Alkaline Phosphatase Isoenzymes Electrophoresis, Serum

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No Fasting Required

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Differentiates ALP sources (liver vs bone vs intestine).

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Alkaline Phosphatase Isoenzymes Electrophoresis Serum

Why is it done?
- Test Purpose: Identifies and measures specific isoenzymes of alkaline phosphatase (ALP) from different tissue sources including liver, bone, intestine, and placenta
- Primary Indications: Determining the source of elevated alkaline phosphatase levels when initial ALP test is elevated
- Clinical Reasons for Ordering: Investigating suspected liver disease, bone disorders, malignancy, or intestinal pathology; evaluating patients with pregnancy complications; monitoring bone metabolism disorders; assessing patients with unexplained elevated total ALP
- Typical Timing: When initial ALP screening reveals elevated levels; during diagnostic workup for liver or bone disease; during follow-up of known hepatic or skeletal conditions; as part of comprehensive metabolic evaluation
Normal Range
- Reference Values (by isoenzyme): Bone ALP: 20-45% of total ALP; Liver ALP: 20-60% of total ALP; Intestinal ALP: 0-35% of total ALP; Placental ALP: Present only in pregnancy; Corded blood levels vary
- Unit of Measurement: Percentage (%) of total alkaline phosphatase or International Units per Liter (IU/L)
- Normal Interpretation: All isoenzymes present in expected proportions; bone and liver isoenzymes constitute majority of total ALP; no single isoenzyme dramatically elevated
- Abnormal Interpretation: Disproportionate elevation of specific isoenzyme(s); marked increase in bone ALP suggests skeletal disease; marked increase in liver ALP suggests hepatobiliary pathology; presence of intestinal ALP may indicate malabsorption or malignancy
- Borderline/Age-Specific Considerations: Children and adolescents normally have higher bone ALP due to growth; elderly patients may show different isoenzyme patterns; pregnancy associated with placental ALP; reference ranges may vary by laboratory methodology
Interpretation
- Elevated Bone Alkaline Phosphatase: Suggests increased bone turnover and osteoblastic activity; indicates Paget's disease, metastatic bone cancer, osteoporosis with active remodeling, hyperparathyroidism, hyperthyroidism, fracture healing, rickets, or vitamin D deficiency
- Elevated Liver Alkaline Phosphatase: Indicates hepatic disease or biliary obstruction; suggests cholestasis, biliary cirrhosis, primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), viral or alcoholic hepatitis, hepatic metastases, drug-induced liver injury, or pregnancy-related cholestasis
- Elevated Intestinal Alkaline Phosphatase: May indicate intestinal pathology, malabsorption, inflammatory bowel disease, celiac disease, bacterial overgrowth, or occasionally associated with malignancy such as gastric or pancreatic cancer
- Presence of Placental Alkaline Phosphatase: Normal finding during pregnancy; elevated levels may indicate pregnancy complications; persistent elevation outside pregnancy suggests malignancy such as lung, gastric, or ovarian cancer
- Factors Affecting Results: Age and growth stage; medications (anticonvulsants, steroids, phenothiazines); alcohol consumption; recent meals; hemolysis of sample; lipemia; pregnancy status; recent bone fractures; recent physical activity; renal function; blood transfusions
- Clinical Significance Patterns: Predominant bone isoenzyme with normal liver isoenzyme suggests primary skeletal pathology; predominant liver isoenzyme suggests hepatobiliary disease; mixed pattern may indicate multisystem involvement; specific isoenzyme profile helps differentiate between disease etiologies and guides further diagnostic workup
Associated Organs
- Primary Organ Systems: Hepatobiliary system (liver and bile ducts); skeletal system (bone and osteocytes); gastrointestinal tract (intestinal epithelium); reproductive system (placenta during pregnancy)
- Liver-Associated Conditions: Cirrhosis, hepatitis (viral, alcoholic, autoimmune), cholestasis, biliary obstruction, fatty liver disease, liver fibrosis, liver metastases, cholangiocarcinoma, hepatocellular carcinoma
- Bone-Associated Conditions: Paget's disease, osteoporosis, osteomalacia, rickets, hyperparathyroidism, bone metastases, osteosarcoma, fractures in healing phase, thyroid disorders affecting metabolism, acromegaly, growth hormone abnormalities
- Intestinal-Associated Conditions: Celiac disease, inflammatory bowel disease (Crohn's disease and ulcerative colitis), malabsorption syndromes, bacterial overgrowth, intestinal lymphoma, gastric carcinoma, pancreatic carcinoma
- Malignancy-Related Conditions: Presence of placental-type ALP outside pregnancy suggests malignancy; associated with lung, gastric, ovarian, breast, and pancreatic cancers; can indicate ectopic hormone production by tumors
- Potential Complications: Delayed diagnosis of serious underlying conditions; progression of untreated liver disease to cirrhosis; complications of untreated bone disease including fractures and deformity; complications of untreated malignancy; vitamin D deficiency leading to secondary complications
Follow-up Tests
- If Elevated Bone ALP: Bone-specific alkaline phosphatase (BSAP); serum calcium and phosphate; vitamin D (25-hydroxyvitamin D); parathyroid hormone (PTH); magnesium; bone turnover markers (P1NP, CTX); imaging studies (X-rays, bone scan, DXA scan); thyroid function tests; acid phosphatase
- If Elevated Liver ALP: Liver function tests (AST, ALT, GGT, bilirubin, albumin); hepatitis panel (A, B, C serology); autoimmune markers (AMA, ASMA, anti-LKM); imaging (ultrasound, CT, or MRI of abdomen); liver biopsy if indicated; prothrombin time/INR; alcohol biomarkers; viral hepatitis RNA/DNA testing
- If Elevated Intestinal ALP: Tissue transglutaminase (tTG) for celiac screening; inflammatory markers (ESR, CRP); fecal chymotrypsin; fat malabsorption testing; endoscopy and colonoscopy with biopsy; imaging of GI tract; tumor markers if malignancy suspected
- If Placental ALP Present Outside Pregnancy: Tumor markers (AFP, CEA, CA 19-9); chest imaging (X-ray or CT); abdominal imaging; endoscopy; oncology consultation; repeat testing for monitoring; additional malignancy screening based on clinical presentation
- Monitoring Frequency: Monthly to quarterly for acute conditions; quarterly to semi-annually for chronic disorders; annually for monitoring treated conditions; more frequently if therapeutic changes made; based on clinical response to treatment
- Related Complementary Tests: Total alkaline phosphatase; gamma-glutamyl transferase (GGT); 5'-nucleotidase; leucine aminopeptidase; liver enzymes panel; bone alkaline phosphatase; osteocalcin; P1NP; CTX
Fasting Required?
- Fasting Status: NO - Fasting is NOT required for alkaline phosphatase isoenzymes electrophoresis
- Reason: Alkaline phosphatase levels are not significantly affected by food intake; test can be performed at any time of day; recent meals do not alter isoenzyme distribution patterns
- Patient Preparation: Can eat and drink normally; no special preparation required; can take regular medications; adequate hydration is helpful
- Medications to Avoid: No medications need to be held unless otherwise directed by healthcare provider; inform laboratory of current medications as some may elevate ALP (anticonvulsants, steroids, some antibiotics, phenothiazines); confirm with provider if uncertain about specific medications
- Other Preparation Requirements: Simple blood draw; no special positioning required; minimal physical activity before test is acceptable; wear loose-fitting clothing for easy blood draw access; inform phlebotomist of recent injuries or trauma; notify staff of pregnancy if applicable
- Sample Collection Considerations: 5-10 mL serum sample required; collected in SST (serum separator tube) or plain tube; sample should be allowed to clot at room temperature for 30 minutes; samples should be processed promptly; avoid hemolysis which can interfere with results; refrigerate if analysis will be delayed

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