ALP Alkaline Phosphatase ΑΛΚΑΛΙΚΗ ΦΩΣΦΑΤΑΣΗ

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Alkaline Phosphatase (ALP)
Acanthamoeba Keratitis
Acetaminophen
Acetylcholine Receptor Antibody Alkaline phosphatase refers to a family of enzymes that catalyze hydrolysis of phosphate esters
Acetylsalicylic Acid at an alkaline pH. ALP is present (in decreasing order of abundance) in placenta, intestine,
Acid Phosphatase kidney, bone and liver. In adults, more than 80% of serum ALP activity derives from liver and
ACTH bone. In late pregnancy, placental ALP is increased. In children and adolescents most serum
ACTH Rapid Stimulation Test ALP activity originates in osteoblasts and correlates with the rate of bone growth. The serum
Activated Clotting Time half life is seven days.
Activated Protein C Resistance
Adrenal Insufficiency
Hepatitis B Screenings Diagnosed with Leukaemia?
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Alcohol
Alcohol Urine
Aldosterone
Alkaline Phosphatase Several caveats must be remembered in interpreting ALP results.
Allergic Bronchopulmonary Aspergillosis
Allergy Workup ALP levels should always be measured after fasting because enzyme levels increase as
Alpha 1 Antitrypsin much as 30 U/L after food ingestion. Patients with blood group O and B who are
Alpha Fetoprotein Maternal Serum secretors can have increased ALP levels after eating a fatty meal because of the release
Alpha Fetoprotein Tumor Marker of intestinal enzyme.
AML Blast Clearance African Americans have 10 to 15% higher ALP serum levels than Caucasians.
Ammonia In children, ALP is increased up to 3 times the upper limit of normal and in pregnant
Amniotic Fluid Optical Density patients it can be increased up to 2 times normal.
Amylase ALP levels may double following bone fracture.
Amyloidosis Smokers have 10% higher ALP levels than nonsmokers do.
Amyloid Precursor Protein ALP levels fluctuate approximately 6% from week to week in a healthy individual.
Anaerobe Bacterial Culture
Angiotensin Converting Enzyme ALP is most useful in diagnosing cholestatic liver diseases. Bile duct obstruction results in
Anion Gap increased synthesis of ALP by bile duct epithelial cells and release of ALP into the serum.
Anthrax Alkaline phosphatase may be increased even if only a few small bile ducts are obstructed and
Anti-Hu Antibody serum bilirubin is normal. Serum ALP often exceeds four times the upper limit of normal in
Anti-IgA Antibody extrahepatic and intrahepatic cholestasis. The most common causes of extrahepatic cholestasis
Anti-beta-2-glycoprotein I Antibody are pancreatic cancer, common duct stones and strictures, and primary sclerosing cholangitis.
Antibody Screen Intrahepatic cholestasis is usually due to primary biliary cirrhosis or drug reactions
Anticardiolipin Antibody (erythromycin, chlorpromazine, estrogens, and methyltestosterone). Patients with primary
Anticoagulants sclerosing cholangitis and primary biliary cirrhosis initially have elevated ALP and normal
Antidiuretic Hormone bilirubin levels.
Antifactor Xa LMW Heparin
Antimicrobial Susceptibility Testing
Antineutrophil Cytoplasmic Antibody
Antinuclear Antibodies
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Anti-Ri Antibody
Antistreptolysin O
Antithrombin When the ALP level is increased disproportionately to the bilirubin level (e.g. a bilirubin < 1.0
Arenavirus mg/dL and ALP > 1000 U/L), granulomatous or infiltrative diseases of the liver are likely.
Arterial Blood Gas Possible diagnoses include sarcoidosis, fungal infections, tuberculosis, and lymphoma. ALP
Arterial Thrombosis Laboratory Testing levels are also increased in hyperthyroidism, cardiac failure, lymphoma, and hypernephroma.
Aspartate Aminotransferase
Atherogenic Dyslipidemia Lower ALP levels (< 3 times the upper limit of normal) are less specific for cholestatic liver
disease and may be seen with hepatocellular diseases such as acute viral hepatitis, chronic
hepatitis, and cirrhosis. However, it is important to remember that incomplete obstruction by
gallstones may produce mildly elevated ALP levels. Intrahepatic cholestasis secondary to
anabolic steroids or birth control pills may cause mild increases in ALP. Gamma
glutamyltransferase (GGT) can be measured to determine if elevated ALP levels are of liver
origin; increased GGT indicates that ALP is most likely from the liver.
Medications that have been reported to increase ALP include; allopurinol, anabolic steroids,
captopril, carbamazepine, chlorpromazine, chlorpropamide, diltiazem, erythromycin, estrogens,
flutamide, gold salts, methimazole, methyltestosterone, phenothiazines, phenylbutazone,
phenytoin, quinidine, sulfonamides, tolazamide, tolbutamide, trimethoprim-sulfamethoxazole,
valproic acid, and verapamil.

2. Sometimes it is useful to look at the relationship of ALP to bilirubin and lactate dehydrogenase
(LD) levels.
Pathology ALP Bilirubin LD
Intra or extrahepatic cholestasis Increased Increased Normal
Focal benign cholestasis Increased Normal Normal
Focal malignant cholestasis Increased Normal Increased
Osteoblastic bone disease can also increase serum ALP. The most common bone disorders
associated with elevated ALP are; Paget's disease, osteomalacia, hyperparathyroidism,
osteogenic sarcoma, and bone metastases.
Low alkaline phosphatase levels have been reported in patients with magnesium deficiency,
hypothyroidism, malnutrition, hemolytic anemia, Wilson's Disease, post coronary bypass
surgery, estrogen replacement therapy, and congenital hypophosphatasia. Blood transfusion
causes transient decreases in ALP, due to chelation of cations by citrate.
Reference range in adults is 40 - 125 IU/L (Vitros Analyzer).
Specimen requirement is one SST tube of blood. If blood is collected in a citrate or EDTA tube,
ALP activity will be almost totally inhibited due to the chelation of zinc and magnesium, which
are necessary enzyme cofactors.
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