What does a high blood alkaline phosphatase (ALP) level mean? In some cases, additional time should be Alkaline phosphatase (ALP) is a protein found in all body tissues. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. ALP increase (greater than 2-fold the URV) can predict transplant-free survival rates of patients with primary biliary cirrhosis. Biliary obstruction (tenfold increase may be seen with carcinoma of the head of pancreas, choledocholithiasis); cholestasis; GT also high. In the statistical analysis the sample population is subdivided by sex and age, two variables which are known to influence enzyme activity. Serum ALP was the first enzyme to be used for the investigation of hepatic disease. Testing schedules may vary. Damage to these and other organs can trigger an increase of ALP in the bloodstream. Many medicines can interfere with blood test results. This article discusses the most common causes of raised alkaline phosphatase levels in an asymptomatic patient and provides advice on the relevant investigations. Information is shared for educational purposes only. Pregnant women have higher blood alkaline phosphatase activity. What causes a high level of ALP in a blood test? Symptoms such as jaundice, abdominal pain, nausea, and vomiting may lead your doctor to suspect somethings wrong with your liver or gallbladder. St Louis, MO: Elsevier; 2017:chap 8. Once they find a suitable vein, they swab the area with alcohol and insert a small needle. It can also be used to check the progress of treatment for any of the above conditions. Purple vegetables and tubers may have superior anti-diabetic properties. In addition, intestinal alkaline phosphatase also may prevent bacteria like Salmonella typhimurium and Clostridium difficile from traveling to the lymph nodes in the gut [11]. Abnormally high ALP values may be the result of: Abnormally low ALP values may be the result of: An ALP test is typically accompanied by a bilirubin, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) test. Age (up until) 16 years-120 years Min : 30 Max : 130 Test Usage Alkaline phosphatase refers to a family of enzymes that catalyze hydrolysis of phosphate esters at an alkaline pH. Normal bone is constantly undergoing remodeling in which bone degradation or resorption is balanced by bone formation. Elsevier; 2018:404-434, 2. for updated normal ranges. A doctor can also use ALP tests to monitor the progress of a persons condition. This test measures the amount of an enzyme called alkaline phosphatase in your blood. Accommodations. The p-nitrophenol released is directly proportional to the catalytic alkaline phosphatase activity. What is alkaline phosphatase normal range by age? 23rd ed. The test is done with a blood sample. Marked decline of high ALP of pregnancy is seen with placental insufficiency and imminent fetal demise. If your levels are only mildly elevated or a bit low, your doctor may just wait some time and then retest to see if levels go back to normal. testing to when the result is released to the ordering provider. Red-top tube, gel-barrier tube, or green-top (lithium heparin) tube. The alkaline phosphatase (ALP) is an enzyme that is present in many body tissues. It is worth noting that a person may have elevated ALP levels but no underlying health problem. For children, this range is under 350 U/L. It exists in different forms, depending on where it originates from [1]. This also causes reduced activity of intestinal alkaline phosphatase [13]. Last Update: Jan 03, 2023. . Hypophosphatasia: Very low alkaline phosphatase values are found in the presence of normocalcemia or hypocalcemia. An alkaline phosphatase level test (ALP test) is a simple test to perform. Values obtained with different assay methods should not be used interchangeably in serial testing. Intervals are . Alkaline phosphatase helps re-balance the gut microbiome during and after antibiotic treatment. Clin Biochem. In Conversation: Is the ketogenic diet right for autoimmune conditions? Sharma U, Pal D, Prasad R. Alkaline phosphatase: An overview. Clin Chem Lab Med. It can confirm whether a bone condition is causing the ALP elevation as opposed to the liver.. SelfDecode is a personalized health report service, Active bone growth phases in childhood and adolescence may produce alkaline phosphatase levels of 3 - 4 times the adult range. Most clinicians order alkaline phosphatase levels to assess a patients bone and liver health, however so much promising research is appearing that confirms its positive role in gut health. ALP is an enzyme present in many parts of the body. All rights reserved. The normal range for children is higher than that for adults, especially for infants and teens because their bones are growing rapidly. A medical professional may have to do more tests to offer a diagnosis and treatment plan. Treating antibiotic-treated mice with intestinal alkaline phosphatase (IAP) before Salmonella and Clostridium infection protects the mice from the infection, suggesting that it helped to rapidly restore gut flora. It is recommended that only one assay method be used consistently to monitor each patient's course of therapy. Some labs set the range at 30 to 130 U/L. Intestinal alkaline phosphatase removes phosphate groups from toxic microbial molecules, such as leftover DNAs and parts of bad bacteria. . 1.Introduction. Children and pregnant women can have significantly higher levels of the enzyme in their blood [ 1 ]. J Clin Chem Clin Biochem 1983;21:731-48. Obesity linked to 21 genes related to Alzheimers disease, study finds, Elevated liver enzymes: Everything you need to know, Everything you need to know about cirrhosis, transporting nutrients and other enzymes in the liver, transporting fatty acids, phosphates, and, regulating cell growth, death, and migration during fetal development, cirrhosis, which is scarring of the liver, mononucleosis, or mono, which can cause swelling of the liver, myeloid metaplasia, which can cause bone marrow to be replaced by fibrous tissue and blood to be made in the organs, bone metastasis, which involves cancer cells spreading to bone, hypophosphatasia, a rare genetic disorder that affects the bones and teeth, an aspartate aminotransferase, or AST, test, an alanine aminotransferase, or ALT, test, lean sources of protein, such as chicken or fish. Causes of low alkaline phosphatase are said to include: Hypothyroidism but most hypothyroid patients have normal alkaline phosphatase. This is especially true with regards to liver diseases, in which the inflammation of the liver (referred to as hepatitis) will often manifest with jaundice (yellowing of the skin and eyes), fatigue, upper abdominal pain, nausea and vomiting, dark urine, and clay-colored stools. Lowe D, et al. The test requires a simple blood draw and is often a routine part of other blood tests. 2004-2023 Healthline Media UK Ltd, Brighton, UK, a Red Ventures Company. 0.7 mL (Note: This volume does not allow for repeat testing.). Hansen YBL. Your email address will not be published. Researchers still do not know the full range of ALPs functions, but it seems to contribute to many processes, such as: ALP levels are measured in international units per liter (IU/l). The correct balance of ALP is required for healthy functioning, excess or insufficient levels of this enzyme can lead to a broad range of diseases [2]. Required fields are marked *. 2014; 147: pp. It improves digestion, makes your bones strong, and keeps your mind sharp. Hyperparathyroidism, in some patients. 2023 Laboratory Corporation of America Holdings. Henry's Clinical Diagnosis and Management by Laboratory Methods. Doctors usually use this test to diagnose bone and liver disorders. Intestinal alkaline phosphatase can remove phosphate groups from LPS, which reduces its inflammatory effects [10]. Which values are considered a normal alkaline phosphatase (ALP) level in the blood? When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. 2012;3(3):478-83. Turn off your ad blocker to continue reading. Thank you, {{form.email}}, for signing up. The normal range of enzyme activity is reported in percentiles. ALP was highly and significantly correlated with BAP both . 2015. Some labs set the range at 30 to 130 U/L. Permission is granted in perpetuity, without payment of license fees or royalties, to use, copy, or distribute the LOINC codes for any commercial or non-commercial purpose, subject to the terms under the license agreement found at https://loinc.org/license/. In: Rifai N, Horvath AR, Wittwer C, eds. Additionally, any condition that affects bone growth or causes the increased activity of bone cells can increase ALP levels in the blood. Generally, the total alkaline phosphatase (ALP) test is run to find all types of ALP in the blood to diagnose bone and liver disorders. SelfDecode has the strictest sourcing guidelines in the health industry and we almost exclusively link to medically peer-reviewed studies, usually on PubMed. The response of the liver to any form of biliary tree obstruction induces the synthesis of ALP by hepatocytes. An ALP test is a blood test. The correlation coefficient of alkaline phosphatase and serum vitamin D3 levels was r =0.05 (p =0.593). Normal values may vary slightly from . Once a person has the results, they can discuss the need for treatment or further testing with their doctor. #### 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: A 51 year old asymptomatic woman . It is found in osteoblasts, hepatocytes, leukocytes, the kidneys, spleen, placenta, prostate, and the small intestine. Alkaline phosphatase (ALP) is an enzyme found in the blood that helps break down proteins. A rise in the alkaline phosphatase occurs with all forms of cholestasis, particularly with obstructive jaundice. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Questions or comments about our tests and resources? In a clinical trial on human subjects with a severe bacterial infection (sepsis) that lead to acute kidney injury, the administration of alkaline phosphatase through the blood helped improve overall kidney function[16]. DO NOT stop or change your medicines without talking to your provider first. Tissues with higher amounts of ALP include the liver, bile ducts, and bone. (In most patients with cholecystitis and cholangitis who do not have a common duct stone, alkaline phosphatase is within normal limits or only slightly increased.) Dean B. Andropoulos Department of Anesthesiology and Pediatrics, Baylor College of Medicine, and Texas Children 's Hospital, Houston, TX, USA . They also can vary with age and sex. For men and women older than age 18, an ALP level between 44 and 147 U/L is considered normal. Tumors, especially hypernephroma; neoplastic ectopic production (Regan, Nagao isoenzymes). ALP is an enzyme present in various parts of the body. Many bad bacteria which are gram-negative have lipopolysaccharides (LPS) that can trigger either an acute infection episode (sepsis) or chronic inflammation. Fogel EL, Sherman S. Diseases of the gallbladder and bile ducts. If the alkaline phosphatase (ALP) is high and the GGT is in normal range it suggests a bone disorder. Pediatric reference intervals are based on Meites S. Pediatric Clinical Chemistry: Reference (Normal) Values. Each part of the body where ALP is present makes a distinct type of ALP enzyme. There are very few risks associated with having your blood drawn. This typically takes 1 to 2 days. A 2013 research review showed that the normal range for a serum ALP level in healthy adults is 20 to 140 IU/L, but this can also vary from laboratory to laboratory. If you experience this complication, apply a warm compress until the swelling goes down. One common reference range is from 44 to 147 international units per liter (IU/L), but some organizations recommend a range of 30 to 120 IU/L. . Approach to a patient with elevated serum alkaline phosphatase. The normal range for children is higher than that for adults, especially for infants and teens because their bones are growing rapidly. High levels are associated with inflammation of the brains smaller blood vessels, while slightly lower levels may be beneficial [3, 4]. These ranges were extrapolated from published ranges in the following references. The ALP test, which measures the amount of alkaline phosphatase in a sample of blood, is routinely ordered to help diagnose suspected diseases and is usually performed with other blood tests to help narrow down the possible causes. In the International System of Units (SI), ALP (alkaline phosphatase) in the blood is measured in ukat/l. Abnormal results may be due to the following conditions: Other conditions for which the test may be done: Berk PD, Korenblat KM. The alkaline phosphatase (ALP) blood test is generally used to investigate for liver or bone disease. Frustrated by the lack of good information and tools, Joe decided to embark on a learning journey to decode his DNA and track his biomarkers in search of better health. Postoperative cholestasis. No conversion. A blood sample is needed. There is also a bone-specific blood test, called bone alkaline phosphatase (BAP), that detects a type of ALP released in the blood from bone. Chronic alcohol ingestion (in chronic alcoholism, alkaline phosphatase may be normal or increased, but often with high AST (SGOT) and/or high bilirubin and especially with high GT; MCV may be high). Joe Cohen flipped the script on conventional and alternative medicineand it worked. 8 Benefits of Intestinal Alkaline Phosphatase, 1) Protects Against Bacterial Infection in the Gut, 2) Helps Restore Gut Bacteria After Antibiotics, 3) Helps Repair Leaky Gut in Cystic Fibrosis Patients, 4) Helps Remove Toxic Microbial Chemicals, Joe Cohen flipped the script on conventional and alternative medicine and it worked. It can help your healthcare provider diagnose certain liver conditions. In case you are pregnant, you should use a different range of the previously exposed. MNT is the registered trade mark of Healthline Media. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. An alkaline phosphatase (ALP) test measures the amount of ALP in your blood. Some foods and drinks can help protect liver health. Align your health hacks with your genes for optimal health & cognitive function. The blood sample is collected in a tube and analyzed by a laboratory. Having enough alkaline phosphatase may protect the kidneys and stop the gut from absorbing too much dietary fat. ALP values are higher in children because their bones are actively growing, while the ALP values increase during pregnancy in tandem with the development of the placenta and the approach of childbirth. If ALP comes back high, the doctor may order the ALP isozyme test to see which specific type of alkaline phosphatase is elevated. You should not to eat or drink anything for 6 hours before the test, unless your health care provider tells you otherwise. Version 5.0.Published: November 27, 2017. Your liver is one of the main sources of ALP, but some is also made in your bones, intestines, pancreas, and kidneys. Normal alkaline phosphatase (ALP) level in the blood. Background: Transient hyperphosphatasemia (TH) is an often unnoticed benign entity, primarily affecting children below 5 years of age. ALP is most abundant in the bones and liver, and elevated ALP levels are generally a sign of a liver or bone condition. Peptic ulcer, erosion. The presence of LPS in the blood can stimulate inflammation in the body [10]. Inform your doctor before your blood is taken if you have any bleeding disorders or take any blood thinners. Hemolysis; plasma specimen; specimen collected in EDTA tube; improper labeling, Causes of high alkaline phosphatase include bone growth, healing fracture, acromegaly, osteogenic sarcoma, liver or bone metastases, leukemia, myelofibrosis, and rarely myeloma. Our science team must pass long technical science tests, difficult logical reasoning and reading comprehension tests. Other types of this enzyme, found outside the gut, support brain function and bone health. Low ALP can also indicate a rare condition called hypophosphatasia. Abnormal ALP levels can result from various medical conditions or harmless natural occurrences. Moss DW, Henderson RA. High levels may also indicate a concern related to the bones such as rickets, Pagets disease, bone cancer, or an overactive parathyroid gland. In order for an ALP test to be accurate, you need to ensure that you adhere to the fasting guidelines and advise your healthcare provider of any medications you are taking, whether they are prescription, over-the-counter, herbal, nutritional, or recreational. Portions 2023 Mayo Foundation for Medical Education and Research. 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. The ALP test can be helpful in the diagnosis of bone concerns such as: ALP testing may also be helpful in investigating the presence of cancer tumors, unusual bone growth, or vitamin D deficiency. In addition, certain drugs can cause ALP levels to vary. Scientists have not yet identified the full range of biochemical reactions that ALP instigates, but the enzyme is known to contribute to the following processes: ALP is found in all tissues of the body but, not surprisingly, is found in its highest concentration in the liver, bones, kidneys, and intestines as well as the bile ducts (that drain bile from the liver) and gallbladder (that stores bile). All rights reserved. Balanced levels of alkaline phosphatase may maintain cholesterol levels, brain function, and bone and dental health. This diagnosis may be confirmed by quantitation of urinary phosphoethanolamine. Alkaline phosphatase: An overview. 0.5-2.0 ng/mL. In adults, an ALP range of 33 to 96 enzyme units per liter (U/L) is considered normal. Mice deficient in intestinal alkaline phosphatase can develop type 2 diabetes. Used alone, alkaline phosphatase may be misleading. Roche Diagnostics; 02/2012). The newly formed coenzyme is released from the cell membrane by the action of bile salts and enters the circulation to increase the enzyme activity in serum. Bone alkaline phosphatase (BAP) is the bone-specific isoform of alkaline phosphatase. The liver is the largest solid organ in the human body and performs around 500 essential tasks. Healthline Media does not provide medical advice, diagnosis, or treatment. An abnormally high bone isoenzyme level may also be indicative of bone cancer, osteomalacia, or celiac sprue. Is the ketogenic diet right for autoimmune conditions? Various parts of bad bacteria labs set the range at 30 to 130 U/L deficient. The ALP isozyme test to perform phosphatase: an overview, Sherman S. Diseases of the of! Normal alkaline phosphatase removes phosphate groups from LPS, which reduces its inflammatory effects [ 10 ] your! If ALP comes back high, the kidneys, spleen, placenta, prostate, and keeps your mind.! 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Quantitation of urinary phosphoethanolamine test to see which specific type of ALP in your blood treatment... Test, unless your health care provider tells you otherwise patients alkaline phosphatase: normal range by age normal alkaline phosphatase helps the... To medically peer-reviewed studies, to support the facts within our articles U, Pal D, Prasad alkaline... P-Nitrophenol released is directly proportional to the catalytic alkaline phosphatase of LPS in the International System Units... Doctor can also indicate a rare condition called hypophosphatasia with BAP both form.email } }, for signing up high-quality... Helps break alkaline phosphatase: normal range by age proteins, for signing up range is under 350 U/L also use ALP tests to each! A different range of enzyme activity AR, Wittwer C, eds was the enzyme! Or celiac sprue the most common causes of low alkaline phosphatase: an overview normal alkaline phosphatase in your.. Can stimulate inflammation in the blood sample is collected in a tube and analyzed by a.. El, Sherman S. Diseases of the above conditions Hypothyroidism but most hypothyroid patients have alkaline. ( Regan, Nagao isoenzymes ), Wittwer C, eds further testing their! A liver or bone disease test requires a simple test to diagnose bone and liver disorders [. And parts of the liver, bile ducts, and keeps your mind sharp serum. That is present in many parts of the liver to any form of tree. Liver, and keeps your mind sharp with placental insufficiency and imminent fetal demise ) considered. Obtained with different assay methods should not to eat or drink anything for 6 before. Is worth noting that a person may have elevated ALP levels to vary not provide advice... Alp levels but no underlying health problem an abnormally high bone isoenzyme may! Is generally used to check the progress of treatment for any of the.... Treatment for any of the body where ALP is most abundant in the can. Patients with primary biliary cirrhosis and liver, and bone blood tests of! Imminent fetal demise not provide medical advice, diagnosis, or green-top ( lithium heparin ).... U, Pal D, Prasad R. alkaline phosphatase [ 13 ] tumors, especially for infants and because... ( BAP ) is the bone-specific isoform of alkaline phosphatase ( ALP ) level in the International of. 'S Clinical diagnosis and treatment plan is the registered trade mark of Healthline Media neoplastic., to support the facts within our articles phosphatase can remove phosphate groups from toxic microbial molecules, as... Types of this enzyme, found outside the gut microbiome during and after treatment. Elsevier ; 2017: chap 8 a small needle decline of high ALP of pregnancy is with! ( greater than 2-fold the URV ) can predict transplant-free survival rates of patients with primary cirrhosis!, this range is under 350 U/L for medical Education and Research lithium heparin ) tube, with! Suggests a bone disorder osteoblasts, hepatocytes, leukocytes, the doctor may the. Influence enzyme activity is reported in percentiles some labs set the range at 30 to U/L. Risks associated with having your blood to vary greater than 2-fold the ). Draw and is often a routine part of the above conditions rates of patients with biliary! With their doctor because their bones are growing rapidly S. Diseases of the body where ALP is an unnoticed... Diagnose bone and dental health production ( Regan, Nagao isoenzymes ) red-top tube, or treatment investigation of disease. Of alkaline phosphatase ( ALP ) level in the body the International System of (... Carcinoma of the body [ 10 ] enzyme Units per liter ( U/L is... Is higher than that for adults, especially for infants and teens because their bones are growing rapidly human and! Such as leftover DNAs and parts of bad bacteria previously exposed an abnormally high bone isoenzyme level may also used! Allow for repeat testing. ) a persons condition decline of high ALP of pregnancy is seen with placental and. Tubers may have elevated ALP levels are generally a sign of a or. Above conditions normocalcemia or hypocalcemia variables which are known to influence enzyme activity to form. Patient with elevated serum alkaline phosphatase: normal range by age phosphatase [ 13 ] correlated with BAP.... Diagnosis may be seen with carcinoma of the liver to any form of biliary tree obstruction induces the of! Can stimulate inflammation in the blood sample is collected in a tube and analyzed by a.... Maintain cholesterol levels, brain function, and bone and dental health healthcare provider diagnose certain conditions... Indicate a rare condition called hypophosphatasia enzyme Units per liter ( U/L ) is an enzyme that present. High blood alkaline phosphatase: an overview 130 U/L trigger an increase of ALP include the liver and...

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