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Test ID: ALKI Alkaline Phosphatase, Total and Isoenzymes, Serum

Reporting Name

Alkaline Phosphatase, Tot and Iso,S

Useful For

Diagnosis and treatment of liver, bone, intestinal, and parathyroid diseases

 

Determining the tissue source of increased alkaline phosphatase (ALP) activity in serum

 

Differentiating between liver and bone sources of elevated ALP

Profile Information

Test ID Reporting Name Available Separately Always Performed
ALP Alkaline Phosphatase, S Yes Yes
ALKE Alkaline Phosphatase Isoenzymes, S No Yes

Specimen Type

Serum


Necessary Information


Patient's age and sex are required.



Specimen Required


Collection Container/Tube:

Preferred: Serum gel

Acceptable: Red top

Submission Container/Tube: Plastic vial

Specimen Volume: 1 mL divided into 2 tubes each containing 0.5 mL


Specimen Minimum Volume

0.5 mL divided into 2 tubes each containing 0.25 mL

Specimen Stability Information

Specimen Type Temperature Time
Serum Frozen (preferred) 14 days
  Ambient  7 days
  Refrigerated  7 days

Reference Values

ALKALINE PHOSPHATASE

Males

4 years: 149-369 U/L

5 years: 179-416 U/L

6 years: 179-417 U/L

7 years: 172-405 U/L

8 years: 169-401 U/L

9 years: 175-411 U/L

10 years: 191-435 U/L

11 years: 185-507 U/L

12 years: 185-562 U/L

13 years: 182-587 U/L

14 years: 166-571 U/L

15 years: 138-511 U/L

16 years: 102-417 U/L

17 years: 69-311 U/L

18 years: 52-222 U/L

≥19 years: 45-115 U/L

Females

4 years: 169-372 U/L

5 years: 162-355 U/L

6 years: 169-370 U/L

7 years: 183-402 U/L

8 years: 199-440 U/L

9 years: 212-468 U/L

10 years: 215-476 U/L

11 years: 178-526 U/L

12 years: 133-485 U/L

13 years: 120-449 U/L

14 years: 153-362 U/L

15 years: 75-274 U/L

16 years: 61-264 U/L

17-23 years: 52-144 U/L

24-45 years: 37-98 U/L

46-50 years: 39-100 U/L

51-55 years: 41-108 U/L

56-60 years: 46-118 U/L

61-65 years: 50-130 U/L

≥66 years: 55-142 U/L

Reference values have not been established for patients who are <4 years of age.

 

ALKALINE PHOSPHATASE ISOENZYMES

Liver 1%

0-6 years: 5.1-49.0%

7-9 years: 3.0-45.0%

10-13 years: 2.9-46.3%

14-15 years: 7.8-48.9%

16-18 years: 14.9-50.5%

≥19 years: 27.8-76.3%

Liver 1

0-6 years: 7.0-112.7 IU/L

7-9 years: 7.4-109.1 IU/L

10-13 years: 7.8-87.6 IU/L

14-15 years: 10.3-75.6 IU/L

16-18 years: 13.7-78.5 IU/L

≥19 years: 16.2-70.2 IU/L

Liver 2%

0-6 years: 2.9-13.7%

7-9 years: 3.7-12.5%

10-13 years: 2.9-22.3%

14-15 years: 2.2-19.8%

16-18 years: 1.9-12.5%

≥19 years: 0.0-8.0%

Liver 2

0-6 years: 3.0-41.5 IU/L

7-9 years: 4.0-35.6 IU/L

10-13 years: 3.3-37.8 IU/L

14-15 years: 2.2-32.1 IU/L

16-18 years: 1.4-19.7 IU/L

≥19 years: 0.0-5.8 IU/L

Bone %

0-6 years: 41.5-82.7%

7-9 years: 39.9-85.8%

10-13 years: 31.8-91.1%

14-15 years: 30.6-85.4%

16-18 years: 38.9-72.6%

≥19 years: 19.1-67.7%

Bone

0-6 years: 43.5-208.1 IU/L

7-9 years: 41.0-258.3 IU/L

10-13 years: 39.4-346.1 IU/L

14-15 years: 36.4-320.5 IU/L

16-18 years: 32.7-214.6 IU/L

≥19 years: 12.1-42.7 IU/L

Intestine %

0-6 years: 0.0-18.4%

7-9 years: 0.0-18.3%

10-13 years: 0.0-11.8%

14-15 years: 0.0-8.2%

16-18 years: 0.0-8.7%

≥19 years: 0.0-20.6%

Intestine

0-6 years: 0.0-37.7 IU/L

7-9 years: 0.0-45.6 IU/L

10-13 years: 0.0-40.0 IU/L

14-15 years: 0.0-26.4 IU/L

16-18 years: 0.0-12.7 IU/L

≥19 years: 0.0-11.0 IU/L

Placental

Not present

Day(s) and Time(s) Performed

Alkaline Phosphatase: Monday through Sunday; Continuously

Alkaline Phosphatase Isoenzymes: Monday through Friday

Test Classification

This test has been cleared or approved by the U.S. Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information

Alkaline Phosphatase, Serum

84075

 

Alkaline Phosphatase Isoenzymes, Serum

84080

LOINC Code Information

Test ID Test Order Name Order LOINC Value
ALKI Alkaline Phosphatase, Tot and Iso,S 24332-9

 

Result ID Test Result Name Result LOINC Value
ALP Alkaline Phosphatase, S 6768-6
89503 Alkaline Phosphatase Isoenzymes, S 49243-9
45488 Liver 1 % 15348-6
57034 Liver 1 13874-3
45489 Liver 2 % 15349-4
57035 Liver 2 13875-0
45490 Bone % 15013-6
57036 Bone 1777-2
45491 Intestine % 15014-4
57037 Intestine 1778-0
29324 Placental 40793-2

Clinical Information

Alkaline phosphatase (ALP) is present in a number of tissues including liver, bone, intestine, and placenta. The activity of ALP found in serum is a composite of isoenzymes from those sites and, in some circumstances, placental or Regan isoenzymes. Serum ALP is of interest in the diagnosis of 2 main groups of conditions-hepatobiliary disease and bone disease associated with increased osteoblastic activity.  

 

A rise in ALP activity occurs with all forms of cholestasis, particularly with obstructive jaundice. The response of the liver to any form of biliary tree obstruction is to synthesize more ALP. The main site of new enzyme synthesis is the hepatocytes adjacent to the biliary canaliculi.

 

ALP also is elevated in disorders of the skeletal system that involve osteoblast hyperactivity and bone remodeling, such as Paget's disease rickets and osteomalacia, fractures, and malignant tumors.

 

Moderate elevation of ALP may be seen in other disorders such as Hodgkin's disease, congestive heart failure, ulcerative colitis, regional enteritis, and intra-abdominal bacterial infections.

Interpretation

Total Alkaline Phosphatase (ALP):

ALP elevations tend to be more marked (more than 3-fold) in extrahepatic biliary obstructions (eg, by stone or cancer of the head of the pancreas) than in intrahepatic obstructions, and the more complete the obstruction, the greater the elevation. With obstruction, serum ALP activities may reach 10 to 12 times the upper limit of normal, returning to normal upon surgical removal of the obstruction. The ALP response to cholestatic liver disease is similar to the response of gamma-glutamyltransferase (GGT), but more blunted. If both GGT and ALP are elevated, a liver source of the ALP is likely.  

 

Among bone diseases, the highest level of ALP activity is encountered in Paget's disease, as a result of the action of the osteoblastic cells as they try to rebuild bone that is being resorbed by the uncontrolled activity of osteoclasts. Values from 10 to 25 times the upper limit of normal are not unusual. Only moderate rises are observed in osteomalacia, while levels are generally normal in osteoporosis. In rickets, levels 2 to 4 times normal may be observed. Primary and secondary hyperparathyroidism are associated with slight to moderate elevations of ALP; the existence and degree of elevation reflects the presence and extent of skeletal involvement. Very high enzyme levels are present in patients with osteogenic bone cancer. A considerable rise in ALP is seen in children following accelerated bone growth.

 

ALP increases of 2 to 3 times normal may be observed in women in the third trimester of pregnancy, although the reference interval is very wide and levels may not exceed the upper limit of normal in some cases. In pregnancy, the additional enzyme is of placental origin.

 

ALP Isoenzymes:

Liver ALP isoenzyme is associated with biliary epithelium and is elevated in cholestatic processes. Various liver diseases (primary or secondary cancer, biliary obstruction) increase the liver isoenzyme.

 

Liver 1 (L1) is increased in some non-malignant diseases (such as cholestasis, cirrhosis, viral hepatitis and in various biliary and hepatic pathologies). It is also increased in malignancies with hepatic metastasis, in cancer of the lungs and digestive tract and in lymphoma.

 

An increase of Liver 2 (L2) may occur in cholestasis and biliary diseases (eg, cirrhosis, viral hepatitis) and in malignancies (eg, breast, liver, lung, prostate, digestive tract) with liver metastasis.

 

Osteoblastic bone tumors and hyperactivity of osteoblasts involved in bone remodeling (eg, Paget's disease) increase the bone isoenzyme. Paget's disease leads to a striking, solitary elevation of bone ALP.

 

The intestinal isoenzyme may be increased in patients with cirrhosis and in individuals who are blood group O or B secretors.

 

The placental (carcinoplacental antigen) and Regan isoenzyme can be elevated in cancer patients.

Clinical Reference

1. Tietz NW: Textbook of Clinical Chemistry, Third edition. Edited by CA Burtis, ER Ashwood. Philadelphia, PA, WB Saunders Company, 1999

2. Moss DW: Alkaline phosphatase isoenzymes. Clin Chem 1982;28:2007-2016

3. Teitelbaum JE, Laskowski A, Barrows FP: Benign transient hyperphosphatasemia in infants and children: a prospective cohort. J Pediatr Endocrinol Metab 2011;24:351-353

4. Jassam NJ, Horner J, Marzo-Ortega H, et al: Transient rise in alkaline phosphatase activity in adults. BMJ Case Rep 2009;2009: bcr09.2009.2250. PMC3028401, Published online Dec 3, 2009

Analytic Time

2 days

Method Name

ALP: Photometric, p-Nitrophenol Phosphate

ALKE: Electrophoresis

Forms

If not ordering electronically, complete, print, and send a Gastroenterology and Hepatology Test Request Form (T728) with the specimen (http://www.mayomedicallaboratories.com/it-mmfiles/gastroenterology-and-hepatology-test-request.pdf)

Mayo Medical Laboratories | Genetics and Pharmacogenomics Catalog Additional Information:

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