“That Alkaline Phosphatase Seems Really High…”

Today at Morning Report we talked about how to approach a patient with an elevated alkaline phosphatase. There’s a fantastic review article from Clinical Liver Disease by Dr. Siddique and Dr. Kowdley from Virginia Mason Medical Center about how to evaluate and work up a patient who presents with an abnormally high alkaline phosphatase. Key points, tables, charts below from the article:

  • Highest concentration of AP is in liver and bone. But also found in intestine, kidney, and placenta.
  • It can vary with age, gender, and blood type.
  • Try to find the source of the elevated AP – fractionation of isoenzymes by electrophoresis or obtaining 5’nucleotidase and gamma glutamyl transpeptidase (GGT) levels, both of which are elevated in hepatobiliary disease
  • Determine whether cholestasis is secondary to intrahepatic or extrahepatic disease process keeping in mind some diseases can cause both such as primary sclerosing cholangitis

Figure 1. Algorithm in evaluating elevated AP

Table

Figure 2. Categories based on liver tests

Table2

Check out the full article below by clicking the link:

Approach to the Patient with Elevated Alkaline Phosphatase 

(Figure 1 and 2 from Siddique, Kowdley. Clin Liver Dis. 2012.)