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Normal levels of ALP range from (44 to 147) U/L (units per liter) and significantly elevated levels may be an indication of conditions such as various types of cancer, bone diseases such as Paget disease, liver diseases such as hepatitis, blood disorders, or other conditions.
In contrast, low levels of ALP is found in hypothyroidism, pernicious anemia, zinc deficiency, and hypophosphatasia. [6] ALP activity is significantly increased in the third trimester of pregnancy. [11] This is due to increased synthesis from the placenta as well as increased synthesis in the liver induced by large amounts of estrogens.
Kidney tumors and infections as well as malnutrition have also shown abnormal level of alkaline phosphatase in blood. [2] Alkaline phosphatase levels in a cell can be measured through a process called the "scoring method". A blood smear is usually taken and stained to categorize each leukocyte into specific leukocyte alkaline phosphatase indices.
The proportion of AST to ALT in hepatocytes is about 2.5:1, but because AST is removed from serum by the liver sinusoidal cells twice as quickly (serum half-life t 1/2 = 18 hr) compared to ALT (t 1/2 = 36 hr), so the resulting serum levels of AST and ALT are about equal in healthy individuals, resulting in a normal AST/ALT ratio around 1.
ALP level can be elevated due to bone turnover. Additionally further tests can be completed to rule out other causes and complications of hyperparathyroidism including a 24-hour urinary calcium for familial hypocalciuric hypercalcemia, DEXA scan to evaluate for osteoporosis , osteopenia , or fragility fractures , and genetic testing.
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.
Levels of ALP may rise within a few hours of cholestasis onset while 5' nucleosidase levels may take a few days. [82] Many labs cannot measure 5' nucleosidase and ALP levels so, GGT may be measured in some cases. [78] Abnormal GGT elevation may be attributable to a variety of factors. [83]
Hypoalbuminemia (or hypoalbuminaemia) is a medical sign in which the level of albumin in the blood is low. [1] This can be due to decreased production in the liver, increased loss in the gastrointestinal tract or kidneys, increased use in the body, or abnormal distribution between body compartments.
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