Predominant rise in ALP is suggestive of biliary or infiltrative disease
- ALP
has two main sources in the non-pregnant adult: liver and bone. Higher
ALP activities are also seen as a normal variant and are associated with
a range of medical conditions (congestive heart failure,
hyperthyroidism, pregnancy and intrahepatic cholestasis during sepsis)
and certain drugs (ibuprofen, paracetamol, cefotaxime).
- Liver and bone profiles should be checked if not already carried out, to exclude other raised indices.
- Isolated raised values up to approximately 145 IU/l are more likely to reflect a statistical rather than clinical finding.
- Although the reference range for women rises with age, the prevalence of primary biliary cirrhosis also rises. Measurement
of anti-mitochondrial antibodies in cases of persistently increased ALP
>200 of liver origin would therefore seem appropriate.
- Raised
ALP without a concomitant rise in GGT in a non-pregnant adult is likely
to be of bone origin. If doubt still exists ALP isoenzyme analysis is
useful e.g. if co-incidentally on enzyme inducing drugs which elevate
GGT.
