Test Details
Methodology
Electrophoresis
Result Turnaround Time
3 - 5 days
Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary.
Test Includes
Relative percentages of liver, bone, and intestinal alkaline phosphatase isoenzymes and total alkaline phosphatase
Use
Evaluate the contribution of the isoforms of ALP from liver, bone, and bowel to total ALP; investigate elevations of ALP to determine the tissue of origin
Special Instructions
State patient's age and sex on the test request form.
Contraindications
Custom Additional Information
Liver is the isoenzyme most frequently elevated when total ALP levels are elevated. Liver ALP increases in the blood early in liver disease before most other liver function tests show abnormalities. The wide group of conditions leading to increased liver ALP include acute hepatitis, cirrhosis, fatty liver, drug-induced liver disease, obstruction of biliary flow by carcinoma at the head of the pancreas, bile duct stricture, primary biliary cirrhosis, and metastatic carcinoma of the liver.
Bone isoenzyme is elevated as a result of increased osteoblastic activity. This isoenzyme is normally elevated in growing children and adults over the age of 50. The highest total ALP values have been attributed to an increased bone isoenzyme level due to Paget disease or renal rickets. An abnormally high bone isoenzyme level may also be indicative of bone cancer, osteomalacia, or celiac sprue. A decreased bone ALP in children may be attributed to cretinism or to hypophosphatasia.
Intestinal alkaline phosphatase is seen normally in the serum of subjects who have B or O blood types, especially after a fatty meal. Pathologically, the band may be present in perforation of the bowel, ulcerative disease of the intestine, and faintly in liver cirrhosis. Acute infarction of the intestine will cause a release of intestinal ALP from the mucosa. Large erosive or ulcerative lesions of the stomach, duodenum or other small intestinal areas, or colon may result in an elevation of the serum ALP level. The small intestinal lesions associated with malabsorption are associated with an elevation of the serum intestinal ALP level only if there is an erosive or ulcerative mucosal lesion.
Specimen Requirements
Specimen
Serum
Volume
1.6 mL
Minimum Volume
0.8 mL (Note: This volume does not allow for repeat testing.)
Container
Red-top tube or gel-barrier tube
Collection Instructions
Separate serum from cells as soon as possible after the blood is allowed to clot.
Stability Requirements
Temperature | Period |
---|---|
Room temperature | 7 days |
Refrigerated | 7 days |
Frozen | 3 months |
Freeze/thaw cycles | Stable x3 |
Reference Range
See table.
LIVER FRACTION | |
Age (Male) | Percentage Range (Male) |
0 to 6 m | Not established |
7 m to 5 y | 3% to 50% |
6 to 17 y | 3% to 31% |
18 to 100 y | 13% to 88% |
Age (Female) | Percentage Range (Female) |
0 to 6 m | Not established |
7 m to 5 y | 3% to 51% |
6 to 12 y | 2% to 25% |
13 to 100 y | 18% to 85% |
BONE FRACTION | |
Age (Male) | Percentage Range (Male) |
0 to 6 m | Not established |
7 m to 5 y | 48% to 97% |
6 to 17 y | 67% to 97% |
18 to 100 y | 12% to 68% |
Age (Female) | Percentage Range (Female) |
0 to 6 m | Not established |
7 m to 5 y | 48% to 97% |
6 to 12 y | 69% to 97% |
13 to 100 y | 14% to 68% |
INTESTINE FRACTION | |
Age (Male) | Percentage Range (Male) |
0 to 30 d | Not established |
1 m to 17 y | 0% to 8% |
18 to 100 y | 0% to 18% |
Age (Female) | Percentage Range (Female) |
0 to 30 d | Not established |
1 m to 17 y | 0% to 8% |
18 to 100 y | 0% to 18% |
Storage Instructions
Refrigerate serum at 2°C to 8°C as soon as possible after collection.
Patient Preparation
Patient should be fasting overnight. Patients who have B or O blood group and are secretors may have an elevated ALP about two hours after a fatty meal.
Causes for Rejection
Patient not fasting; citrate, oxalate, or EDTA anticoagulated plasma
LOINC® Map
Order Code | Order Code Name | Order Loinc | Result Code | Result Code Name | UofM | Result LOINC |
---|---|---|---|---|---|---|
001612 | Alk Phos Isoenzyme | 24332-9 | 001107 | Alkaline Phosphatase | IU/L | 6768-6 |
001612 | Alk Phos Isoenzyme | 24332-9 | 016239 | Liver Fraction: | % | 15015-1 |
001612 | Alk Phos Isoenzyme | 24332-9 | 016240 | Bone Fraction: | % | 15013-6 |
001612 | Alk Phos Isoenzyme | 24332-9 | 016241 | Intestinal Frac.: | % | 15014-4 |
Order Code | 001612 | |||||
Order Code Name | Alk Phos Isoenzyme | |||||
Order Loinc | 24332-9 | |||||
Result Code | 001107 | |||||
Result Code Name | Alkaline Phosphatase | |||||
UofM | IU/L | |||||
Result LOINC | 6768-6 | |||||
Order Code | 001612 | |||||
Order Code Name | Alk Phos Isoenzyme | |||||
Order Loinc | 24332-9 | |||||
Result Code | 016239 | |||||
Result Code Name | Liver Fraction: | |||||
UofM | % | |||||
Result LOINC | 15015-1 | |||||
Order Code | 001612 | |||||
Order Code Name | Alk Phos Isoenzyme | |||||
Order Loinc | 24332-9 | |||||
Result Code | 016240 | |||||
Result Code Name | Bone Fraction: | |||||
UofM | % | |||||
Result LOINC | 15013-6 | |||||
Order Code | 001612 | |||||
Order Code Name | Alk Phos Isoenzyme | |||||
Order Loinc | 24332-9 | |||||
Result Code | 016241 | |||||
Result Code Name | Intestinal Frac.: | |||||
UofM | % | |||||
Result LOINC | 15014-4 |