Alkaline Phosphatase (ALP)

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Alkaline phosphatase is an enzyme found in high amounts in bone and liver. Smaller amounts of ALP are found in the placenta of women who are pregnant, and in the intestines. Each of these body parts makes different forms of ALP. The different forms are called isoenzymes.


Alkaline phosphatase in serum consists of 4 structural genotypes: the liver-bone-kidney type, the intestinal type, the placental type, and the variant from the germ cells. It occurs in osteoblasts, hepatocytes, leukocytes, the kidneys, spleen, placenta, prostate, and the small intestine. The liver-bone-kidney type is particularly important.

A rise in the alkaline phosphatase occurs with all forms of cholestasis, particularly with obstructive jaundice. It is also elevated in diseases of the skeletal system, such as Paget disease, hyperparathyroidism, rickets and osteomalacia, as well as with fractures and malignant tumours. A considerable rise in the alkaline phosphatase activity is sometimes seen in children and juveniles. It is caused by increased osteoblast activity following accelerated bone growth.


Fasting is preferred but not essential for this test. Eating a meal can increase the ALP level slightly for a few hours in some people. It is usually better to do the test after fasting overnight. In this case, only water is permitted.


ALP is generally part of a routine laboratory test profiles called liver function tests or bone profile. It is usually requested with several other tests if a patient has symptoms of a liver or bone disorder. It mostly used to diagnose and monitoring treatment of liver, bone, intestinal, and parathyroid diseases.


Raised levels of ALP are usually due to a disorder of either the bone or liver. If other liver function tests such as bilirubin, gamma-glutamyl transferase (GGT) or alanine aminotransferase (ALT) are also raised, this usually indicates that the ALP is coming from the liver. However, if calcium and phosphate measurements are abnormal, this suggests that the ALP might be coming from the bone. In some forms of liver disease, such as hepatitis, ALP is usually much less elevated than AST or ALT. However, when the bile ducts are blocked (for example by gallstones, scars from previous gallstones or surgery, or by a tumour), ALP and bilirubin may be increased much more than either AST or ALT.

ALP can also be raised in bone diseases such as Paget’s disease (where bones become enlarged and deformed), osteomalacia, in certain cancers that spread to bone or in vitamin D deficiency.


The laboratory test results are NOT to be interpreted as results of a "stand-alone" test. The test results have to be interpreted after correlating with suitable clinical findings and additional supplemental tests/information. Your healthcare providers will explain the meaning of your tests results, based on the overall clinical scenario. Certain medications that you may be currently taking may influence the outcome of the test. Hence, it is important to inform your healthcare provider of the complete list of medications (including any herbal supplements) you are currently taking. This will help the healthcare provider interpret your test results more accurately and avoid unnecessary chances of a misdiagnosis.

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