 |
|
In a
neurological setting, diagnosis of WD is easier, as a
|
KF
ring would be positive in almost all cases and along
|
with
either a low ceruloplasmin or high urinary copper,
|
would
be diagnostic. In liver disease, diagnosis can be
|
more
complex. WD is strongly suggested by any two of
|
the
following – low ceruloplasmin, high urinary copper,
|
presence
of KF rings, and confirmed by a high hepatic
|
Cu.
If a liver biopsy is not possible due to coagulopathy,
|
but
other investigations are suggestive of WD, chelation
|
therapy
can be started immediately. Liver biopsy must
|
then
be done at the earliest opportunity, as hepatic
|
copper
may remain elevated despite years of therapy and
|
clin-
|
|
ical
improvement
|
|