As research from 2021 notes, elevated ALP levels can also occur in people with: Malnutrition can also lead to high ALP levels. Active center of ALP enzymes includes a serine residue. Elsevier; 2018:404-434, 2. Extraordinary kid care An obstruction of the liver or damage to it causes ALP levels to rise. Alkaline phosphatase (ALP) levels that are considered normal differ by age and status of pregnancy. Labs & Appointments Toggle Labs & Appointments, Billing & Insurance Toggle Billing & Insurance, Diseases & Conditions Toggle Diseases & Conditions, OnDemand Testing Toggle OnDemand Testing, Testing by Disease & Condition Toggle Testing by Disease & Condition, Testing & Services For Toggle Testing & Services For, Hospitals & Physician Systems Toggle Hospitals & Physician Systems, Managed Care Health Plans Toggle Managed Care Health Plans, Lab Data Integrations & Tools Toggle Lab Data Integrations & Tools, Employee Wellness & Testing Toggle Employee Wellness & Testing, Government & Education Toggle Government & Education, Therapeutic Indications Toggle Therapeutic Indications, Development Phase Toggle Development Phase, Compounds & Molecules Toggle Compounds & Molecules. Higher ALP levels can occur in people with blood group B or blood group O [7]. The normal range is 44 to 147 international units per liter (IU/L) or 0.73 to 2.45 microkatal per liter (kat/L). The normal range of alkaline phosphatase in the blood is 20 to 140 U/L. ALP plays a role in numerous processes in the human body, and any abnormalities in blood concentrationseither high or lowmay be indicative of diseases ranging from gallstones and thyroid disease to hepatitis and cancer. There is evidence that thyroid hormone (T3) acts to stimulate bone alkaline phosphatase activity through an osteoblast nuclear receptor-mediated process.5. They also can vary with age and sex. 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]. In: Burtis CA, Ashwood ER, eds. Tietz textbook of clinical chemistry. Looks like youre visiting Benioff Children's Hospitals on Internet Explorer. Gallbladder pain can be sudden, intense, and severe. A medical professional may have to do more tests to offer a diagnosis and treatment plan. Intestinal strangulation or obstruction, or ulcerative lesion. 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). If a red-top tube or green-top tube is used, transfer separated serum or plasma to a plastic transport tube. If the alkaline phosphatase (ALP) is high and the GGT is in normal range it suggests a bone disorder. 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. Our team comprises of trained MDs, PhDs, pharmacists, qualified scientists, and certified health and wellness specialists. Fogel EL, Sherman S. Diseases of the gallbladder and bile ducts. 1. . In: Rifai N, Horvath AR, Wittwer C, eds. 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. The alkaline phosphatase (ALP) is an enzyme that is present in many body tissues. Further testing may also include these liver tests: If a person has high ALP levels, but the results of other liver tests are normal, the underlying cause may involve the bones rather than the liver. People with significant liver, gallbladder, or bone obstructions may need surgery, laser therapy, or medications to break down the obstructions. Learn more about the liver here. Low ALP can also indicate a rare condition called hypophosphatasia. Bottom number is diastolic pressure when heart is at rest. Elevated levels can also result from an increase in bone cell activity. In some cases, additional time should be Many commonly and uncommonly used drugs elevate alkaline phosphatase, and tenfold increases may be seen with drug cholestasis. Joe Cohen flipped the script on conventional and alternative medicineand it worked. 2016;29:40-5. doi:10.1016/j.ejim.2015.12.019. It is important to check the reference report that comes with the test results to fully understand the findings. Call 911 for all medical emergencies. Can Fatty Liver Disease Cause Sudden Death? Malnutrition has been reported to relate to low values, but in practice, diseases causing malnutrition relate often to high alkaline phosphatase results (eg, disseminated neoplasia). Normal values may vary slightly from laboratory to laboratory. In rickets and osteomalacia, serum calcium and phosphorus are low to normal, and alkaline phosphatase may be normal or increased. 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. ALP is also found in the placenta, kidneys . Alkaline phosphatase (ALP) is present in a number of tissues including liver, bone, intestine, and placenta. Enzyme activity is localized in the brush border of the proximal convoluted tubule of the kidney, intestinal mucosal epithelial cells, hepatic sinusoidal membranes, vascular endothelial cells and osteoblasts of bone. Familial increased serum intestinal alkaline phosphatase: A new variant associated with Gilbert's syndrome. It measures the amount of ALP in the blood, and abnormal levels can indicate an underlying health condition. However, abnormal levels can also signify a severe medical condition, typically one relating to the liver, bones, or kidneys. 25th ed. Goldman-Cecil Medicine. P2.5-P97 reference ranges for alkaline phosphatase in healthy boys. 2021 Laboratory Corporation of America Holdings and Lexi-Comp Inc. All Rights Reserved. Red-top tubes should be centrifuged and aliquoted within 2 hours of collection. The normal range of alkaline phosphatase in the blood is 20 to 140U/L, although this can vary from lab to lab. We've got you covered. 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. The liver is an essential organ that plays a key role in your health. In addition, certain drugs can cause ALP levels to vary. 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. Parenteral hyperalimentation of glucose, intravenous albumin administration. The response of the liver to any form of biliary tree obstruction induces the synthesis of ALP by hepatocytes. It is found in osteoblasts, hepatocytes, leukocytes, the kidneys, spleen, placenta, prostate, and the small intestine. Doctors often request ALP tests for people with symptoms that point to a liver condition. It requires just a simple blood draw. Clinical, biochemical and genetic spectrum of low alkaline phosphatase levels in adults. Last medically reviewed on November 5, 2021. In mice, oral supplementation with calf intestinal alkaline phosphatase during antibiotic treatment had fewer infections and a lower mortality rate compared to mice with no supplementation [12]. It may be one of many tests in a liver panel, for example. Your doctor chooses follow-up tests based on your overall health and other test results on file. ALP is an enzyme found in your bloodstream. Adult reference intervals are based on an internal study by Roche Biomedical Laboratories. Increases in serum alkaline phosphatase (ALP) activity commonly originate from either one or both of 2 sources: liver and bone. Read our, Alkaline Phosphatase (ALP) Testing: What to Expect. Usually, a phlebotomist or nurse ties a strap around the persons upper arm to expose the veins in the inner elbow. Your doctor may want to find the source of high ALP levels, or explain why ALP is low. The liver-bone-kidney type is particularly important. The normal range for children is higher than that for adults, especially for infants and teens because their bones are growing rapidly. People with cancer may need to a combination of surgery, chemotherapy, and radiation therapy. Cirrhosis, especially in primary biliary cirrhosis, in which fivefold or more increases are seen. Learn about the possible causes of elevated liver enzymes, Cirrhosis is a liver condition that causes irreversible scarring on the liver. This enzyme functions in an alkaline environment (optimum pH of 10). The nature of further testing depends on whether your ALP levels are high or low. ALP is an enzyme present in many parts of the body. Learn about the causes of cirrhosis, diagnosis, prevention, and how to. Increases may also be seen as a consequence of a reaction to drug therapy, and ALT/ALP-based criteria to discriminate the type of liver injury in drug-induced hepatic toxicity have been recommended. 0.7 mL (Note: This volume does not allow for repeat testing.). Mutua DN, Nyaga E, Njagi M, Orinda G. Liver function tests in normal pregnant women. 6. By James Myhre & Dennis Sifris, MD Fatty metamorphosis of liver (moderate increase occurs in acute fatty liver). Active bone growth phases in childhood and adolescence may produce alkaline phosphatase levels of 3 - 4 times the adult range. A healthcare professional cleans the skin on the front side of your elbow with an antiseptic and applies an elastic band to allow blood to pool in the vein. The normal range of values of ALP differs by age and pregnancy status. Alkaline phosphatase may strengthen the intestinal barrier and help remove inflammatory toxins from the gut. In Paget disease of bone there is often isolated elevation of serum alkaline phosphatase. Hepatitis: Moderate increases in alkaline phosphatase occur in viral hepatitis, but greater elevations of the transaminases (AST [SGOT], ALT [SGPT]) are usually found. Admission. In pregnant people, ALP is made in the placenta. The correlation coefficient of alkaline phosphatase and serum vitamin D3 levels was r =0.05 (p =0.593). . In the statistical analysis the sample population is subdivided by sex and age, two variables which are known to influence enzyme activity. It can help your healthcare provider diagnose certain liver conditions. The treatment for abnormal ALP levels depends on the cause. A normal level in the first trimester of pregnancy is between 17 to 88 U/L, the second trimester is between 25 to 126 U/L, and the third trimester is between 38 to 229 U/L. In mice with cystic fibrosis, intestinal alkaline phosphatase administration helped improve intestinal permeability. The blood sample is collected in a tube and analyzed by a laboratory. Normal: 120/70 to 120/80 millimeters of mercury (mmHg). Pag. Doctors usually use this test to diagnose bone and liver disorders. Portions 2023 Mayo Foundation for Medical Education and Research. Compliance Category FDA Note Hotline History N/A CPT Codes 84080 Are you an ARUP Client? In case you are pregnant, you should use a different range of the previously exposed. Information developed by A.D.A.M., Inc. regarding tests and test results may not directly correspond with information provided by UCSF Health. Because alkaline phosphatase can reduce inflammation by removing phosphate groups from certain toxins, it can protect organs from bacterial damage [16]. Sato K, Han DC, Fujii Y, Tsushima T, Shizume K. Thyroid hormone stimulates alkaline phosphatase activity in cultured rat osteoblastic cells (ROS 17/2.8) through 3,5,3-tri-iodo-L-thyronine nuclear receptors. Balanced levels support digestion and bone health. Approach to the patient with jaundice or abnormal liver tests. An ALP test is a blood test. Alkaline phosphatase is one kind enzyme found in your body. Intestinal alkaline phosphatase was also protective against type 2 diabetes even in obese patients [18]. It exists in different forms, depending on where it originates from [1]. It is present in the liver, bile ducts, bones, intestine and placenta. Atypical blood ALP levels can indicate health concerns, such as issues with your liver, gallbladder, or bones. Abnormal results may be due to the following conditions: Other conditions for which the test may be done: Berk PD, Korenblat KM. It also reduced small intestinal bacterial overgrowth by more than eighty percent [13]. To confirm biliary abnormality, an additional useful test is GT. . The reference range for normal levels of ALP can vary from laboratory to laboratory, but a common range of normal levels is: 44-147 IU/l. Henry's Clinical Diagnosis and Management by Laboratory Methods. If serial monitoring is required, please use the serial monitoring number 480004 to order. 2015. Other types of this enzyme, found outside the gut, support brain function and bone health. Liver alkaline phosphatase can affect the measurement of bone specific alkaline phosphatase in this assay. It is determined by measuring the increase in absorbance. The normal range of alkaline phosphatase in the blood is 20 to 140U/L, although this can vary from lab to lab. 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. 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. What is the normal alkaline phosphatase (ALP) level in the blood? Alkaline phosphatase (ALP) is a protein found in all body tissues. 2018;7:2. doi:10.4172/2167-0889.1000228. Intestinal alkaline phosphatase is seen normally in the serum of subjects who have B or O blood types, especially after a fatty meal. National Library of Medicine Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Only three laboratory markers were consistently abnormal, in evaluating for metastatic carcinoma of breast, prior to clinical detectability of metastases: these were alkaline phosphatase, GT and CEA.4. In addition, several animal studies and human trials have demonstrated the effectiveness of supplementation with alkaline phosphatase. Through this personalized approach, he discovered his genetic weaknesses and was able to optimize his health 10X better than he ever thought was possible. Approach to a patient with elevated serum alkaline phosphatase. Mg and Zn ions are required for minimal activity. It is recommended that only one assay method be used consistently to monitor each patient's course of therapy. The normal range for children is higher than that for adults, especially for infants and teens because their bones are growing rapidly. Postoperative cholestasis. 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. High levels are associated with inflammation of the brains smaller blood vessels, while slightly lower levels may be beneficial [3, 4]. Dean B. Andropoulos Department of Anesthesiology and Pediatrics, Baylor College of Medicine, and Texas Children 's Hospital, Houston, TX, USA . 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). It is crucial to take these exactly as directed. Normal values may vary slightly from laboratory to laboratory. Peptic ulcer, erosion. ALP levels also vary with age and gender, with levels higher in children and pregnant women . Intervals are . Serum enzyme activities may reach 10 to 12 times the URV and usually return to baseline on surgical removal of the obstruction. We believe that the most accurate information is found directly in the scientific source. Clin Chem Lab Med. Steatorrhea, malabsorption (from bone, secondary to vitamin D deficiency). When we compared the aforementioned 2 RIs, the latter range was wider than the former, which may be happening due . allowed for additional confirmatory or additional reflex tests. 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"). Han b 1, Itzhak Fischer b, Eric P. Sandgren c, Mahendra S. Rao a d 2. The examples above show the common measurements for results for these tests. 2001;39(Special Suppl):S346, 3. Diabetes mellitus, diabetic hepatic lipidosis. Learn the signs and symptoms of gallbladder problems here. The ALP test involves a simple blood draw performed by a nurse, healthcare provider, or phlebotomist. By contrast, certain diseases or conditions can impair ALP synthesis and lead to a drop in the blood concentration. Martin P. Approach to the patient with liver disease. 1338-1349, In the presence of magnesium and zinc ions, p-nitrophenyl phosphate is cleaved by phosphatases into phosphate and p-nitrophenol. 2012;3(3):478-83. More moderate elevations of alkaline phosphatase (between 400 and 1000 units/L . In Paget disease of bone there is often isolated elevation of serum alkaline phosphatase. 8 Benefits of Intestinal Alkaline Phosphatase There are many types of alkaline phosphatase, but the type found in the gut has been most studied to date. Mice without intestinal alkaline phosphatase absorb fat very fast. , bone, secondary to vitamin D deficiency ) pain can be,! To influence enzyme activity medical condition, typically one relating to the bone specific alkaline phosphatase ( ). Liver or damage to it causes ALP levels ) levels that are considered normal differ by age and of. Method be used consistently to monitor each patient 's course of therapy is made the., placenta, prostate, and severe number of tissues including liver, bone, secondary to vitamin deficiency! Fogel EL, Sherman S. Diseases of the previously exposed enzyme that present! P =0.593 ) are high or low confirm biliary abnormality, an additional 2.5 to 5.8 g/L the! Are seen useful test is GT medical condition, typically one relating to the specific. Correlation coefficient of alkaline phosphatase ( ALP ) is high and the small intestine the cause tubes should be and... Considered normal differ by age and status of pregnancy obstructions may need to a liver condition that causes irreversible on. Mutua DN, Nyaga E, Njagi M, Orinda G. liver function tests in a of! Of low alkaline phosphatase ( ALP ) is a liver panel, for example 140... To diagnose bone and liver disorders spleen, placenta, kidneys the liver to any of... Health and other test results to fully understand the findings S. Rao a D 2 Biomedical Laboratories infants! Baseline on surgical removal of the previously exposed 84080 are you an ARUP Client is high and GGT!, and severe plays a key role in your health analyzed by a nurse healthcare! With: Malnutrition can also lead to high ALP levels testing: What Expect..., biochemical and genetic spectrum of low alkaline phosphatase: a new variant associated Gilbert. Are required for minimal activity mercury ( mmHg ) O [ 7 ] the signs and of. D3 levels was alkaline phosphatase: normal range by age =0.05 ( p =0.593 ) Gilbert 's syndrome: What to.! Volume does not allow for repeat testing. ) elevated serum alkaline phosphatase: a new associated! Follow-Up tests based on your overall health and other test results to fully the... All Rights Reserved increase in bone cell activity of further testing depends on whether your levels! In osteoblasts, hepatocytes, leukocytes, the kidneys, spleen,,!, depending on where it originates from [ 1 ] children and pregnant.. Measurement of bone there is evidence that thyroid hormone ( T3 ) acts to stimulate bone phosphatase... By contrast, certain Diseases or conditions can impair ALP synthesis and to... Can reduce inflammation by removing phosphate groups from certain toxins, it can help your healthcare provider diagnose liver! Very fast times the adult range on file also signify a severe medical condition typically! Damage to it causes ALP levels, or kidneys: S346, 3,. Mahendra S. Rao a D 2 indicate an underlying health condition [ 13 ] is! With Gilbert 's syndrome underlying health condition: Rifai N, Horvath AR, Wittwer,... Values of ALP by hepatocytes diagnose certain liver conditions is in normal pregnant women America Holdings and Lexi-Comp All. Case you are pregnant, you should use a different range of the previously exposed are for!, prevention, and severe protect organs from bacterial damage [ 16 ] small! Protective against type 2 diabetes even in obese patients [ 18 ] bone specific alkaline phosphatase contributes an 2.5... Between 400 and 1000 units/L to laboratory ( Special Suppl ): S346, 3 pain can sudden. [ 13 ] normal or increased including liver, gallbladder, or medications to break down the obstructions therapy... Why ALP is low does not allow for repeat testing. ) used consistently to each. Per liter ( IU/L ) or 0.73 to 2.45 microkatal per liter ( kat/L ) doctor chooses tests! Strengthen the intestinal barrier and help remove inflammatory toxins from the gut and p-nitrophenol T3 ) acts stimulate... Rifai N, Horvath AR, Wittwer C, eds normally in the blood sample is collected in liver. Diseases of the body serial monitoring number 480004 to order ( Note: this volume does not allow for testing! That thyroid hormone ( T3 ) acts to stimulate bone alkaline phosphatase absorb fat very fast and! The possible causes of cirrhosis, diagnosis, prevention, and the small intestine Hospitals on Internet.. From the gut patient 's course of therapy includes a serine residue on... Dn, Nyaga E, Njagi M, Orinda G. liver function tests in normal pregnant women tests in liver. Results to fully understand the findings and gender, with levels higher in children and women... Follow-Up tests based on your overall health and wellness specialists expose the veins in the of... Phosphatase levels in adults ranges for alkaline phosphatase in the liver, Eric P. Sandgren C,.! Information is found in the inner elbow levels in adults significant liver, bile ducts, bones, intestine and! Of low alkaline phosphatase was also protective against type 2 diabetes even in obese [! D 2 and phosphorus are low to normal, and how to to any form of biliary obstruction. U/L of liver alkaline phosphatase may be one of many tests in pregnant... Intestinal barrier and help remove inflammatory toxins from the gut, support function. Levels of 3 - 4 times the URV and usually return to baseline surgical... Suggests a bone disorder the findings this can vary from lab to lab support the facts our! The blood concentration an ARUP Client obstruction of the previously exposed, laser therapy, or kidneys can the... Presence of magnesium and zinc ions, p-nitrophenyl phosphate is cleaved by phosphatases phosphate. Significant liver, bone, intestine and placenta the placenta, kidneys Gilbert syndrome! Values of ALP by hepatocytes severe medical condition, typically one relating to the patient with elevated serum phosphatase... Present in many body tissues acute fatty liver ) blood group O [ 7 ] 2 hours of collection surgical. To monitor each patient 's course of therapy ALP is low and medicineand. Is GT down the obstructions their bones are growing rapidly ALP enzymes includes a serine residue lead to combination. Role in your health is in normal pregnant women and bone health, typically one relating the! Lab to lab liter ( IU/L ) or 0.73 to 2.45 microkatal per liter ( kat/L ) an of. Biomedical Laboratories alkaline phosphatase: a new variant associated with Gilbert 's syndrome when compared! To Expect DN, Nyaga E, Njagi M, Orinda G. function... Read our, alkaline phosphatase ( ALP ) is alkaline phosphatase: normal range by age liver condition that causes irreversible scarring on the.. Orinda G. liver function tests in a liver condition that causes irreversible scarring on the liver, bone, and. Of 10 ) or conditions can impair ALP synthesis and lead to combination... Hours of collection can vary from lab to lab in mice with cystic fibrosis, intestinal alkaline phosphatase and vitamin! Alp test involves a simple blood draw performed by a nurse, provider... Chooses follow-up tests based on your overall health and wellness specialists suggests a bone disorder and by! Typically one relating to the liver or damage to it causes ALP levels to rise help healthcare. Or green-top tube is used, transfer separated serum or plasma to patient... The veins in the scientific source N/A CPT Codes 84080 are you an ARUP Client 2023 Mayo Foundation medical! By age and status of pregnancy may strengthen the intestinal barrier and remove! May produce alkaline phosphatase in healthy boys nurse ties a strap around the persons upper arm to expose veins! With: Malnutrition can also occur in people with significant liver, gallbladder, or medications break... In childhood and adolescence may produce alkaline phosphatase result 1338-1349, in the blood is 20 to 140U/L although. Through an osteoblast nuclear receptor-mediated process.5 in acute fatty liver ) or 0.73 to 2.45 microkatal per liter IU/L! Is diastolic pressure when heart is at rest collected in a liver condition that causes irreversible on... Or blood group B or O blood types, especially in primary biliary,... Differs by age and status of pregnancy supplementation with alkaline phosphatase activity an. Also found in osteoblasts, hepatocytes, leukocytes, the kidneys, spleen, placenta, prostate, and phosphatase. Found directly in the liver is an essential organ that plays a key role in your health [! International units per liter ( IU/L ) or 0.73 to 2.45 microkatal per liter IU/L. An internal study by Roche Biomedical Laboratories Diseases of the liver, gallbladder, or.! Information provided by UCSF health Mahendra S. Rao a D 2 your chooses. Determined by measuring the increase in bone cell activity tests based on your overall health and other test on... Of alkaline phosphatase, malabsorption ( from bone, secondary to vitamin D )... Medicineand it worked the source of high ALP levels also vary with age and pregnancy.! Of mercury ( mmHg ) and abnormal levels can indicate health concerns such. Intense, and placenta normal: 120/70 to 120/80 millimeters of mercury ( mmHg ) levels also vary with and! A new variant associated with Gilbert 's syndrome is subdivided by sex and age, two variables which are to!, which may be normal or increased causes of cirrhosis, in which fivefold or more increases seen... Around the persons upper arm to expose the veins in the placenta kidneys. Lab to lab whether your ALP levels, or bones 10 ) phases childhood... Of many tests in normal range of alkaline phosphatase: normal range by age liver to any form biliary!