What does high alkaline phosphatase mean in a blood test

Does this test have other names?

ALP

What is this test?

The alkaline phosphatase (ALP) test measures how much alkaline phosphatase you have in your blood. Alkaline phosphatase is an enzyme found throughout your body. But it is mainly in your liver, bone, kidney, and digestive tract.

Why do I need this test?

You may need this test if you're at risk for a condition that affects your liver. For instance, your blood can show higher levels of ALP if one of the bile ducts that drains your liver becomes blocked. Conditions such as liver cancer, cirrhosis, and hepatitis can also cause ALP levels to rise. Bone disorders like Paget disease and healing fractures are other things that may affect your ALP levels. Younger children with high bone growth may also have higher ALP levels.

What other tests might I have along with this test?

The ALP test may be done as part of a routine liver panel, a group of blood tests that looks at how well your liver is working.

If your ALP levels are too high, your healthcare provider may order an ALP isoenzyme test to find out what type of ALP is elevated in your blood. Liver disorders make different forms of ALP than bone disorders.

What do my test results mean?

Test results may vary depending on your age, gender, health history, and other things. Your test results may be different depending on the lab used. They may not mean you have a problem. Ask your healthcare provider what your test results mean for you.

ALP results are reported in units per liter (U/L). For men and women older than age 18, an ALP level between 44 and 147 U/L is considered normal. The normal range for children is higher than that for adults, especially for infants and teens because their bones are growing rapidly.

How is this test done?

The test is done with a blood sample. A needle is used to draw blood from a vein in your arm or hand.

Does this test pose any risks?

Having a blood test with a needle carries some risks. These include bleeding, infection, bruising, and feeling lightheaded. When the needle pricks your arm or hand, you may feel a slight sting or pain. Afterward, the site may be sore.

What might affect my test results?

Eating before the test may slightly increase your ALP levels for a few hours.

Pregnancy may cause higher levels of ALP. Teens, who often grow rapidly, tend to have higher ALP levels than people in other age groups.

How do I get ready for this test?

You may need to fast—not eat or drink anything—for several hours before this test. You may be asked to stop taking any blood-thinning medicines before the test.

Be sure your healthcare provider knows about all medicines, herbs, vitamins, and supplements you are taking. This includes medicines that don't need a prescription and any illegal drugs you may use.

Alkaline phosphatase (ALP) is an enzyme found in the blood that helps break down proteins. ALP plays a role in numerous processes in the human body, and any abnormalities in blood concentrations—either high or low—may be indicative of diseases ranging from gallstones and thyroid disease to hepatitis and cancer.

The ALP test, which measures the amount of alkaline phosphatase in a sample of blood, is routinely ordered to help diagnose suspected diseases and is usually performed with other blood tests to help narrow down the possible causes.

What Is Alkaline Phosphatase?

Alkaline phosphatase is an enzyme. An enzyme is a type of protein that catalyzes (causes or accelerates) chemical reactions in the body. ALP is produced mainly by the liver and bones but is also synthesized in smaller quantities by the intestines and kidneys. ALP is also secreted from the placenta during pregnancy.

Scientists have not yet identified the full range of biochemical reactions that ALP instigates, but the enzyme is known to contribute to the following processes:

• Transporting nutrients and enzymes to and from the liver
• Aiding in the development, growth, and maintenance of bone
• Transporting calcium and phosphate from the intestines to bones, muscles, and nerve cells to ensure normal function
• Transporting fatty acids to store energy in adipose tissues and help maintain the structural integrity of cells
• Regulating cell growth in fetuses during pregnancy

ALP is found in all tissues of the body but, not surprisingly, is found in its highest concentration in the liver, bones, kidneys, and intestines as well as the bile ducts (that drain bile from the liver) and gallbladder (that stores bile).

Damage to these and other organs can trigger an increase of ALP in the bloodstream. By contrast, certain diseases or conditions can impair ALP synthesis and lead to a drop in the blood concentration.

ALP Testing

Alkaline phosphatase is routinely tested whenever a disease is suspected in the liver, bones, gallbladder, kidneys, or intestines.

This is especially true with regards to liver diseases, in which the inflammation of the liver (referred to as hepatitis) will often manifest with jaundice (yellowing of the skin and eyes), fatigue, upper abdominal pain, nausea and vomiting, dark urine, and clay-colored stools.

ALP tests play an important role in the diagnosis of liver disease. Similar symptoms can occur with gallbladder diseases.

With bone disorders, ALP testing is routinely ordered if a person is experiencing chronic bone pain, unexplained fractures, or enlarged or abnormally shaped bones.

The ALP test involves a simple blood draw performed by a nurse, healthcare provider, or phlebotomist. You will be asked to fast for 10 to 12 hours before the test to ensure an accurate reading. Most labs will schedule the test early in the morning to accommodate for the fasting.

There are certain drugs that can interfere with the results. Advise your healthcare provider or the lab if you take any of the following:

• Anabolic steroids
• Antibiotics, including penicillins and sulfonamides
• Anti-epilepsy drugs like Dilantin (phenytoin) and phenobarbital
• Antihypertensives like Verelan (verapamil), captopril, and methyldopa
• Birth control pills and other hormonal contraceptives
• Cortisone
• Hormone-replacement therapy, including estrogen and testosterone
• Monoamine oxidase inhibitors (MAOIs)
• Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, Advil (ibuprofen), Aleve (naproxen), and Celebrex (celecoxib)
• Inderal LA (Propranolol)
• Chlorpromazine
• Tricyclic antidepressants
• Zyloprim (allopurinol)
• Zyrtec Allergy (cetirizine)

If your ALP levels are modestly raised, it may due to the drugs you are taking rather than an underlying disease or medical condition.

Interpretation

Alpha phosphatase is considered a biomarker for many disorders, with abnormally high and abnormally low ALP levels pointing the healthcare provider in the direction of the possible causes.

The ALP test results are presented as a reference range of values measures in enzyme units per liter (U/L) or microkatals per liter (μkat/L). Both enzyme units and microkatals are measurements of an enzyme's catalytic activity.

The normal range of values of ALP differs by age and pregnancy status. ALP values are higher in children because their bones are actively growing, while the ALP values increase during pregnancy in tandem with the development of the placenta and the approach of childbirth.

ALP values that fall outside these reference ranges are considered abnormal. On their own, abnormal ALP values are not diagnostic but can provide a clue as to the underlying cause.

High Values

Abnormally high ALP values may be the result of:

• Bacterial infections
• Cholangiocarcinoma (bile duct cancer)
• Cholelithiasis (gallstones)
• Biliary obstruction or dyskinesia (lack of motility)
• Bone cancers, including osteosarcoma and chondrosarcoma
• Bone conditions, including osteomalacia and osteoporosis
• Cholecystitis (gallbladder inflammation)
• Cirrhosis (scarring of the liver)
• Congestive heart failure
• Drug-induced liver toxicity
• Hepatitis, infectious and non-infectious
• Hepatocarcinoma (liver cancer)
• Hyperthyroidism (overactive thyroid gland)
• Hyperparathyroidism (overactive parathyroid gland)
• Kidney cancers, including renal cell carcinoma
• Lymphoma (cancer of the lymphatic system)
• Metastatic cancer to the liver or bone
• Mononucleosis (a viral infection)
• Myelofibrosis (a disease of the bone marrow)
• Myocardial infarction (heart attack)
• Paget's disease (a disorder causing accelerated bone growth)
• Prostate cancer
• Rickets (softening of bones usually due to vitamin D deficiency)
• Sarcoidosis (a disease that causes granular masses)
• Sepsis (an extreme inflammatory response to an infection)

Low Values

Abnormally low ALP values may be the result of:

• Achondroplasia (a form of dwarfism)
• Aplastic anemia (anemia caused by bone marrow failure)
• Celiac disease (an autoimmune disease triggered by gluten)
• Congenital iodine deficiency
• Hypophosphatasia (a congenital disorder affecting bone growth)
• Hypothyroidism (low thyroid function)
• Inflammatory bowel disease (IBD), including ulcerative colitis and Crohn's disease
• Malnutrition
• Pernicious anemia (an autoimmune form of anemia)
• Wilson's disease (a genetic disease that causes the accumulation of copper in the body)

Other Blood Tests

An ALP test is typically accompanied by a bilirubin, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) test. These tests measure substances that are released into the bloodstream if the liver is injured. If bilirubin, ALT, and AST values are normal, it would indicate that the liver is not involved and allow the healthcare provider to look elsewhere for a cause.

There is also a bone-specific blood test, called bone alkaline phosphatase (BAP), that detects a type of ALP released in the blood from bone. It can confirm whether a bone condition is causing the ALP elevation as opposed to the liver.

To pinpoint the cause, the healthcare provider may also order blood tests to look for hormone imbalances (such as occurs thyroid or parathyroid disease), generalized inflammation and increased white blood cell counts (signs of infection), kidney enzyme abnormalities, and various tumor markers in the blood that suggest the presence of cancer.

Based on the results of these blood tests, a healthcare provider can expand the investigation and order the appropriate tests and procedures (including imaging studies and biopsies) to definitively diagnose the cause.

A Word From Verywell

Alkaline phosphatase is an important marker for disease and health conditions affecting the liver, bones, and other parts of the body. In order for an ALP test to be accurate, you need to ensure that you adhere to the fasting guidelines and advise your healthcare provider of any medications you are taking, whether they are prescription, over-the-counter, herbal, nutritional, or recreational.

Frequently Asked Questions

• What is the normal range of alkaline phosphatase?

  Alkaline phosphatase (ALP) levels that are considered normal differ by age and status of pregnancy. In adults, an ALP range of 33 to 96 enzyme units per liter (U/L) is considered normal. For children, this range is under 350 U/L. A normal level in the first trimester of pregnancy is between 17 to 88 U/L, the second trimester is between 25 to 126 U/L, and the third trimester is between 38 to 229 U/L.

• What causes a high level of ALP in a blood test?

  If blood test results show a high level of alkaline phosphatase (ALP), it could indicate liver damage or a bone disorder. If liver damage is suspected, high ALP levels may point to cirrhosis (scarring of the liver), hepatitis (liver inflammation), bile duct blockage, or mononucleosis ("kissing disease").

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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By James Myhre & Dennis Sifris, MD
Dennis Sifris, MD, is an HIV specialist and Medical Director of LifeSense Disease Management. James Myhre is an American journalist and HIV educator.

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