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Test Code ALK PHSIS Alkaline Phosphatase, Total and Isoenzymes, Serum

Reporting Name

Alkaline Phosphatase, Tot and Iso,S
Seattle Children's Hospital Note:

Clinical System Name: Alkaline Phosphatase Isoenzyme

Useful For

Diagnosis and treatment of liver, bone, intestinal, and parathyroid diseases

 

Determining the tissue source of increased alkaline phosphatase (ALP) activity in serum

 

Differentiating between liver and bone sources of elevated ALP


Necessary Information


Patient's age and sex are required.



Specimen Required


Collection Container/Tube:

Preferred: Serum gel

Acceptable: Red top

Submission Container/Tube: Plastic vial

Specimen Volume: 1 mL divided into 2 tubes each containing 0.5 mL


Specimen Type

Serum

Specimen Minimum Volume

0.5 mL divided into 2 tubes each containing 0.25 mL

Specimen Stability Information

Specimen Type Temperature Time
Serum Frozen (preferred) 14 days
  Ambient  7 days
  Refrigerated  7 days

Day(s) and Time(s) Performed

Alkaline Phosphatase: Monday through Sunday; Continuously

Alkaline Phosphatase Isoenzymes: Monday through Friday

Performing Laboratory

Mayo Medical Laboratories in Rochester

Method Name

ALP: Photometric, p-Nitrophenol Phosphate

ALKE: Electrophoresis

Method Description

Total Alkaline Phosphatase (ALP):

In the presence of magnesium and zinc ions, p-nitrophenyl phosphate is cleaved by phosphatases into phosphate and p-nitrophenol. The p-nitrophenol released is directly proportional to the catalytic alkaline phosphatase ALP activity. It is determined by measuring the increase in absorbance.(Package insert: Roche Alkaline Phosphatase reagent, Indianapolis, IN, March February 19992012)

 

ALP Isoenzymes:

Serum samples are electrophoresed through alkaline buffered (pH 9.1) agarose gels. Almost all ALP isoenzymes can be separated by electrophoresis according to their charge difference. However, because the electrophoretic mobilities of the liver and bone isoenzymes are quite similar, a modification is required for separation. The Sebia system utilizes differences between liver and bone isoenzyme sialation in order to achieve separation. Each sample is applied to the agarose gel in duplicate. One sample is passed through wheat germ lectin (wheat germ agglutin:WGA) and is deposited anodally from the point of sample application. The bone isoenzyme, which is rich in sialic acids, reacts with WGA and precipitates adjacent to the lectin application point. The separated isoenzymes are visualized using a specific chromogenic substrate, 5-bromo-4-chloro-3-indolyl phosphate/nitro blue tetrazolium in aminomethyl propanol (AMP) buffer, pH 10.0. The dried gels are read on a densitometer for the quantification of tissue isoforms.(Package insert: Sebia Hydragel 7 and 15 ISO-PAL, Sebia, Norcross, GA)

Reference Values

ALKALINE PHOSPHATASE

Males

4 years: 149-369 U/L

5 years: 179-416 U/L

6 years: 179-417 U/L

7 years: 172-405 U/L

8 years: 169-401 U/L

9 years: 175-411 U/L

10 years: 191-435 U/L

11 years: 185-507 U/L

12 years: 185-562 U/L

13 years: 182-587 U/L

14 years: 166-571 U/L

15 years: 138-511 U/L

16 years: 102-417 U/L

17 years: 69-311 U/L

18 years: 52-222 U/L

≥19 years: 45-115 U/L

Females

4 years: 169-372 U/L

5 years: 162-355 U/L

6 years: 169-370 U/L

7 years: 183-402 U/L

8 years: 199-440 U/L

9 years: 212-468 U/L

10 years: 215-476 U/L

11 years: 178-526 U/L

12 years: 133-485 U/L

13 years: 120-449 U/L

14 years: 153-362 U/L

15 years: 75-274 U/L

16 years: 61-264 U/L

17-23 years: 52-144 U/L

24-45 years: 37-98 U/L

46-50 years: 39-100 U/L

51-55 years: 41-108 U/L

56-60 years: 46-118 U/L

61-65 years: 50-130 U/L

≥66 years: 55-142 U/L

Reference values have not been established for patients who are <4 years of age.

 

ALKALINE PHOSPHATASE ISOENZYMES

Liver 1%

0-6 years: 5.1-49.0%

7-9 years: 3.0-45.0%

10-13 years: 2.9-46.3%

14-15 years: 7.8-48.9%

16-18 years: 14.9-50.5%

≥19 years: 27.8-76.3%

Liver 1

0-6 years: 7.0-112.7 IU/L

7-9 years: 7.4-109.1 IU/L

10-13 years: 7.8-87.6 IU/L

14-15 years: 10.3-75.6 IU/L

16-18 years: 13.7-78.5 IU/L

≥19 years: 16.2-70.2 IU/L

Liver 2%

0-6 years: 2.9-13.7%

7-9 years: 3.7-12.5%

10-13 years: 2.9-22.3%

14-15 years: 2.2-19.8%

16-18 years: 1.9-12.5%

≥19 years: 0.0-8.0%

Liver 2

0-6 years: 3.0-41.5 IU/L

7-9 years: 4.0-35.6 IU/L

10-13 years: 3.3-37.8 IU/L

14-15 years: 2.2-32.1 IU/L

16-18 years: 1.4-19.7 IU/L

≥19 years: 0.0-5.8 IU/L

Bone %

0-6 years: 41.5-82.7%

7-9 years: 39.9-85.8%

10-13 years: 31.8-91.1%

14-15 years: 30.6-85.4%

16-18 years: 38.9-72.6%

≥19 years: 19.1-67.7%

Bone

0-6 years: 43.5-208.1 IU/L

7-9 years: 41.0-258.3 IU/L

10-13 years: 39.4-346.1 IU/L

14-15 years: 36.4-320.5 IU/L

16-18 years: 32.7-214.6 IU/L

≥19 years: 12.1-42.7 IU/L

Intestine %

0-6 years: 0.0-18.4%

7-9 years: 0.0-18.3%

10-13 years: 0.0-11.8%

14-15 years: 0.0-8.2%

16-18 years: 0.0-8.7%

≥19 years: 0.0-20.6%

Intestine

0-6 years: 0.0-37.7 IU/L

7-9 years: 0.0-45.6 IU/L

10-13 years: 0.0-40.0 IU/L

14-15 years: 0.0-26.4 IU/L

16-18 years: 0.0-12.7 IU/L

≥19 years: 0.0-11.0 IU/L

Placental

Not present

Test Classification

This test has been cleared or approved by the U.S. Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information

Alkaline Phosphatase, Serum

84075

 

Alkaline Phosphatase Isoenzymes, Serum

84080

LOINC Code Information

Test ID Test Order Name Order LOINC Value
ALKI Alkaline Phosphatase, Tot and Iso,S 24332-9

 

Result ID Test Result Name Result LOINC Value
ALP Alkaline Phosphatase, S 6768-6
89503 Alkaline Phosphatase Isoenzymes, S 49243-9
45488 Liver 1 % 15348-6
57034 Liver 1 13874-3
45489 Liver 2 % 15349-4
57035 Liver 2 13875-0
45490 Bone % 15013-6
57036 Bone 1777-2
45491 Intestine % 15014-4
57037 Intestine 1778-0
29324 Placental 40793-2

Reject Due To

Hemolysis

Mild reject; Gross reject

Lipemia

Mild OK; Gross OK

Icterus

Mild OK; Gross OK

Other

NA

Profile Information

Test ID Reporting Name Available Separately Always Performed
ALP Alkaline Phosphatase, S Yes Yes
ALKE Alkaline Phosphatase Isoenzymes, S No Yes

Forms

If not ordering electronically, complete, print, and send a Gastroenterology and Hepatology Test Request Form (T728) with the specimen (http://www.mayomedicallaboratories.com/it-mmfiles/gastroenterology-and-hepatology-test-request.pdf)