A 57 year old man presented to his physician for an annual physical examination.

Question

A 57 year old man presented to his physician for an annual physical examination. He had no specific complaints and claimed to be in good health. No abnormal findings were presented on physical examination. Laboratory findings were unremarkable except for an elevated total alkaline phosphate (ALP) of 249 U/L (reference range, 25-90 U/L). There was no indication of liver disease by palpitation, malignancy by increased globulins, or bone dyscrasia. The patient did not recall any incident that may have induced any medication other than aspirin (approximately four tablets per month). Laboratory results are shown. Repeated laboratory tests yielded similar findings.

1. What condition(s) could be responsible for the ALP elevation?
2. What tests could be ordered for the differential diagnosis of elevations in ALP?
3. What other biochemical tests are used for the diagnosis of bone disorders?

Laboratory Data. SI Units Conventional Units Tests Patient's Results Reference Ranges Patient's Results Reference Ranges Serum calcium Sodium Phosphorus ALT Total protein 2.50 mmolL 141 mmoVL 1.13 mmolL 22 UL 70 g/L 2.20-2.58 135-147 0.741.20 30 60-80 10.0 mgldL 141 mEq/L 3.5 mgldL 22 U/L 7.0 g/dL 88-10.3 135-147 23-3.7 30 6.0-8.0 ALT, alanine aminotransferase.

Explanation / Answer

Elevated alkaline phosphate(ALP) describes the situation where the level of alkaline phosphate exceeds the reference range.normal range of ALP range from 44 to 147 U/L(unit per liter)

This group pof enzymes have low substrate specificity and catalyzes the hydrolysis of esters

function of alkaline phosphatase

ALP helps intranspoting across cell membranes.

location of alkalinephosphate in human body

Alkaline phosphatase are present in bone,intestine,kidney, liver,placenta and white blood cells

damage to this tissues causes release of ALP into blood stream .

elevated alkaline phosphate is associated with certain medical conditions or syndrome

for eg:hyperphosphatasia with mental retardation syndrome(HPMRS) .It serves as a significant indication for certain medical conditions.

diagnosis for elevation of ALP:

elevated alkaline phosphate can be detected by blood tests .

if the reason for alkaline phostase is unknown isoenzyme studies using electrophoresis can confirm the source of ALP.

heat stability also distinguishes bone and liver isoenzymes

biochemical tests:

Alkaline phosphatase isoenzyme test :

it can be done to check for elevated ALP levels.

Tissues that contain high levels of ALP include liver bile ducts and bones .normal range of ALP range from 44 to 147 U/L(unit per liter).

elevated alkalinephosphate is most commonly caused by liver and bone disorders.

testing of ALP primarily consists of obtaining blood samples from a patient . it is mainly used to distinguish between different forms of isoenzymes of ALP produced by different tissues

In order to pinpoint the cause of elevated level of ALP and treat the patient for either liver or bone disorder.The most rapid way of testing ALP concentration is by using nitrophenyl phosphate as substrate.

for this the required volume of serum is 5 cubic mm for each testing.

the sample is incubated at 30min at 380c in a buffered solution in the presence of p-nitrophenyl phosphatase. by the action of ALP phosphate groups are removed from substrate and p- nitrophenol is liberated giving off a yellow colour in solution which is measured spectrophotometrically

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