Healthline Media does not provide medical advice, diagnosis, or treatment. All of our content is written by scientists and people with a strong science background. What does a high blood alkaline phosphatase (ALP) level mean? 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. Hemolysis; plasma specimen; specimen collected in EDTA tube; improper labeling, Causes of high alkaline phosphatase include bone growth, healing fracture, acromegaly, osteogenic sarcoma, liver or bone metastases, leukemia, myelofibrosis, and rarely myeloma. Pediatric reference values should be used to properly interpret alkaline phosphatase values in children and adolescents. Both high and low blood levels can be problematic. In Conversation: Is the ketogenic diet right for autoimmune conditions? Steatorrhea, malabsorption (from bone, secondary to vitamin D deficiency). 2023 Dotdash Media, Inc. All rights reserved. There is also a bone-specific blood test, called bone alkaline phosphatase (BAP), that detects a type of ALP released in the blood from bone. Clin Chem Lab Med. It is often completed with other blood tests for assessment purposes. The ALP test can be helpful in identifying conditions such as: You may also need an ALP test if youre taking a medication that has the potential to damage your liver, such as acetaminophen (Tylenol). Additional information regarding LOINC codes can be found at LOINC.org, including the LOINC Manual, which can be downloaded at LOINC.org/downloads/files/LOINCManual.pdf. Referrals made easy The enzyme interacts with the gut, the food we eat, and the microbes found in our body. A blood sample is needed. Lammers WJ, van Buuren HR, Hirschfield GM, et al: Levels of alkaline phosphatase and bilirubin are surrogate end points of outcomes of patients with primary biliary cirrhosis: An international follow-up study. Some foods and drinks can help protect liver health. Accommodations. . 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. Normal values may vary slightly from laboratory to laboratory. What is the normal range of alkaline phosphatase? In addition, several animal studies and human trials have demonstrated the effectiveness of supplementation with alkaline phosphatase. Alkaline phosphatase (S, P) Age M/F (U/L) 0-5 days 110-300 6 days -11 months 110-320 1-3yrs 145-320 4-6yrs 150-380 7-9yrs 175-420 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. The normal range for children is higher than that for adults, especially for infants and teens because their bones are growing rapidly. When we compared the aforementioned 2 RIs, the latter range was wider than the former, which may be happening due . For men and women older than age 18, an ALP level between 44 and 147 U/L is considered normal. It is crucial to take these exactly as directed. Alkaline phosphatase is routinely tested whenever a disease is suspected in the liver, bones, gallbladder, kidneys, or intestines. . . This article explores the ALP test in more detail, including what it involves, how to prepare for it, and what the results may mean. Tietz NW, Rinker D, Shaw LM. Call 911 for all medical emergencies. (2013). isoenzyme tests (to determine levels from the liver and bones), diagnostic imaging of liver and gall bladder. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. 25th ed. Nathan, David G. U.S. Department of health and human Services. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. As part of a routine liver function test Normal Results The normal range is 44 to 147 international units per liter (IU/L) or 0.73 to 2.45 microkatal per liter (kat/L). Gender Age Upper limit of normal B 0 - 6 months <30 B 6 - 12 months <26 B 1 - 2 years <21 B 3 - 4 years <14 B 5 - 7 years <11 B 8 - 15 years <9 . 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. 1.Introduction. They also can vary with age and gender. They are an example of a healthy man of about 45 years old with no known disease and not taking any medication. The normal range is 44 to 147 international units per liter (IU/L) or 0.73 to 2.45 microkatal per liter (kat/L). 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. Clin Biochem. In the statistical analysis the sample population is subdivided by sex and age, two variables which are known to influence enzyme activity. Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. It helps break down proteins in the body and exists in different forms, depending on where it originates. Normal alkaline phosphatase (ALP) level in the blood. Read on to learn about its role in the body and whether your values are normal. Parenteral hyperalimentation of glucose, intravenous albumin administration. Your liver is one of the main sources of ALP, but some is also made in your bones, intestines, pancreas, and kidneys. Bone alkaline phosphatase (BAP) is the bone-specific isoform of alkaline phosphatase. Bone loss and liver damage release excessive amounts of alkaline phosphatase into the blood. Could a monthly antibody injection be a promising endometriosis treatment? Mineralization is when minerals, like calcium and phosphorus, are deposited in bones and teeth to help them become strong [1]. 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. 0.5-2.0 ng/mL. An enzyme is a type of protein that catalyzes (causes or accelerates) chemical reactions in the body. 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. With bisphosphonate therapy, the BAP decreased, and the elevated ALP decreased to normal range levels. Causes of low alkaline phosphatase are said to include: Hypothyroidism but most hypothyroid patients have normal alkaline phosphatase. 2016;29:40-5. doi:10.1016/j.ejim.2015.12.019. Required fields are marked *. but is for informational and educational purposes alone. MNT is the registered trade mark of Healthline Media. Washington, DC: AACC Press; 1989:204. Is the ketogenic diet right for autoimmune conditions? Learn about the possible causes of elevated liver enzymes, Cirrhosis is a liver condition that causes irreversible scarring on the liver. 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. What is the range for alkaline phosphatase? These ranges depend on the makeup of the local population, the technologies used and the accuracy of the measurement. Intestinal strangulation or obstruction, or ulcerative lesion. Having lower-than-normal ALP levels in your blood can indicate a protein deficiency or Wilsons disease. Pseudohyperparathyroidism. In: Rifai N, Horvath AR, Wittwer C, eds. Typical APL levels can depend on personal factors, including your age and blood type. Pediatric reference intervals are based on Meites S. Pediatric Clinical Chemistry: Reference (Normal) Values. Pancreatitis, carcinoma of pancreas, cystic fibrosis. Your doctor may want to find the source of high ALP levels, or explain why ALP is low. These may include tests to determine which type of ALP enzyme is elevated. Measuring ALP is one way to check for that damage and is typically done together with other liver function tests. Mice without intestinal alkaline phosphatase absorb fat very fast. It is present in the liver, bile ducts, bones, intestine and placenta. Our website services, content, and products are for informational purposes only. Information developed by A.D.A.M., Inc. regarding tests and test results may not directly correspond with information provided by UCSF Health. This causes fragile bones that can easily fracture and are slow to heal. Dennis Sifris, MD, is an HIV specialist and Medical Director of LifeSense Disease Management. Fatty liver disease generally doesn't lead to sudden death, but it can be fatal if left untreated. However, the prevalence among healthy children is unknown. St Louis, MO: Elsevier; 2017:chap 8. Bottom number is diastolic pressure when heart is at rest. The blood sample is collected in a tube and analyzed by a laboratory. Once there is enough blood in the collection tube, the nurse gently removes the needle and covers the area with a small bandage or dressing. In this case, the doctor may request imaging tests to check the bones. For men and women older than age 18, an ALP level between 44 and 147 U/L is considered normal. Caspian J Intern Med. It is found in osteoblasts, hepatocytes, leukocytes, the kidneys, spleen, placenta, prostate, and the small intestine. The normal range for children is higher than that for adults, especially for infants and teens because their bones are growing rapidly. In Paget disease of bone there is often isolated elevation of serum alkaline phosphatase. 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. Children and pregnant women can have significantly higher levels of the enzyme in their blood [ 1 ]. Normal values may vary slightly from . is a clickable link to peer-reviewed scientific studies. Joe Cohen flipped the script on conventional and alternative medicineand it worked. 3. It is caused by increased osteoblast activity following accelerated bone growth. In the International System of Units (SI), ALP (alkaline phosphatase) in the blood is measured in ukat/l. 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]. Hyperparathyroidism, in some patients. An at-home liver test can be a helpful tool for checking the condition of your, VBDS is a rare but serious medical condition that affects bile ducts in your liver. ALP is also found in the placenta, kidneys . In: Burtis CA, Ashwood ER, eds. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Gallbladder pain can be sudden, intense, and severe. The normal range is 44 to 147 international units per liter (IU/L) or 0.73 to 2.45 microkatal per liter (kat/L). Pulmonary infarct (one to three weeks after embolism. Why take an alkaline phosphatase level test? 2012;3(3):478-83. Alkaline phosphatase may reduce inflammation in the gut and may protect against type 2 diabetes. Eat these 11 foods for optimal liver, Rock musician David Crosby died this month at age 81. Tumors, especially hypernephroma; neoplastic ectopic production (Regan, Nagao isoenzymes). You can learn more about how we ensure our content is accurate and current by reading our. allowed for additional confirmatory or additional reflex tests. How is this test done? An alkaline phosphatase level test (ALP test) is a simple test to perform. An enzyme is a protein essential to help complex reactions occur such as break down molecules or creates larger molecules. Testing schedules may vary. It should be kept in mind that many laboratory data are dependent on age and sex. Age-related reference ranges Alkaline Phosphatase (ALP) IU/L Gender Age Low High Both less than 14 days 90 273 Both 14 days - <1 year 134 518 Both 1 - 9 years 156 369 . Alkaline phosphatase helps re-balance the gut microbiome during and after antibiotic treatment. A similar increase is seen in patients with advanced primary liver cancer or widespread secondary hepatic metastases. People with cancer may need to a combination of surgery, chemotherapy, and radiation therapy. No statistically significant influence of blood type on enzyme activity was observed. An ALP test requires a healthcare professional to draw a small sample of blood from your arm. Why normal levels can differ across different labs? Ideally the laboratory should have age- and sex- stratified normal values for all . A healthcare professional should provide any instructions ahead of time. Diagnosing and monitoring treatment of liver, bone, intestinal, and parathyroid diseases. An ALP test requires a blood sample from a vein. Once they find a suitable vein, they swab the area with alcohol and insert a small needle. What is the normal range of alkaline phosphatase? Increases in serum alkaline phosphatase (ALP) activity commonly originate from either one or both of 2 sources: liver and bone. Lowe D, John S. Alkaline phosphatase. In: Goldman L, Schafer AI, eds. Balanced levels support digestion and bone health. 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. Alkaline phosphase (ALP). An ALP test measures how much ALP is circulating in the blood stream. 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. 2005-2023 Healthline Media a Red Ventures Company. 6. Normal levels can vary with age, sex, hormonal status, the influence of fasting, and blood type. Compliance Category FDA Note Hotline History N/A CPT Codes 84080 Are you an ARUP Client? 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). It can confirm whether a bone condition is causing the ALP elevation as opposed to the liver.. P2.5-P97 reference ranges for alkaline phosphatase in healthy boys. 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. #### 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 . You can learn more about how we ensure our content is accurate and current by reading our. 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. IFCC methods for the measurement of catalytic concentration of enzymes Part 5. Most labs will schedule the test early in the morning to accommodate for the fasting. Do not use oxalate, EDTA, or citrate plasma. However, the injection did not cure the necrotizing enterocolitis [19]. . We avoid using tertiary references. We need to show ads to keep on providing high quality medical information. 7. High levels may also indicate a concern related to the bones such as rickets, Pagets disease, bone cancer, or an overactive parathyroid gland. Concise Book of Medical Laboratory Technology: Methods and Interpretations. What causes a high level of ALP in a blood test? Clinical, biochemical and genetic spectrum of low alkaline phosphatase levels in adults. Therefore, alkaline phosphatase may not be used as a screening test to rule out vitamin D deficiency. An obstruction of the liver or damage to it causes ALP levels to rise. A rise in the alkaline phosphatase occurs with all forms of cholestasis, particularly with obstructive jaundice. Other labs may consider the normal range to be 30120 IU/l. Enzyme serves a biomarker for liver, bone, and other diseases. Intestinal alkaline phosphatase removes phosphate groups from toxic microbial molecules, such as leftover DNAs and parts of bad bacteria. 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