alkaline phosphatase

[MAWorried]

I received blookwork results that showed that my alkaline phosphatase level is 153, my doctor said that high normal is 136.  All other bloodwork and enzymes are fine.  I am being sent for a gall bladder ultrasound and liver panel.  Other than gallstones what else could be causing this?  How far out of range am I, is 153 low or high?  My doctor says not to worry on one hand but then on the other says that it could be a broad range of things.   How common is it to get a high reading? I'm very worried because I have read that this can be attributed to liver and bone cancers.  Would my other blood work be normal if this is the case.  Can vitamins and aspirin cause my type of reading.  Presently, I take a multi-vitamin, 400IUs of Vitamin E, Coral Calcium and I have been taking aspirin approx. 3 times per week for the past few months due to a problem with my rotator cuff.  I do not drink any alcohol and don't smoke.  My cholestral is only 174 and I am a 37 year old female.  Any information that you could provide would be greatly appreciated.

[Kevin Pho, MD]

An alkaline phosphatase of 153 is mildly elevated.  There are many reasons why this can be elevated.  Here is a excerpt from UptoDate that lists the many diseases associated with an isolated alkaline phosphatase:

Isolated elevations of hepatic alkaline phosphatase or disproportionate elevation compared with other tests, such as the serum aminotransferases and bilirubin, can occur in a number of circumstances including:

- Partial bile duct obstruction due to gallstones or tumor. The mechanism is unknown but probably represents local areas of bile duct obstruction with induction and leakage into serum of hepatic alkaline phosphatase from these obstructed areas.

- Early in the course of some cholestatic liver diseases such as primary sclerosing cholangitis and primary biliary cirrhosis.

- Infiltrative diseases such as amyloidosis, sarcoidosis, hepatic abscesses, tuberculosis, and metastatic carcinoma.

- Extrahepatic diseases such as myeloid metaplasia, peritonitis, diabetes mellitus, subacute thyroiditis, and uncomplicated gastric ulcer. The increase in alkaline phosphatase in these disorders is thought to be related to hepatic dysfunction despite the absence of overt liver disease.

- Extrahepatic tumors, including osteosarcomas, lung, gastric, head and neck, renal cell carcinoma, ovarian, uterine cancer, and Hodgkin's disease, that secrete alkaline phosphatase (often a form known as the Regan isoenzyme) or cause leakage of hepatic alkaline phosphatase into serum by an unknown mechanism.

- Certain drugs such as phenytoin.

I would discuss whether workup of these other diseases would be a reasonable next step.  If the workup is negative, you may want to consider repeating the tests on a routine basis to make sure that they don't continue to rise.  It is also possible that the mild elevation is non-specific and a variant not associated with disease.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

Bibliography:
Pratt et al.  Alkaline phosphatase and other enzymatic measures of cholestasis.  UptoDate, 2004.