraction. Ann Transl Med. 2019;7(Suppl 2):S70. doi:10.21037/atm.2019.03.02
2. McMillin GA, Travis JJ, Hunt JW. Direct measurement of free copper in serum or plasma ultrafiltrate. Am J Clin Pathol. 2009;131(2):160-5. doi:10.1309/AJCP7Z9KBFINVGYF
3. Quarles CD Jr, Macke M, Michalke B, et al. LC-ICP-MS method for the determination of "extractable copper" in serum. Metallomics. 2020;12(9):1348-1355
4. Shribman S, Marjot T, Sharif A, et al. Investigation and management of Wilson's disease: a practical guide from the British Association for the Study of the Liver. Lancet Gastroenterol Hepatol. 2022;7(6):560-575
5. Strathmann FG, Blum LM. Toxic elements. In: Rifai N, Chiu RWK, Young I, Burnham CAD, Wittwer CT, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 7th ed. Elsevier; 2023:chap 44
6. Alman B, Fay M, Antezana A, et al. Toxicological Profile for Copper. ATSDR; 2022. Revised October 2024. Accessed September 5, 2025. Available at www.atsdr.cdc.gov/toxprofiles/tp132.pdf
7. Bitzer AC, Fox J, Day PL, et al. Establishment of a labile bound copper reference interval in a healthy population via an inductively coupled plasma mass spectrometry dual filtration-based assay. Arch Pathol Lab Med. 2024;148(7):818-827. doi:10.5858/arpa.2023-0259-OA. PMID: 37870242
8. Schilsky ML, Roberts EA, Bronstein JM, et al. A multidisciplinary approach to the diagnosis and management of Wilson disease: 2022 Practice Guidance on Wilson disease from the American Association for the Study of Liver Diseases. Hepatology. 2025;82(3):E41-E90. doi:10.1002/hep.32801
9. Marino Z, Schilsky ML Wilson disease: Novel diagnostic and therapeutic approaches. Semin Liver Dis. 2025;45(2):221-235. doi:10.1055/a-2460-8999
10. Bornhorst JA, Bitzer AC, Day PL, et al. Total copper and labile bound copper fraction as a selective and sensitive tool in the evaluation of Wilson Disease. J Appl Lab Med. 2024;9(6):1014-1027. doi:10.1093/jalm/jfae090
11. European Association for Study of Liver. EASL Clinical Practice Guidelines: Wilson's disease. J Hepatol. 2012;56(3):671-685. doi:10.1016/j.jhep.2011.11.007
Day(s) Performed
Wednesday
Report Available
7 to 15 daysPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
82525
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| LBCS | Labile Bound Copper, S | 105459-2 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 620895 | Labile Bound Copper, S | 96257-1 |
| 620896 | Labile Bound Copper Fraction | 96463-5 |