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Alkaline-phosphatase-alp



Why Get Tested

To screen for or monitor treatment for a liver or bone disorder

When To Get Tested

As part of a routine liver panel or when you have symptoms of a liver or bone disorder

Sample Required

A blood sample drawn from a vein in your arm

Test Preparation Needed

Fasting overnight preferred but not required




Common Questions


The alkaline phosphatase test ALP is used to help detect liver disease or bone disorders In conditions affecting the liver damaged liver cells release increased amounts of ALP into the blood This test is often used to detect blocked bile ducts because ALP is especially high in the edges of cells that join to form bile ducts If one or more of them are obstructed for example by a tumor then blood levels of ALP will often be high Any condition that affects bone growth or causes increased activity of bone cells can affect ALP levels in the blood An ALP test may be used for example to detect cancers that have spread to the bones or to help diagnose Paget s disease a condition that causes malformed bones This test may also sometimes be used to monitor treatment of Paget s disease or other bone conditions such as vitamin D deficiency If ALP results are increased but it is not clear whether this is due to liver or bone disease tests for ALP isoenzyme may be done to determine the cause A GGT test and or a test for 5 -nucleotidase may also be done to differentiate between liver and bone disease GGT and 5 -nucleotidase levels are increased in liver disease but not in bone disorders

An ALP test may be ordered as part of routine laboratory testing often with a group of other tests called a liver panel It is also usually ordered along with several other tests when a person has symptoms of a liver or bone disorder Signs and symptoms of liver involvement may include Weakness fatigue Loss of appetite Nausea vomiting Abdominal swelling and or pain Jaundice Dark urine light-colored stool Itching pruritus Some examples of the signs and symptoms suggesting a bone disorder include Bone and or joint pain Increased frequency of fractures Deformed bones

High ALP usually means that either the liver has been damaged or a condition causing increased bone cell activity is present If other liver tests such as bilirubin aspartate aminotransferase AST or alanine aminotransferase ALT are also high usually the increased ALP is coming from the liver If GGT or 5 -nucleotidase is also increased then the high ALP is likely due to liver disease If either of these two tests is normal then the high ALP is likely due to a bone condition Likewise if calcium and or phosphorus measurements are abnormal usually the ALP is coming from bone If it is not clear from signs and symptoms or from other routine tests whether the high ALP is from liver or bone then a test for ALP isoenzymes may be necessary to distinguish between bone and liver ALP ALP in liver disease ALP results are usually evaluated along with other tests for liver disease In some forms of liver disease such as hepatitis ALP is usually much less elevated than AST and ALT When the bile ducts are blocked usually by gallstones scars from previous gallstones or surgery or by cancers ALP and bilirubin may be increased much more than AST or ALT ALP may also be increased in liver cancer ALP in bone disease In some bone diseases such as Paget s disease where bones become enlarged and deformed or in certain cancers that spread to bone ALP may be increased If a person is being successfully treated for Paget s disease then ALP levels will decrease or return to normal over time If someone with bone or liver cancer responds to treatment ALP levels should decrease Moderately elevated ALP may result from other conditions such as Hodgkin s lymphoma congestive heart failure ulcerative colitis and certain bacterial infections Low levels of ALP may be seen temporarily after blood transfusions or heart bypass surgery A deficiency in zinc may cause decreased levels A rare genetic disorder of bone metabolism called hypophosphatasia can cause severe protracted low levels of ALP Malnutrition or protein deficiency as well as Wilson disease could also be possible causes for lowered ALP

Pregnancy can increase ALP levels Temporary elevations are also seen with healing fractures Children and adolescents normally have higher ALP levels than adults because their bones are growing and ALP is often very high during a growth spurt which occurs at different ages in boys and girls Some drugs may affect ALP levels For example oral contraceptives may decrease levels while anti-epileptics may increase levels

There are other commonly used liver tests that measure other enzymes found in liver cells such as alanine aminotransferase ALT and aspartate aminotransferase AST A test for bilirubin a substance produced by the breakdown of red blood cells and removed from the body by the liver may also be performed Sometimes these tests along with albumin and total protein testing are run together as a liver panel Other tests that may be performed individually or as part of a liver panel to detect or monitor liver disease include gamma-glutamyl transferase GGT lactate dehydrogenase LDH and prothrombin time PT

Some of those who are at risk of liver disease include the following People who have been exposed to hepatitis viruses Heavy drinkers People who take medication that can be toxic to the liver or who are exposed to other liver toxins Those who are obese have metabolic syndrome or insulin resistance Those who suffer from congestive heart failure People with an inherited disorder affecting the liver such as Wilson disease or hemachromatosis See the article on Liver Disease for more on these

Depending on the cause your condition may be diagnosed and or monitored using other tests such as calcium phosphorus parathyroid hormone vitamin D or bone markers a group of tests used to measure bone formation and bone resorption