Micrograph showing changes that may be associated with an elevated alkaline phosphatase (cholestasis and feathery degeneration). Liver biopsy. H&E stain.
Specialty
Pathology
Elevated alkaline phosphatase occurs when levels of alkaline phosphatase (ALP) exceed the reference range. This group of enzymes has a low substrate specificity and catalyzes the hydrolysis of phosphate esters in a basic environment. The major function of alkaline phosphatase is transporting chemicals across cell membranes.[1] Alkaline phosphatases are present in many human tissues, including bone, intestine, kidney, liver, placenta and white blood cells.[2] Damage to these tissues causes the release of ALP into the bloodstream. Elevated levels can be detected through a blood test. Elevated alkaline phosphate is associated with certain medical conditions[3] or syndromes (e.g., hyperphosphatasia with mental retardation syndrome, HPMRS). It serves as a significant indicator for certain medical conditions, diseases and syndromes.[citation needed]
If the cause for alkaline phosphatase elevation is unknown, isoenzyme studies using electrophoresis can confirm the source of the ALP. Heat stability also distinguishes bone and liver isoenzymes ("bone burns, liver lasts").[clarification needed]
It is essential to use age-specific normal reference values, as healthy infants and children usually have levels that would be considered elevated in adults.[4] Additionally, ALP levels are "not well defined" as of 2020, and can vary by sex and by racial group.[5] Latinos tend to have higher normal levels, followed by those of African heritage, Europeans, and Asians or Pacific Islanders tend to have the lowest baseline ALP levels (all groups assuming body mass index within normal weight range).[5] Men tend to have slightly higher normal ALP levels than women,[5] except during pregnancy.
^Celik, Handan; Tosun, Midraci; Cetinkaya, Mehmet Bilge; Bektab, Ahmet; Malatyalýodlu, Erdal (2009-08-01). "Markedly elevated serum alkaline phosphatase level in an uncomplicated pregnancy". The Journal of Maternal-Fetal & Neonatal Medicine. 22 (8): 705–7. doi:10.1080/14767050802702323. PMID 19544151. S2CID 37866377.
^Kaplan, Marshall M. (1972). "Alkaline Phosphatase". New England Journal of Medicine. 286 (4): 200–2. doi:10.1056/nejm197201272860407. PMID 4550137.
^Li-Fern H, Rajasoorya C (February 1999). "The elevated serum alkaline phosphatase—the chase that led to two endocrinopathies and one possible unifying diagnosis". Eur. J. Endocrinol. 140 (2): 143–7. doi:10.1530/eje.0.1400143. PMID 10069658.
^Gholami Bahnemiri M, Mirabedini S, Mohammadi P, Barmaki H, Qaffaripour Z, Rezapour M, Alijanpour M (2022). "Determination of serum alkaline phosphatase reference in healthy children aged 1-18 years". Caspian J Intern Med. 13 (4): 749–756. doi:10.22088/cjim.13.4.749. PMC 9659844. PMID 36420337.
^ abcGonzalez H, Imam Z, Wong R, Li J, Lu M, Trudeau S, Gordon S, Imam M, Gish R (October 2020). "Normal alkaline phosphatase levels are dependent on race/ethnicity: NationalGEP Health and Nutrition Examination Survey data". BMJ Open Gastroenterol. 7 (1): e000502. doi:10.1136/bmjgast-2020-000502. PMC 7559036. PMID 33055108.
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