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Alkaline Phosphatase

Test Overview

An alkaline phosphatase (ALP) test measures the amount of the enzyme ALP in the blood. ALP is made mostly in the liver and in bone with some made in the intestines and kidneys. It also is made by the placenta of a pregnant woman.

The liver makes more ALP than the other organs or the bones. Some conditions cause large amounts of ALP in the blood. These conditions include rapid bone growth (during puberty), bone disease (osteomalacia or Paget's disease), or a disease that affects how much calcium is in the blood (hyperparathyroidism), vitamin D deficiency, or damaged liver cells.

If the ALP level is high, more tests may be done to find the cause.

Why It Is Done

A test for alkaline phosphatase (ALP) is done to:

Check for liver disease or damage to the liver. Symptoms of liver disease can include jaundice, belly pain, nausea, and vomiting. An ALP test may also be used to check the liver when medicines that can damage the liver are taken.
Check bone problems (sometimes found on X-rays), such as rickets, osteomalacia, bone tumours, Paget's disease, or too much of the hormone that controls bone growth (parathyroid hormone). The ALP level can be used to check how well treatment for Paget's disease or a vitamin D deficiency is working.

How To Prepare

An alkaline phosphatase test is often done at the same time as a routine blood test. You do not need to do anything before having a routine blood test.

If you are having a follow-up ALP test, you may be asked to not eat or drink for 10 hours before the test. The ALP level generally goes up after eating, especially after eating fatty foods.

Many medicines may change the results of this test. Be sure to tell your doctor about all the non-prescription and prescription medicines you take.

Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form (What is a PDF document?).

How It Is Done

The health professional drawing your blood will:

Wrap an elastic band around your upper arm to stop the flow of blood. This makes the veins below the band larger so it is easier to put a needle into the vein.
Clean the needle site with alcohol.
Put the needle into the vein. More than one needle stick may be needed.
Attach a tube to the needle to fill it with blood.
Remove the band from your arm when enough blood is collected.
Put a gauze pad or cotton ball over the needle site as the needle is removed.
Put pressure to the site and then a bandage.

How It Feels

The blood sample is taken from a vein in your arm. An elastic band is wrapped around your upper arm. It may feel tight. You may feel nothing at all from the needle, or you may feel a quick sting or pinch.

Risks

There is very little chance of a problem from having blood sample taken from a vein.

You may get a small bruise at the site. You can lower the chance of bruising by keeping pressure on the site for several minutes.
In rare cases, the vein may become swollen after the blood sample is taken. This problem is called phlebitis. A warm compress can be used several times a day to treat this.
Ongoing bleeding can be a problem for people with bleeding disorders. ASA, warfarin (Coumadin), and other blood-thinning medicines can make bleeding more likely. If you have bleeding or clotting problems, or if you take blood-thinning medicine, tell your doctor before your blood sample is taken.

Results

An alkaline phosphatase (ALP) test measures the amount of the enzyme ALP in the blood.

Normal

Normal values may vary from lab to lab.

**Alkaline phosphatase**
Adults:					25–100 units per litre (U/L) or 0.43–1.70 microkat/litre (mckat/L)
Children:					Less than 350 U/L or less than 5.95 mckat/L

Women in the third trimester of pregnancy have high ALP levels because the placenta makes ALP. Children normally have much higher ALP than adults because rapid bone growth is normal in children and bones make ALP.

High values

Very high levels of ALP can be caused by liver problems, such as hepatitis, blockage of the bile ducts (obstructive jaundice), gallstones, cirrhosis, liver cancer, or cancer that has spread (metastasized) to the liver from another part of the body.
High ALP levels can be caused by bone diseases, such as Paget's disease, osteomalacia, rickets, bone tumours, or tumours that have spread from another part of the body to the bone, or by overactive parathyroid glands (hyperparathyroidism). Normal healing of a bone fracture can also raise ALP levels.
Heart failure, heart attack, mononucleosis, or kidney cancer can raise ALP levels. A serious infection that has spread through the body (sepsis) can also raise ALP levels.

Low values

Conditions that lead to malnutrition (such as celiac disease) or are caused by a lack of nutrients in the diet (such as scurvy) can cause low ALP levels.

What Affects the Test

Reasons you may not be able to have the test or why the results may not be helpful include:

Taking medicines that may damage the liver, such as some antibiotics, birth control pills, long-term ASA use, and oral diabetes medicines.
Being pregnant. Women in the third trimester of pregnancy have high ALP levels because the placenta makes ALP.
Going through menopause. Post-menopausal women may have higher ALP levels than women who still have menstrual cycles.
Your age. Children normally have much higher ALP levels than adults because rapid bone growth is normal in children and bones make ALP.
Drinking a lot of alcohol.

What To Think About

If the ALP level is high, other tests may be done to determine whether a liver or bone problem is present.
If liver disease is suspected, more blood tests, an ultrasound, or a CT scan are generally recommended to find the problem.
Other tests to check liver function, such as alanine aminotransferase, aspartate aminotransferase, and bilirubin, are often done at the same time as an alkaline phosphatase (ALP) test. For more information, see the topics Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), and Bilirubin.
Gamma glutamyl transferase (GGT), or gamma glutamyl transpeptidase, may be measured in the blood to check the difference between bone ALP and liver ALP. High levels of GGT are present when the liver is damaged but not present with bone disease. A high level of GGT may be caused by alcohol use or may mean that blocked bile ducts are causing inflammation. The level of GGT may be high with the use of certain medicines, such as phenytoin and phenobarbital. In some medical centres, a test that measures a substance called 5-nucleotidase is done instead of the GGT test because it is better at finding liver disease.

References

Other Works Consulted

Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.

Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.

Pagana KD, Pagana TJ (2010). Mosby’s Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier.

Credits

By	Healthwise Staff
Primary Medical Reviewer	E. Gregory Thompson, MD - Internal Medicine
Primary Medical Reviewer	Brian D. O'Brien, MD - Internal Medicine
Specialist Medical Reviewer	Alan C. Dalkin, MD - Endocrinology
Last Revised	September 30, 2010

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Why It Is Done

Last Revised: September 30, 2010

Author: Healthwise Staff

Medical Review: E. Gregory Thompson, MD - Internal Medicine & Brian D. O'Brien, MD - Internal Medicine & Alan C. Dalkin, MD - Endocrinology

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