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Alkaline phosphatase (ALP)
Related Subjects: |Chronic liver disease |Cirrhosis |Alkaline phosphatase (ALP) |Liver Function Tests |Ascites Assessment and Management |Budd-Chiari syndrome |Autoimmune Hepatitis |Primary Biliary Cirrhosis |Primary Sclerosing Cholangitis |Wilson disease |Hereditary Haemochromatosis |Alpha-1 Antitrypsin (AAT) deficiency |Non-alcoholic steatohepatitis (NASH) |Spontaneous Bacterial Peritonitis |Alcoholism and Alcoholic Liver Disease
ℹ️ About
- Bone derived ALP is a marker of osteoblast activity seen when new bone is being laid down.
- Hepatobiliary derived ALP is typically seen with cholestasis and GGT is also elevated.
- It is also produced by the gut and placenta
Sample requirements
- For adults, blood taken into a 5mL gold top gel tube (or rust top for the Acute Unit)
🧬 Aetiology
- There are two isoenzymes derived from bone and liver, and placenta.
- It is called alkaline phosphatase as it acts best at a pH of 9-10.
- The action of the enzyme is to remove 5' phosphate groups from DNA and RNA.
- It will also remove phosphates from nucleotides and proteins.
Increased Alkaline Phosphatase
- Normal Calcium
- Growing children and Teenagers
- Congestive cardiac failure
- Following a fracture
- Paget's disease ↑ bone turnover
- Placenta so pregnancy
- Obstructive liver disease
- Low calcium
- Osteomalacia/Rickets - check 25(OH)D3
- Renal failure
- High Calcium in some
- Hyperparathyroidism
- Paget's disease- increased bone turnover
- Metastases - osteoblastic e.g. Breast, Prostate
Liver - Heat stable isoenzyme ALP1
- Elevated along with GGT and 5' nucleotidase
- Elevated with any cause of liver obstruction
- Primary biliary cirrhosis, Hepatic metastases
- Mild elevations in hepatitis and liver congestion
Bone - Heat labile ALP2 isoenzyme "Bone burns"
- Paget's disease, Hyperparathyroidism
- Osteoblastic Bone met - Breast and Prostate
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