Test Catalog

Test Id : ALKP

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Alkaline Phosphatase, Total and Isoenzymes, Serum

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Overview

Test Catalog

Useful For
Suggests clinical disorders or settings where the test may be helpful

Aid in the diagnosis and treatment of liver, bone, intestinal, and parathyroid diseases

 

Determining the tissue source of increased alkaline phosphatase (ALP) activity in serum

 

Differentiating between liver and bone sources of elevated ALP

Profile Information
A profile is a group of laboratory tests that are ordered and performed together under a single Mayo Test ID. Profile information lists the test performed, inclusive of the test fee, when a profile is ordered and includes reporting names and individual availability.

Test Id Reporting Name Available Separately Always Performed
ALP Alkaline Phosphatase, S Yes Yes
ALPI Alkaline Phosphatase Isoenzymes, S No Yes

Method Name
A short description of the method used to perform the test

ALP: Colorimetric

ALPI: Electrophoresis

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Alkaline Phosphatase, Tot and Iso,S

Specimen Type
Describes the specimen type validated for testing

Serum

Necessary Information

Patient's age and sex are required.

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Patient Preparation: Fasting (8 hours) required

Supplies: Sarstedt Aliquot Tube, 5 mL (T914)

Collection Container/Tube:

Preferred: Serum gel

Acceptable: Red top

Submission Container/Tube: Plastic vial

Specimen Volume: 1 mL

Collection Instructions:

1. Within 2 hours of collection, centrifuge the specimen.

2. For red top tubes, immediately aliquot into a plastic vial.

3. For serum gel tubes, serum may sit on gel refrigerated but must be aliquoted within 7 days.

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.

1 mL

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

Gross hemolysis Reject
Gross lipemia OK
Gross icterus Reject

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen Type Temperature Time Special Container
Serum Ambient 7 days
Refrigerated 7 days
Frozen (preferred) 14 days

Useful For
Suggests clinical disorders or settings where the test may be helpful

Aid in the diagnosis and treatment of liver, bone, intestinal, and parathyroid diseases

 

Determining the tissue source of increased alkaline phosphatase (ALP) activity in serum

 

Differentiating between liver and bone sources of elevated ALP

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Serum alkaline phosphatase (ALP) is used in the diagnosis of hepatobiliary disease and bone disease associated with increased osteoblastic activity. ALP is present in a number of tissues including liver, bone, intestine, and placenta. The activity of ALP found in serum is a composite of isoenzymes from those sites.

 

A rise in liver ALP activity occurs with all forms of cholestasis, particularly with obstructive jaundice.

 

Bone ALP is elevated in disorders of the skeletal system that involve osteoblast hyperactivity and bone remodeling, such as Paget disease, rickets, osteomalacia, fractures, and malignant tumors.

 

Moderate elevation of ALP may be seen in other disorders such as Hodgkin disease, congestive heart failure, ulcerative colitis, regional enteritis, and intra-abdominal bacterial infections.

Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

ALKALINE PHOSPHATASE

Males

0-14 days: 83-248 U/L

15 days-<1 year: 122-469 U/L

1-<10 years: 142-335 U/L

10-<13 years: 129-417 U/L

13-<15 years: 116-468 U/L

15-<17 years: 82-331 U/L

17-<19 years: 55-149 U/L

> or =19 years: 40-129 U/L

Females

0-14 days: 83-248 U/L

15 days-<1 year: 122-469 U/L

1-<10 years: 142-335 U/L

10-<13 years: 129-417 U/L

13-<15 years: 57-254 U/L

15-<17 years: 50-117 U/L

> or =17 years: 35-104 U/L

 

ALKALINE PHOSPHATASE ISOENZYMES

Ages:

< or =17 years: Refence values have not been established for patients less than 18 years of age.

> or =18 years:

Liver %: 30.2-74.7

Liver U/L: 15.8-71.9

Bone %: 23.8-68.3

Bone U/L: 12.0-56.7

Intestine %: < or =22.5

Intestine U/L: < or =12.6

Interpretation
Provides information to assist in interpretation of the test results

Liver alkaline phosphatase (ALP) isoenzyme is most frequently elevated when total ALP is elevated. Increased liver ALP is associated with a wide group of conditions including acute hepatitis, cirrhosis, fatty liver, drug induced liver disease, obstruction of biliary flow, bile duct stricture, primary biliary cirrhosis, and metastatic carcinoma of the liver.

 

Bone ALP is elevated due to increased osteoblastic activity. Abnormally elevated bone ALP may be indicative of bone tumors, Paget’s disease, or renal rickets.

 

Intestinal ALP is detectable in approximately 20% of samples tested. Intestinal ALP is most frequently noted postprandially in patients with blood group O or B.

Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Alkaline phosphatase (ALP) Isoenzyme:

-High concentrations of phosphate, oxalate, citrate, and cyanide will inhibit ALP activity.

-Excess glycine may inhibit ALP activity by complexing magnesium.

-Patients should be fasting. Patients may have an elevated intestinal ALP about two hours after a fatty meal.

Clinical Reference
Recommendations for in-depth reading of a clinical nature

1. Rifai N, Horvath AR, Wittwer CT, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics 6th ed. Elsevier; 2018

2. Lowe D, Sanvictores T, John S. Alkaline phosphatase. In: StatPearls [Internet]. StatPearls Publishing; 2021. Updated August 11, 2021. Accessed November 10, 2021. Available at www.ncbi.nlm.nih.gov/books/NBK459201

3. Teitelbaum JE, Laskowski A, Barrows FP. Benign transient hyperphosphatasemia in infants and children: a prospective cohort. J Pediatr Endocrinol Metab. 2011;24(5-6):351-353

4. Jassam NJ, Horner J, Marzo-Ortega H, Sinclair M, Barth JH. Transient rise in alkaline phosphatase activity in adults. BMJ Case Rep. 2009;2009:bcr09.2009.2250

5. Verma J, Gorard DA. Persistently elevated alkaline phosphatase. BMJ Case Rep. 2012;24;2012:bcr2012006768

6. Sharma U, Pal D, Prasad R. Alkaline phosphatase: an overview. Indian J Clin Biochem. 2014;29(3):269-278

Method Description
Describes how the test is performed and provides a method-specific reference

Total Alkaline Phosphatase:

In the presence of magnesium and zinc ions, p-nitrophenyl phosphate is cleaved by phosphatases into phosphate and p-nitrophenol. The p-nitrophenol released is directly proportional to the catalytic alkaline phosphatase (ALP) activity. It is determined by measuring the increase in absorbance.(Package insert: Alkaline Phosphatase reagent. Roche Diagnostics; V 9.0 10/2021)

 

Alkaline phosphatase Isoenzymes:

Alkaline phosphatase isoenzymes are separated by agarose gel electrophoresis and visualized using BCIP (5-Bromo-4-chloro-3-indolyl phosphate p-toluidine salt) substrate.(Package insert: SPIFE Touch Alkaline Phosphatase [ALP] Isoenzyme. Helena Laboratories; 02/2017)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Tuesday through Saturday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

3 to 5 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

7 days

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

Fees
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their account representative. For assistance, contact Customer Service.

Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

84075

84080

LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
ALKP Alkaline Phosphatase, Tot and Iso,S 24332-9
Result Id Test Result Name Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
ALP Alkaline Phosphatase, S 6768-6
622367 Alkaline Phosphatase Isoenzymes, S 12805-8
622369 Liver Percent 15015-1
622368 Liver 1779-8
622371 Bone Percent 15013-6
622370 Bone 1777-2
622373 Intestine Percent 15014-4
622372 Intestine 1778-0

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports

Test Update Resources

Change Type Effective Date
New Test 2025-01-30