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Elevated alkaline phosphatase occurs when levels of alkaline phosphatase (ALP) exceed the reference range. This group of enzymes has a low substrate specificity and catalyzes the hydrolysis of phosphate esters in a basic environment. The major function of alkaline phosphatase is transporting chemicals across cell membranes. [1]
The level of alkaline phosphatase in the blood is checked through the ALP test, which is often part of routine blood tests. The levels of this enzyme in the blood depend on factors such as age, sex, or blood type. [2] Blood levels of alkaline phosphatase also increase by two to four times during pregnancy.
The diagnosis of hyperphosphatemia is made through measuring the concentration of phosphate in the blood. A phosphate concentration greater than 1.46 mmol/L (4.5 mg/dL) is indicative of hyperphosphatemia, though further tests may be needed to identify the underlying cause of the elevated phosphate levels. [5]
An elevated level of alkaline phosphatase in the blood in combination with normal calcium, phosphate, and aminotransferase levels in an elderly patient are suggestive of Paget's disease. Markers of bone turnover in urine eg. Pyridinoline; Elevated levels of serum and urinary hydroxyproline are also found.
Abnormalities in liver enzyme tests are usually present and elevated gamma-glutamyl transferase and alkaline phosphatase are found in early disease. [11] Elevations in bilirubin occur in advanced disease. Antimitochondrial antibodies are the characteristic serological marker for PBC, being found in 90–95% of patients and only 1% of controls.
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It is defined as the quantity of alkaline phosphatase that liberates 1 mg of phosphate ion during the first hour of incubation with a buffered substrate containing sodium β-glycerophosphate. [1] This technique was the first test to measure blood alkaline phosphatase levels, and was developed by Aaron Bodansky in the early 1930s. [2]
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