Alkaline phosphatase

Collection Container/Tube: Preferred: Serum gel Acceptable: Red top Submission Container/Tube: Plastic vial Specimen Volume: 1 mL Collection Instructions: 1. Serum gel tubes should be centrifuged within 2 hours of collection. 2. Red-top tubes should be centrifuged and aliquoted within 2 hours of collection. Alkaline phosphatase in serum consists of 4 structural genotypes: liver-bone-kidney, intestinal, and placental types, and the variant from the germ cells. It is found in osteoblasts, hepatocytes, leukocytes, the kidneys, spleen, placenta, prostate, and the small intestine. The liver-bone-kidney type is particularly important. A rise in the alkaline phosphatase occurs with all forms of cholestasis, particularly with obstructive jaundice. It is also elevated in diseases of the skeletal system, such as Paget disease, hyperparathyroidism, rickets, and osteomalacia, as well as with fractures and malignant tumors. A considerable rise in the alkaline phosphatase activity is sometimes seen in children and teenagers. It is caused by increased osteoblast activity following accelerated bone growth. Males 0-14 days: 83-248 U/L 15 days- or =19 years: 40-129 U/L Females 0-14 days: 83-248 U/L 15 days- or =17 years: 35-104 U/L Increases in serum alkaline phosphatase (ALP) activity commonly originate from either one or both of 2 sources: liver and bone. Consequently, serum ALP measurements are of particular interest in the investigation of 2 groups of conditions: hepatobiliary disease a...

Clinical Information Alkaline phosphatase in serum consists of 4 structural genotypes: liver-bone-kidney, intestinal, and placental types, and the variant from the germ cells. It is found in osteoblasts, hepatocytes, leukocytes, the kidneys, spleen, placenta, prostate, and the small intestine. The liver-bone-kidney type is particularly important. A rise in the alkaline phosphatase occurs with all forms of cholestasis, particularly with obstructive jaundice. It is also elevated in diseases of the skeletal system, such as Paget disease, hyperparathyroidism, rickets, and osteomalacia, as well as with fractures and malignant tumors. A considerable rise in the alkaline phosphatase activity is sometimes seen in children and teenagers. It is caused by increased osteoblast activity following accelerated bone growth. Interpretation Increases in serum alkaline phosphatase (ALP) activity commonly originate from either one or both of 2 sources: liver and bone. Consequently, serum ALP measurements are of particular interest in the investigation of 2 groups of conditions: hepatobiliary disease and bone disease associated with increased osteoblastic activity. Serum ALP was the first enzyme to be used for the investigation of hepatic disease. The response of the liver to any form of biliary tree obstruction induces the synthesis of ALP by hepatocytes. The newly formed coenzyme is released from the cell membrane by the action of bile salts and enters the circulation to increase the enzyme ...

Medical Significance A number of different medical conditions within the liver and throughout the bile duct system can lead to elevated ALP. High ALP levels can indicate a problem with an obstruction of the bile ducts. These ducts normally carry bile produced by the liver and stored in the gallbladder out to the intestines. High Levels of ALP Clinicians consider the degree of elevation when evaluating ALP levels in a medical context. For example, ALP is often four times higher than normal, or even more than that, in medical conditions that block the flow of bile out the body. For example, this might be due to a cancer blocking the ducts, gallstones in the bile ducts, or other causes. Follow-Up You might not need extensive medical evaluation if your ALP is only a little elevated. Instead, your clinician may choose to monitor you with repeated blood tests. Somewhat increased ALP can occur in some individuals, even though no real problem is present. However, high levels need further medical investigation. It is also sometimes helpful to run a different type of ALP test (electrophoresis). This test gives information about the fraction of ALP that comes from different organs, indicating the probable organ of concern. Most of the time, these tests find the increase coming from bone disease or liver or gallbladder problems. Other blood tests may also be needed, depending on the context. For example, if your clinician is concerned that hepatitis might be the cause of your symptoms...

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Alkaline phosphatase (ALP) is an enzyme in blood that helps break down proteins. An ALP test measures how much ALP is circulating in the blood stream. Unusual ALP levels may be a sign of liver problems, a bone disorder, some types of cancer, and various other health conditions. Slightly abnormal ALP levels can occur naturally and This article explores the ALP test in more detail, including what it involves, how to prepare for it, and what the results may mean. Share on Pinterest Douglas Sacha/Getty Images An ALP test is a blood test. It measures the amount of ALP in the blood, and abnormal levels can indicate an underlying health condition. Doctors Symptoms of a liver problem can include: • • • • tiredness • • swelling or • • frequent itching • A doctor may also order an ALP test if a person has symptoms of a bone disorder, such as: • • • enlarged bones • unusually shaped bones • increased frequency of bone fractures The ALP test can be part of screening. It may be one of many tests in a liver panel, for example. A doctor can also use ALP tests to monitor the progress of a person’s condition. In addition to an ALP test, a doctor may order an ALP isoenzyme test. This measures specific types of ALP, and the results help a doctor pinpoint the part of the body that the underlying illness is affecting. ALP is an enzyme present in many parts of the body. It is Researchers still do not know the full range of ALP’s functions, but it seems to contribute to many processes, such as: ...

Learning points If alkaline phosphatase is raised in an asymptomatic patient and serum bilirubin, liver transaminases, creatinine, adjusted calcium, thyroid function, and blood count are normal: • Consider growth spurts in adolescents, pregnancy in women, drugs, and age related increases • As most likely sources are either bone or liver, differentiate by measuring γ-glutamyltransferase (raised in liver) and investigate accordingly • For liver cases investigate with abdominal ultrasound scan (cholestasis and hepatic space occupying lesion) and antimitochondrial antibodies (primary biliary cirrhosis) • For bone cases investigate vitamin D A 51 year old asymptomatic woman presented to her general practitioner for cascade screening for familial hypercholesterolaemia. Blood tests revealed a normal full blood count, renal function, thyroid function, lipid profile, glucose levels, bone profile, and liver profile except for an isolated increased alkaline phosphatase (ALP) concentration at 171 U/L (reference interval 30-130). What is the next investigation? ALP is found in high concentrations in liver, bone, kidney, intestine, and placenta. In adults, circulating ALP is predominantly of hepatic and bony origin. Serum ALP levels increase in pregnancy and by the third trimester can be twofold to fourfold higher as a result of a physiological increase in placental ALP. Reference intervals are age and sex related, gradually increasing from age 40 to 65 years, especially in women, and c...