What is alkaline phosphatase and what does its level show

How to recognize the symptoms of this condition?

If the pathology of the liver was the cause of the disease, then the child begins with mechanical jaundice. He may feel sick, there are bouts of vomiting. The kid quickly weakens and gets tired.

Parents observe his weight gain is below normal, the child eats poorly. He often has bleeding and bruising on his skin.

If the causes are diseases of the bone tissue, then the localization of the affected bones is important. The child may complain that the bones hurt, the arms or legs go numb, and tingling occurs in them.

In addition, the child is often injured up to fractures.

Indications for analysis

There are several types of analysis. The most common of them is the determination of the level of alkaline phosphatase in blood serum.

Normally, the cells of the intestines, bones, liver and bile ducts are constantly updated. Therefore, part of the enzyme enters the systemic circulation. Enhanced destruction of cell membranes due to various pathologies leads to an increase in the concentration of the enzyme in the blood. In some cases of diseases, alkaline blood phosphatase may be less than optimal values. This is also taken into account in the analysis.

Thus, as a result of the study, there can be three options: normal, increase and decrease in the level of phosphatase. The doctor already further forms the necessary series of additional examinations in case of deviations.

The treating doctor is engaged in interpretation. Attempts to independently deal with what is happening in the body without a medical education are doomed to failure.

Alkaline phosphatase (the norm in women is up to 400 U / L) does not show the full picture of the pathology and is a relative concept. First, you need to remember situations when exceeding normal values ​​is physiologically determined.

Secondly, the influence of drugs on the level of the enzyme in the blood is excluded. Therefore, the doctor should help to figure out which of the drugs taken can potentially affect the results of the analysis.

A blood test for alkaline phosphatase is included in liver tests of a biochemical study and is prescribed for the diagnosis of diseases in the presence of symptoms indicating:

  • violation of the liver (yellowness of the skin, mucous membranes and eyes, constant itching of the skin, pain in the right hypochondrium);
  • pathology of the biliary tract (indigestion, nausea, vomiting, diarrhea, discoloration of feces);
  • destructive bone change (pain in the limbs at night and during physical exertion, stiffness of movements, frequent fractures and prolonged healing).

Also, the alkaline phosphatase index is taken into account to assess the liver before surgery, in cases of general anesthesia, and in the treatment of rickets in children to determine the dosage of vitamin D.

In order for the result of the study to display the exact level of alkaline phosphatase in the blood, you should adhere to the general rules for preparing for analysis:

  • give blood on an empty stomach in the morning;
  • exclude the use of any medications before the study;
  • 12 hours to exclude the use of alcohol and fatty foods,

With regard to the normal level of alkaline phosphatase in the blood, these readings fluctuate over fairly wide ranges, ranging from 44 to 147 IU / L. In this case, it is worth paying attention to the sex of the person from whom blood was taken for research, as well as to his age. In pregnant women, this indicator may be slightly overstated, as well as in adolescents who are at the stage of puberty, but will not indicate any deviations in their body. It is simply connected with the restructuring of some life support systems, as well as with the growth of bone tissue or placenta.

In addition, the norm indicators can vary depending on the reagents used for its research in various laboratories, since there is no standardized methodology at this time. Specific figures vary, but the range of their fluctuations, however, remains insignificant, therefore, when determining the norm, you can rely on the following average indicators:

for children under 10 years old – from 150 to 350

for children from 10 to 19 – from 155 to 500

for adults under the age of 50 – from 30 to 120

for the age category from 50 to 75 – from 110 to 135

for people over 75 years old – from 165 to 190

These reference values ​​are based on international units per liter.

The activity of alkaline phosphatase is associated with processes in the liver, bile ducts, and small intestine. Analysis of the enzyme level is very important in the diagnosis of liver pathologies, blockage of the bile ducts with gallbladder stones and tumors of the pancreas, primary biliary cirrhosis and sclerosing cholangitis

The increased activity of bone cells also affects the level of phosphatase in the blood, which is important in the diagnosis of primary or secondary bone tumors.

Increased activity of alkaline phosphatase (other medical abbreviations – ALP, ALKP) during pregnancy is considered normal, and in other cases, as a rule, indicates liver disease or pathological processes in the bones. Under such conditions, some related indicators become important for diagnosis. So, a parallel increase in the levels of bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT) is likely to indicate liver damage. A change in the levels of minerals – calcium and phosphorus – will show bone pathology.

A reduced level of the enzyme alkaline phosphatase is much less common than high. Such a result can be obtained by oral contraceptives, blood transfusion, a lack of magnesium and zinc in the body. In addition, low level of bone isoenzymes is the main indicator of hypophosphatasia, a rare genetic disease characterized by impaired bone formation. If the disease manifests itself in children (juvenile form), it is characterized by frequent fractures, rickets, tooth loss.

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The level of ALP is determined by blood serum, often during biochemical analysis, sometimes separately. Blood sampling is carried out from a vein, the study is carried out on an empty stomach. Indications for analysis include patient complaints of fatigue, weakness, loss of appetite, vomiting or nausea, dark urine and lightening of feces, pain in the right hypochondrium, yellowing of the skin and sclera. Doctors of various fields are sent for research: therapists, gastroenterologists, endocrinologists, urologists, infectious disease specialists, and hematologists.

This is a group of active substances that are part of almost all tissues of the human body. Their greatest concentration falls on bone tissue, bile ducts, intestinal mucosa. The production of enzymes occurs in the surface layer of the intestinal mucosa, but they play a secondary role in the digestive system.

Alkaline phosphatase is mainly focused on two tasks. With its help, phosphoric acid is cleaved, which forms the basis for various organic compounds, and phosphorus is transferred to all systems, organs.

In pediatrics, an analysis of the activity of this group of enzymes is of great importance in the diagnosis of liver diseases, in which bile enters the duodenum in a reduced amount. This occurs against the background of an increase in alkaline phosphatase in the bloodstream in children.

In medical practice, the level of alkaline phosphatase is very important in the diagnosis of various diseases in children. It is determined during a biochemical blood test. It is necessary to monitor the condition of children and adolescents with diseases of the liver, kidneys, endocrine system and digestive tract in history. An analysis for biochemistry is prescribed for both inpatient and outpatient patients.

For the correct analysis, venous blood sampling is required, which is performed on an empty stomach. Also, before analysis, the child should not experience increased physical activity.

Decryption of the analysis results with alkaline phosphatase parameters should be carried out exclusively by a qualified specialist, as well as prescribe additional diagnostics.

The range of indications of normal levels in the blood of alkaline phosphatase is quite wide. Readings range from 44 IU / L to 147 IU / L. Do not panic immediately if alkaline phosphatase is elevated. The reasons can be completely harmless. For example, this indicator in pregnant women is usually slightly overestimated. It is also overpriced in adolescents who have opened the stage of puberty.

All this is associated with the growth of the placenta or bone tissue, and does not at all indicate various deviations in the human body. Also, the phosphatase index depends on the age and gender of the person. At the moment, there is no standardized methodology, so the variation of the norm depends on the reagents that are used in the laboratory for research.

During the analysis of alkaline phosphatase in the blood, specific reagents that respond to phosphatase are added to the serum of the donor. Then, using accurate methods, the concentration of the resulting products is measured. Each tissue, whether intestine, placenta or liver, contains its own specific type of alkaline phosphatase. During the analysis, the concentration of specific types of enzyme is measured.

To take a blood sample for this enzyme, the patient will need several minutes. In some cases, in humans, after eating, the intestines intensely produce alkaline phosphatase. In this case, the analysis results may be distorted. Therefore, the patient should not eat or drink water before taking this analysis.

Thanks to modern laboratory methods, test results can be obtained after just a few hours.

Based on all the data, we can conclude that the minimum alkaline phosphatase in the blood is normal. An increase in the level of this enzyme can both warn of any deviations or irregularities, and absolutely not alarm. In any case, this is not the last indicator of changes in the human body.

Causes of Elevated Alkaline Phosphatase

The level of alkaline phosphatase depends on age, gender and blood type. In individuals with blood type I and III and in men, the rate of alkaline phosphatase is higher than in women. After reaching puberty, the concentration of the enzyme in the blood gradually decreases.

Age,The norm in men, units / lThe norm in women, units / l
Up to a year134 – 518
1 – 5156 – 349
6 – 10150 – 380
10 – 13141 – 460
13 – 15127 – 51762 – 280
15 – 1789 – 36554 – 128
17 – 1985 – 24550 – 104
Older than 2048 – 9559 – 164

In children, in the process of intensive growth and development of the skeletal system, the rate of alkaline phosphatase in the blood is several times higher compared to adults, especially during the first 5 years and in adolescence (12-15 years).

Depending on the research method, units of measure and reagents used, the reference values ​​of alkaline phosphatase may differ, therefore, when decoding the results, it is necessary to focus solely on the analysis form.

Diseases that can cause an increase in alkaline phosphatase in the blood are divided into several categories depending on the characteristics of the development of pathological processes in the body.

Increased alkaline phosphatase in the blood can be caused by cholestasis (a decrease or cessation of the flow of bile into the duodenum) or impaired liver function, which is observed with such diseases:

  • oncological tumors causing obstruction (blockage) of the biliary tract (cholangiocarcinoma, adenocarcinoma);
  • narrowing of the biliary tract;
  • cholangitis – inflammation of the intrahepatic and extrahepatic bile ducts;
  • severe alcoholic hepatitis – toxic liver damage, accompanied by the destruction of hepatocytes and proliferation of fibrous tissue;
  • cirrhosis of the liver – replacement of parenchymal tissue with fibrous cells due to prolonged alcohol intoxication or parasitic infections;
  • alcohol poisoning.

As a result of pathological processes in the bone tissue, an increase in the level of alkaline phosphatase in the blood occurs, due to a violation of the formation of young and destruction of old cells, as well as bone mineralization, which indicates the development of such diseases of the bone system, such as:

  • bone metastases in the late stages of cancer – occur after the spread of malignant cells with blood and lymph flow;
  • Paget’s disease (osteodystrophy) – a violation of the processes of renewal of bone tissue cells, leading to deformation and fragility of bones;
  • osteogenic sarcoma – malignant degeneration of osteoblasts and osteoclasts (immature bone cells) into a tumor that spreads to other tissues of the internal organs;
  • hyperparathyroidism is an increased function of the parathyroid glands, leading to a violation of calcium metabolism in the body;
  • hyperthyroidism – an increase in the production of thyroid hormones. Serious consequences of pathology are resorption and a decrease in bone density, as well as a decrease in calcium absorption;
  • osteomalacia – a decrease in bone density due to improper mineral metabolism and a deficiency of phosphoric acid, calcium salts and vitamins in the body.

In some cases, alkaline phosphatase is increased as a result of the development of viral and bacterial infections that negatively affect the metabolic processes in the liver, causing inflammation and destruction of the organ, namely:

  • viral hepatitis (A, B) – are accompanied by inflammation due to the multiplication of virus cells in hepatocytes, and in some cases lead to cirrhosis;
  • osteomyelitis – inflammation of the bone marrow with complications in the form of fractures, purulent arthritis, malignant tissue degeneration;
  • infectious mononucleosis – damage to the lymph nodes, spleen and liver caused by the Epstein-Barr virus;
  • intra-abdominal infections – caused by the penetration of bacteria into the sterile cavity of the peritoneum, including the liver, kidneys, gall bladder with the formation of inflammatory processes.

Diseases accompanied by the development of tumors and metastases that do not directly affect the liver, but can cause an increase in alkaline phosphatase as a result of metabolic processes and phosphorus-calcium metabolism, namely:

  • Hodgkin’s lymphoma (lyphogranulomatosis) – damage to the lymphatic system of the body with possible proliferation in the form of metastases, which leads to an increase in the liver, spleen, as well as a deterioration in blood supply to the bone marrow;
  • myeloid metaplasia – proliferation of cells of the tubular bones, liver, lymph nodes and spleen;
  • extrahepatic bile duct cancer – develops as a result of gallstone disease or with abnormalities in the structure of the bile ducts (common hepatic or bile duct).

Also, an increase in alkaline phosphatase in the blood can occur under the influence of external factors (malnutrition, prolonged treatment), namely:

  • calorie deficiency, starvation;
  • lack of calcium and phosphate in food;
  • an overdose of vitamin C;
  • fracture healing;
  • the use of drugs (aspirin, paracetamol, antibiotics, oral contraceptives, sulfonamides).

With menopause

An increased level of alkaline phosphatase in menopause can be caused by a change in the hormonal background and a decrease in the absorption of minerals necessary to maintain the chemical composition of the bones, as a result of which postmenstrual osteoporosis develops, a significant decrease in the number and density of bone tissue.

To prevent the development of postmenstrual osteoporosis, women over 50 are recommended to check the level of:

  • bone alkaline phosphatase
  • hydroxyproline
  • osteocalcin,
  • pyridinoline,
  • phosphates
  • calcium.

In some cases, alkaline phosphatase drops below normal and leads to a violation of mineral metabolism, an increase in the content of inorganic compounds of phosphorus, copper and other elements in the body, to a gradual destruction of bone tissue, and is manifested as a result of such reasons as:

  • Deficiency of micro and macro elements can cause a decrease in alkaline phosphatase (especially in children with an increased need for nutrients for growth). Deficiency causes both malnutrition and problems with the absorption of nutrients from food, for example, celiac disease, irritable bowel syndrome, lactose intolerance.
  • Hypophosphatasia. Mutation of a gene involved in the production of alkaline phosphatase leads to critically low levels of alkaline phosphatase, which negatively affects the condition of bones and teeth. In infants with hypophosphatasia, inorganic phosphorus salts accumulate in the body, inhibiting the process of bone mineralization.
  • Hypothyro >

During pregnancy, the level of alkaline phosphatase gradually increases in proportion to the growth of the fetus and placenta, the tissues of which additionally produce a significant amount of the enzyme (more than 40%). The alkaline phosphatase index returns to normal within a month after delivery.

TrimesterNorm, ME / L
I17 – 88
II25 – 126
III38 – 229

If during pregnancy, alkaline phosphatase rises above normal, then this may indicate the development of serious pathologies:

  • preeclampsia;
  • pathology of the functioning of the placenta;
  • stagnation of bile;
  • disruption of the liver;
  • bone disease.

With an increased level of alkaline phosphatase during pregnancy, an additional diagnosis of the state of the hepatobiliary system is mandatory to prevent diseases of the liver, biliary tract and bladder, which is carried out using such studies as:

  • AST and ALT are amino acid metabolism enzymes in the body. Increased indicators indicate a violation of the functioning of the hepatobiliary system;
  • Calcium, phosphorus – increase with infectious mononucleosis and bone damage.

In some cases, a high level of alkaline phosphatase in children, as well as in adults, manifests itself in violation of liver functions caused by hepatitis A (Botkin’s disease) or mononucleosis (Epstein-Barr virus), as the most common infections in childhood.

In infancy, especially in premature babies, the development of bone diseases, in particular, rickets, is a violation of bone mineralization caused by a deficiency of vitamin D or a decrease in the absorption of minerals.

Also, the enzyme in a child can be increased as a result of the use of drugs for temperature (iburofen) and antibiotics (chloramphenicol, oxacillin, tetracycline, sulfonamides in combinations).

One of the options for determining abnormalities in the body is alkaline phosphatase. The norm in women, men and children is slightly different, this should be noted. The level of this enzyme in the body in women is slightly lower than that in men. While in children the level of this enzyme is much higher than in adults.

– in newborns: 245-255 units / l; – in children aged 1 to 9 years: 345-355 units / l; – in children aged 10 to 15 years: 275-285 units / l; – in adolescents, age from 16 to 19 years: 145-155 units / l.

– from 21 to 30 years old: 100-110 units / l; – from 30 to 45 years old: 110-120 units / l; – from 46 to 54 years old: 120-130 units / l; – aged from 55 to 70 years: 135-145 units / l; – over the age of 71 years: 180-190 units / l.

In adults, depending on gender, alkaline phosphatase is slightly different.

– from 21 to 30 years old: 80-90 units / l; – from 30 to 45 years old: 90-100 units / l; – from 46 to 54 years old: 105-115 units / l; – aged from 55 to 70 years: 125-135 units / l; – over the age of 71 years: 155 -165 units / l;

It can be concluded that in men, relative to female indicators, alkaline phosphatase is slightly increased. The norm in women is less than the male norm by about 20 units / liter.

It has already been said what alkaline phosphatase depends on. The rate is increased, and this may not pose a health risk. But it happens, and vice versa, when an increased indicator is the first and accurate warning that significant violations are observed in the patient’s body.

– a bile duct tumor; – obstructive jaundice that can cause obstruction of the bile ducts; – liver cancer; – bile duct scars provoked by surgical interventions; – stones in the bile ducts; – stomach or pancreas cancer; – cirrhosis of the liver; – infectious mononucleosis; – any origin of hepatitis. With this disease, approximately 3 times alkaline phosphatase is increased.

Alkaline phosphatase increased

In childhood, its activity in any case is greater compared to adults, but most often it is one of the few ways to diagnose malignant tumors in the liver. There are a number of factors that affect excess rates.

Medication administration

A child may begin an allergic reaction to drugs if they become toxic to his body. A similar effect is observed with the use of paracetamol, penicillin, erythromycin. If the reason is this, the side effect stops after refusing the drugs that cause it.

After the fracture

When a person’s skeleton is injured, all the body’s resources are sent to the problem area in order to restore it. The process of metabolism in bone tissues is accelerated. This enables bone fractures to heal together due to increased production of enzymes.

Active growth

Features of the physiological state can cause an increase in enzyme activity. When a child’s body develops, significant changes occur in it. Bone-forming cells are updated faster, which leads to excess rates. This is considered the norm for a growing organism if there are no pathological factors influencing it.

A study of increasing or decreasing the level of phosphatase in the blood is carried out according to some indications. This may be a preparation for surgery, as well as a routine examination of the patient. They take blood to determine the level of this enzyme and when conducting “liver tests” to assess the functional ability of the organ.

Often, when patients complain of fatigue, loss of appetite, nausea or pain in the right hypochondrium, the level of alkaline phosphatase in the blood is studied. An indicative result is also for the diagnosis of various lesions of bones and bone tissue.

When alkaline phosphatase is elevated, it almost always means either a lesion or involvement in any pathological process of either the bones, or the liver, or biliary tract. Additional studies help to differentiate and clarify the results, so if, along with this enzyme, there is an overestimation of the level of ALT and AST, then this clearly indicates liver disease. If, in combination with alkaline phosphatase, the level of calcium and phosphorus is increased, then bone tissue damage is evident.

How much does the study cost?

The first group of diseases in which the definition of phosphatase can be valuable is those associated with stagnation of bile.

Therefore, the doctor has the right to prescribe an analysis in the presence of the following complaints and symptoms:

  • yellowness of the skin;
  • icteric sclera and mucous membranes (light yellow staining);

If the norm of alkaline phosphatase is exceeded, then jaundice appears

  • the presence of bleached feces;
  • abdominal pain, more on the right and on top;
  • weakness;
  • nausea;
  • severe skin itching, in which even antihistamines do not always help.
  • Doctors recommend testing for alkaline phosphatase to confirm or rule out impaired liver function. In parallel with this, it is important to know the level of cholesterol, aspartate aminotransferase, alanine aminotransferase, as well as to conduct a thymol test and determine the content of protein and its fractions.

    To exclude bone diseases, bone metastases of tumors, the described analysis is also recommended. The examination is supplemented by determining the amount of phosphorus and calcium in serum as part of a biochemical analysis.

    The price category differs in different institutions. According to the OMS tariff agreement, the cost of blood sampling from a vein is 40 rubles, and the analysis itself costs 120 rubles. In private clinics, the price exceeds this value, since these institutions operate according to their own price lists.

    Most importantly, only fasting blood is donated. This means that the last meal should be no later than 4 hours before the study. The result will be as reliable as possible, if you stand the 8 hour interval. Dinner on the eve of the study should be light, not plentiful.

    Refusal of alcohol at least a day before the planned blood donation will prevent false results of the study. The same goes for smoking. Nicotine causes an unjustified and unexplained increase in the concentration of the enzyme in the blood.

    Before surrendering, it is better not to be nervous, to eliminate stress. If physical exercise was performed before, it is recommended to rest for at least 5 minutes. Neglect of this advice can also cause distorted results and their interpretation.

    How is biomaterial taken

    In stationary conditions, a laboratory assistant comes to the department and takes blood in the treatment room. In the clinic, patients arrive at the appointed early morning time, where they are sampled for research in order of priority.

    The laboratory assistant places up to 15 ml of the patient’s venous blood in a dry clean tube. The site of the puncture of the vein is treated with a swab with an antiseptic, which is then disposed of.

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    Svetlana Borszavich

    General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
    Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
    The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
    The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.