Alkaline Phosphatase

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), or damaged liver cells.

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

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 tumors, 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 is working.
• Check the cause of a high blood calcium level.

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 nonprescription 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?).

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.
• Pur a gauze pad or cotton ball over the needle site as the needle is removed.
• Put pressure to the site and then a bandage.

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.

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. Aspirin, 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.

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

Normal

Normal values may vary from lab to lab.

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 tumors, tumors 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.

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 aspirin 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. Postmenopausal 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.
• Using alcohol.

• If the alkaline phosphatase level is high, many health professionals will order a special test to help find the cause. This test is called alkaline phosphatase isoenzymes, or ALP isoenzymes.
• 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 medical tests 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 centers, a test that measures a substance called 5-nucleotidase is done instead of the GGT test because it is better at finding liver disease.

Other Works Consulted

• Chernecky CC, Berger BJ, eds. (2004). Laboratory Tests and Diagnostic Procedures, 4th ed. Philadelphia: Saunders.

• Fischbach FT, Dunning MB III, eds. (2004). Manual of Laboratory and Diagnostic Tests, 7th ed. Philadelphia: Lippincott Williams and Wilkins.

• Pagana KD, Pagana TJ (2006). Mosby’s Manual of Diagnostic and Laboratory Tests, 3rd ed. St. Louis: Mosby.