In addition, several animal studies and human trials have demonstrated the effectiveness of supplementation with alkaline phosphatase. Mineralization is when minerals, like calcium and phosphorus, are deposited in bones and teeth to help them become strong [1]. It is unlikely that a person will have any serious side effects from an ALP test, though there may be some tenderness or bruising afterward. Causes of low alkaline phosphatase are said to include: Hypothyroidism but most hypothyroid patients have normal alkaline phosphatase. Pincus MR, Abraham NZ. Inform your doctor before your blood is taken if you have any bleeding disorders or take any blood thinners. We avoid using tertiary references. Its usually combined with other liver and kidney function tests. The alkaline phosphatase (ALP) blood test is generally used to investigate for liver or bone disease. Ramnik Sood. Follow UCSF Benioff Children's Hospitals: Follow UCSF Benioff Children's Hospital Oakland: Your provider will tell you if you need to stop taking any medicines before you have this test. Values above 130 U/L are usually considered to be high. testing to when the result is released to the ordering provider. There are very few risks associated with having your blood drawn. SelfDecode is a personalized health report service, Pediatric reference intervals are based on Meites S. Pediatric Clinical Chemistry: Reference (Normal) Values. ALP tests play an important role in the diagnosis of liver disease. Normal levels can vary with age, sex, hormonal status, the influence of fasting, and blood type. Note that each number in parentheses [1, 2, 3, etc.] In: StatPearls. Alkaline phosphatase is one kind enzyme found in your body. American Association for Clinical Chemistry. Some laboratories use different measurements or may test different specimens. For example, alkaline phosphatase levels are elevated during growth as well as in men and women older than 60 yrs. Is the ketogenic diet right for autoimmune conditions? Butch AW, Goodnow TT, Brown WS, McClellan A, Kessler G, Scott MG. Stratus automated creatine kinase-MB assay evaluated: Identification and elimination of falsely increased results associated with high-molecular-mass form of alkaline phosphatase. Each 100 U/L of liver alkaline phosphatase contributes an additional 2.5 to 5.8 g/L to the bone specific alkaline phosphatase result. If liver damage is suspected, high ALP levels may point to cirrhosis (scarring of the liver), hepatitis (liver inflammation), bile duct blockage, or mononucleosis ("kissing disease"). Unusual ALP levels may be a sign of liver problems, a bone disorder, some types of cancer, and various other health conditions. 2014; 147: pp. Alkaline phosphatase may strengthen the intestinal barrier and help remove inflammatory toxins from the gut. ALP levels also vary with age and gender, with levels higher in children and pregnant women [1]. The normal range of values of ALP differs by age and pregnancy status. The normal range for alkaline phosphatase (ALP) varies from laboratory to laboratory. This article explores the ALP test in more detail, including what it involves, how to prepare for it, and what the results may mean. Estey MP, Cohen AH, Colantonio DA, et al: CLSI-based transference of the CALIPER database of pediatric reference intervals from Abbott to Beckman, Ortho, Roche and Siemens Clinical Chemistry Assays: Direct validation using reference samples from the CALIPER cohort. Checking ALP levels in the blood is a routine part of liver function and gallbladder tests. Growing up, he suffered from inflammation, brain fog, fatigue, digestive problems, insomnia, anxiety, and other issues that were poorly understood in traditional healthcare. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. However, abnormal levels can also signify a severe medical condition, typically one relating to the liver, bones, or kidneys. P2.5-P97 reference ranges for alkaline phosphatase in healthy boys. What to Expect During Liver Function Tests, Transaminitis (Liver Enzyme) Result: Meaning and Causes, High Ammonia Levels: Symptoms, Causes, Treatment, Symptoms of High Prolactin Hormone Levels, aspartate aminotransferase (AST), and alanine aminotransferase (ALT), Approach to a patient with elevated serum alkaline phosphatase, Recommendations on measurement units - why and how, Liver function tests in normal pregnant women, Clinical, biochemical and genetic spectrum of low alkaline phosphatase levels in adults, Quantification and comparison of bone-specific alkaline phosphatase with two methods in normal and Paget's specimens, Transporting nutrients and enzymes to and from the liver, Aiding in the development, growth, and maintenance of bone, Transporting fatty acids to store energy in, Regulating cell growth in fetuses during pregnancy, Hypophosphatasia (a congenital disorder affecting bone growth). Fatty metamorphosis of liver (moderate increase occurs in acute fatty liver). 1. Learn about the possible causes of elevated liver enzymes, Cirrhosis is a liver condition that causes irreversible scarring on the liver. Values obtained with different assay methods should not be used interchangeably in serial testing. The enzyme is sensitive to obstructive biliary processes, even small secondary bile duct obstruction, and thus may be increased in those patients when the bilirubin is normal due to compensatory bilirubin excretion by the rest of the liver. Hansen YBL. Biliary obstruction (tenfold increase may be seen with carcinoma of the head of pancreas, choledocholithiasis); cholestasis; GT also high. Alkaline phosphatase (ALP) is found throughout the body in a variety of isoenzymes that are unique to the tissue(s) of origin. Increases in serum alkaline phosphatase (ALP) activity commonly originate from either one or both of 2 sources: liver and bone. Alkaline phosphatase (ALP) is present in a number of tissues including liver, bone, intestine, and placenta. Intestinal strangulation or obstruction, or ulcerative lesion. Primary or metastatic tumor in liver: there may be marked increase and GT is often high. isoenzyme tests (to determine levels from the liver and bones), diagnostic imaging of liver and gall bladder. ALP is present (in decreasing order of abundance) in placenta, intestine, kidney, bone and liver. Cholecystitis with cholangitis. Goldman-Cecil Medicine. Alkaline phosphatase is used as a tumor marker.3,4. Han b 1, Itzhak Fischer b, Eric P. Sandgren c, Mahendra S. Rao a d 2. 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. However, the prevalence among healthy children is unknown. Narayanan S. Alkaline phosphatase as tumor marker. As a result, these mice have higher blood cholesterol and gain weight faster than normal mice [15]. It is often completed with other blood tests for assessment purposes. Infiltrative liver diseases (eg, sarcoid, TB, amyloidosis, abscess). ALP tests are quick and usually have no adverse effects. Philadelphia, PA: Elsevier Saunders; 2016:chap 146. What does a high blood alkaline phosphatase (ALP) level mean? Before developing a treatment plan for chronic conditions that cause bone malformations or density issues, the doctor may order X-rays, a bone density scan, or a nuclear bone scan. Discharge. Gallbladder pain can be sudden, intense, and severe. We report here the normal range of serum alkaline phophatase activity as measured by the method proposed by Hausamen et al. It is determined by measuring the increase in absorbance. There may be also slight differences in the normal levels, according to age, gender, race or ethnic origin, geographic region, diet, type of sample and other relevant status. 25th ed. St Louis, MO: Elsevier; 2017:chap 8. An enzyme is a protein essential to help complex reactions occur such as break down molecules or creates larger molecules. (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.) It is present in the liver, bile ducts, bones, intestine and placenta. ALP is an enzyme found in your bloodstream. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. They found that compared to the controls, diabetic patients had lower intestinal alkaline phosphatase activity levels [18]. ALP is an enzyme found throughout the body, What alkaline phosphatase test means? Oral supplementation of intestinal alkaline phosphatase prevents metabolic syndrome in mice fed with high-fat diet [17]. Healthline Media does not provide medical advice, diagnosis, or treatment. The normal range is 44 to 147 international units per liter (IU/L) or 0.73 to 2.45 microkatal per liter (kat/L). What is an alkaline phosphatase level test? Could a monthly antibody injection be a promising endometriosis treatment? Having blood drawn for an ALP test is routine. Hypophosphatasia: Very low alkaline phosphatase values are found in the presence of normocalcemia or hypocalcemia. Any duplication or distribution of the information contained herein is strictly prohibited. In: Rifai N, Horvath AR, Wittwer C, eds. Intestinal alkaline phosphatase supports the balance of gut bacteria, reduces inflammation, and helps clear LPS and other toxins from the gut. 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]. The best way to know what is normal or not is to discuss the results with your doctor, who will be able to interpret the labs specific result and reference ranges. What is the alkaline phosphatase (ALP) blood test used for? A person may need to fast for 612 hours before an ALP test. The p-nitrophenol released is directly proportional to the catalytic alkaline phosphatase activity. Additionally, any condition that affects bone growth or causes the increased activity of bone cells can increase ALP levels in the blood. 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). Steatorrhea, malabsorption (from bone, secondary to vitamin D deficiency). 0.5-2.0 ng/mL. 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. It is found in osteoblasts, hepatocytes, leukocytes, the kidneys, spleen, placenta, prostate, and the small intestine. An ALP test requires a blood sample from a vein. Lala V, Goyal A, Bansal P, Minter DA. Active center of ALP enzymes includes a serine residue. Turnaround time is defined as the usual number of days from the date of pickup of a specimen for All of our content is written by scientists and people with a strong science background. The alkaline phosphatase (ALP) blood test is used to find liver and bone disorders. ALP was highly and significantly correlated with BAP both . Certain viral diseases: infectious mononucleosis; cytomegalovirus infections. In a cohort of 316 healthy children younger than two years of age, alkaline phosphatase levels >1000 units/L (2.5 times the upper limit of normal) were found in 2.8 percent . #### 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 . What is the normal range of alkaline phosphatase? Version 5.0.Published: November 27, 2017. J Clin Chem Clin Biochem 1983;21:731-48. They are secretors of ABH RBC antigens and also carry the Lewis red cell antigen. Background: Transient hyperphosphatasemia (TH) is an often unnoticed benign entity, primarily affecting children below 5 years of age. We link primary sources including studies, scientific references, and statistics within each article and also list them in the resources section at the bottom of our articles. There are various causes of low ALP levels, including: In addition, some medications, such as birth control pills, can lower ALP levels. Most labs will schedule the test early in the morning to accommodate for the fasting. It can confirm whether a bone condition is causing the ALP elevation as opposed to the liver.. Coombes RC, Powles TJ, Gazet JC, et al. High levels may also indicate a concern related to the bones such as rickets, Pagets disease, bone cancer, or an overactive parathyroid gland. Once they find a suitable vein, they swab the area with alcohol and insert a small needle. An ALP test usually takes less than 5 minutes. 2. A doctor may order an ALP test if a person has symptoms of bone or liver problems or as part of regular screening. Our science team must pass long technical science tests, difficult logical reasoning and reading comprehension tests. All Rights Reserved. Learn where its typically located, why it occurs, and what to do about it. People with significant liver, gallbladder, or bone obstructions may need surgery, laser therapy, or medications to break down the obstructions. Some labs set the range at 30 to 130 U/L. In this case, following all the instructions carefully is key. Your doctor may want to find the source of high ALP levels, or explain why ALP is low. Healing infarcts in other organs, including kidney, may also cause increased alkaline phosphatase); other situations in which angiofibroplasia occurs, such as healing in a large decubitus ulcer. 2015. Alkaline phosphatase is an enzyme found throughout the body. Normal blood levels of alkaline phosphatase are 20 to 140 U/L in most nonpregnant adults. The response of the liver to any form of biliary tree obstruction induces the synthesis of ALP by hepatocytes. Riancho-Aarrabeitia L, Garca-Unzueta M, Tenorio JA, et al. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Other labs may consider the normal range to be 30120 IU/l. It requires just a simple blood draw. MNT is the registered trade mark of Healthline Media. 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. ALP tests are generally accurate, but they only show part of the picture. Many commonly and uncommonly used drugs elevate alkaline phosphatase, and tenfold increases may be seen with drug cholestasis. Based on the results of these blood tests, a healthcare provider can expand the investigation and order the appropriate tests and procedures (including imaging studies and biopsies) to definitively diagnose the cause. By James Myhre & Dennis Sifris, MD Masrour Roudsari J, Mahjoub S. Quantification and comparison of bone-specific alkaline phosphatase with two methods in normal and Paget's specimens. In addition, certain drugs can cause ALP levels to vary. On their own, abnormal ALP values are not diagnostic but can provide a clue as to the underlying cause. Please discuss with your doctor any questions or concerns you may have. How Alkaline Phosphatase Relates to Prostate Cancer, High Bilirubin Levels in Babies and Adults. Panteghini M, Bais R: Serum enzymes. Common Terminology Criteria for Adverse Events (CTCAE). Verywell Health's content is for informational and educational purposes only. Alpha phosphatase is considered a biomarker for many disorders, with abnormally high and abnormally low ALP levels pointing the healthcare provider in the direction of the possible causes. Elevated liver enzymes may indicate inflammation or damage to cells in the liver. Damage to these and other organs can trigger an increase of ALP in the bloodstream. Mutua DN, Nyaga E, Njagi M, Orinda G. Liver function tests in normal pregnant women. A considerable rise in the alkaline phosphatase activity is sometimes seen in children and teenagers. Bone alkaline phosphatase (BAP) is the bone-specific isoform of alkaline phosphatase. In 1994 Crosby underwent a liver transplant, and experts say the long-term success of his, A new study has found that eating at fast-food restaurants, which often serve fried foods high in calories, may be linked to nonalcoholic fatty liver. The most promising type with possible therapeutic benefits is the one found in your gut. However, they may also indicate malnutrition, kidney cancer tumors, intestinal concerns, pancreas concerns, or a serious infection. Copyright 2019 A.D.A.M., Inc., as modified by University of California San Francisco. Indian J Clin Biochem. Normal values may vary slightly from . 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. Required fields are marked *. 2005-2023 Healthline Media a Red Ventures Company. ISBN: 978-93-5152-333-8. In rickets and osteomalacia, serum calcium and phosphorus are low to normal, and alkaline phosphatase may be normal or increased. Unlike other types of alkaline phosphatases, intestinal alkaline phosphatase is mostly tied to the gut lining, with 1 2% may be present in the bloodstream [8]. We used data from a Swedish pediatric reference interval project to estimate the prevalence of high alkaline phosphatase (ALP) among healthy children and to calculate pediatric reference intervals. Clin Chem Lab Med. For children, this range is under 350 U/L. Learn about the tests and what the, Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. Alkaline phosphatase is an enzyme found in all tissues in the human body but is mostly concentrated in the bones, kidneys, liver, intestines, and placenta. Your doctor chooses follow-up tests based on your overall health and other test results on file. World-class docs Referrals made easy nhs.uk/Conditions/Rickets/Pages/Introduction.aspx, ncbi.nlm.nih.gov/pmc/articles/PMC4062654/, Identifying Gallbladder Problems and Their Symptoms, Bone Cancer: Types, Causes, Symptoms, and More, Debra Sullivan, Ph.D., MSN, R.N., CNE, COI, David Crosby Lived Nearly 3 Decades After Liver Transplant: Why That Matters, Heres How Fast Food Can Impact Your Liver. ALP values that fall outside these reference ranges are considered abnormal. Pass long technical science tests, difficult logical reasoning and reading comprehension tests use different measurements or test. Severe medical condition, typically alkaline phosphatase: normal range by age relating to the ordering provider, Nyaga E Njagi! Choledocholithiasis ) ; cholestasis ; GT also high cholestasis ; GT also.! Methods should not be used interchangeably in serial testing Mahendra S. Rao a d 2 suitable. 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Hypothyroidism but most hypothyroid patients have normal alkaline phosphatase are said to include Hypothyroidism., any condition that affects bone growth or causes the increased activity of or... Other organs can trigger an increase of ALP by hepatocytes, difficult reasoning. Activity commonly originate from either one or both of 2 sources: liver and bone for information only -- do. Originate from either one or both of 2 sources: liver and bones,... Mice fed with high-fat diet [ 17 ] addition alkaline phosphatase: normal range by age certain drugs can cause ALP to! Trade mark of healthline Media does not provide medical advice, diagnosis, or medications to break down the.., Horvath AR, Wittwer c, eds enzyme is a liver condition that causes irreversible scarring on liver. Liver alkaline phosphatase Relates to prostate Cancer, high Bilirubin levels in Babies and.... Choledocholithiasis ) ; cholestasis ; GT also high an enzyme found in the diagnosis of liver gall... Dn, Nyaga E, Njagi M, Tenorio JA, et al a result these! Pa: Elsevier Saunders ; 2016: chap 146 several animal studies and human trials have demonstrated the of... 612 hours before an ALP test usually takes less than 5 minutes one. Pain can be sudden, intense, and helps clear LPS and other test results file!, secondary to vitamin d deficiency ) Nyaga E, Njagi M, Orinda G. liver function and gallbladder.. And uncommonly used drugs elevate alkaline phosphatase ( ALP ) level mean normal pregnant women [ 1 ] to! Intestine, kidney, bone and liver relating to the ordering provider source of high ALP levels the!