CC 2 ACTIVITY 3

1. The alkaline phosphatase test (ALP) is used to help detect liver disease or bone
disorders. It is often ordered along with other tests, such as a gamma-glutamyl
transferase (GGT) test and/or as part of a liver panel.
a. 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
gallstones or by a tumor, then blood levels of ALP will often be high.
b. 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 disease, a condition that causes malformed bones. This
test may also sometimes be used to monitor treatment of Paget 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.

Lab Test Online. (2020, May 6). Alkaline Phosphatase (ALP). Retrieved from
https://labtestsonline.org/tests/alkaline-phosphatase-alp

Alkaline phosphatase is one kind enzyme found in your body. Enzymes are
proteins that help chemical reactions happen. For instance, they can break big
molecules down into smaller parts, or they can help smaller molecules join
together to form bigger structures. If your liver isn’t working right, the amount of
ALP in your blood may be high. Doctors often use the test to look for blocked bile
ducts. Other conditions that can cause problems with your liver include:

● Liver cancer
● Cirrhosis
● Hepatitis
● Blockage in the bile ducts

The test can also spot problems with your bones, including:

● Cancers that have spread to your bones

● Paget’s disease, which affects how bones grow
 ● Issues caused by vitamin D deficiency

WebMD. (2019, May 15). Alkaline Phosphatase Test (ALP): High vs. Low Levels. Retrieved
from https://www.webmd.com/digestive-disorders/alkaline_phosphatase_test#1

2. You may have to limit food and liquids for several hours before the test. Some
medicines interfere with the results, so make sure your doctor knows about all
drugs you take, including over-the-counter medicines, vitamins, and
supplements. Be sure to let your doctor know if you are pregnant, because that
will increase the level of ALP in your blood.

WebMD. (2019, May 15). Alkaline Phosphatase Test (ALP): High vs. Low Levels. Retrieved
from https://www.webmd.com/digestive-disorders/alkaline_phosphatase_test#1

The alkaline phosphatase (ALP) test measures how much alkaline phosphatase
you have in your blood. Alkaline phosphatase is an enzyme found throughout
your body. But it is mainly in your liver, bone, kidney, and digestive tract. Test
results may vary depending on your age, gender, health history, the method
used for the test, and other things. Your test results may not mean you have a
problem. Ask your healthcare provider what your test results mean for you. ALP
results are reported in units per liter (U/L). For men and women older than age 18,
an ALP level between 44 and 147 U/L is considered normal. The normal range for
children is higher than that for adults, especially for infants and teens because
their bones are growing rapidly.

Englert, C. H., & Turley, K. (2020). Alkaline Phosphatase. Retrieved from

https://www.urmc.rochester.edu/encyclopedia/content.aspx?
contenttypeid=167&contentid=alkaline_phosphatase#:~:text=For%20instance%2C
%20your%20blood%20can,may%20affect%20your%20ALP%20levels.

3. There are many potential analytic sources of error. Factors such as

concentrations of phosphate, magnesium, citrate, type, and concentration of
buffer maintenance of the correct temperature may affect the result.

Lowe, D. (2020, August 30). Alkaline Phosphatase. Retrieved from

https://www.ncbi.nlm.nih.gov/books/NBK459201/
 Hemolysis may cause slight elevations because ALP is approximately six times
more concentrated in erythrocytes than in serum. ALP assays should be run as
soon as possible after collection. Activity in serum increases approximately 3% to
10% on standing at 25°C or 4°C for several hours. Diet may induce elevations in
ALP activity of blood group B and O individuals who are secretors. Values may
be 25% higher following ingestion of a high fat meal.

BISHOP, M. (2020)3: Enzymes. In CLINICAL CHEMISTRY: Principles, techniques, and

correlations (8th ed., p. 281). S.l.: JONES & BARTLETT LEARNING.. Chapter 1

Shantikumar, S. (2019, January 14). Sources of variation, its measurement and control.
Retrieved from https://www.healthknowledge.org.uk/public-health-textbook/research-
methods/1a-epidemiology/sources-variation-measurement-control?
fbclid=IwAR1P1LNXcb-dvX16YBybHFFrpYYS8P4jDF7n4iLIg62VQHno_6OZNEUmlag
 4. Mean serum ALP levels (U/L), -2SD, +2SD and square root transformed mean and
SD values by age groups

Turan, S., Topcu, B., Gökçe, İ, Güran, T., Atay, Z., Omar, A., . . . Bereket, A. (2011, March).
Serum alkaline phosphatase levels in healthy children and evaluation of alkaline
phosphatase z-scores in different types of rickets. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065317/
BISHOP, M. (2020). Chapter 13: Enzymes. In CLINICAL CHEMISTRY: Principles, techniques,
and correlations (8th ed., p. 281). S.l.: JONES & BARTLETT LEARNING.

5. High Performance liquid chromatography

- using weak anion-exchange columns has been able to separate at least six
different isoforms of ALP in the sera of healthy individuals
Electrophoretic Separation
- Standard cellulose acetate and agarose gel electrophoresis cannot
completely resolve bone and liver isoenzymes, making them unsuitable for other
than qualitative studies.

McPherson, R., & Pincus, M. (2021). HENRY'S CLINICAL DIAGNOSIS AND

MANAGEMENT BY LABORATORY METHODS. S.l.: ELSEVIER - HEALTH SCIENCE.