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Elevated Alkaline Phosphatase
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Elevated Alkaline Phosphatase

Does anyone know if it is normal to have Alkaline Phosphatase at 140 if all other lab numbers are within normal range?
I have been undetected for over 4 months, still on riba and 7977. My labs look great except for this glaringly high number. I know it is related to liver disease/damage but if anyone has more info, add, I would appreciate it.
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Mine didn't drop to normal ranges until after tx.
Although you're not doing interferon, the alk phos could possibly have to do with the meds your on.

The range is from 50-136. Mine have been much higher.
Yours aren't  that high, don't worry.
Thanks OH. Good to know.
I found this old post from MikeSimon back in 2007.  

From: http://www.hepatitis-central.com/hcv/labs/alp.html

Alkaline Phosphatase (ALP)

ALP comprises a group of related enzymes found in high concentration in liver & biliary tract, bone, intestinal mucosa and placenta

Cholestasis stimulates increased synthesis of hepatic ALP and leakage of the enzyme into blood

Circulating ALP levels are very sensitive to cholestasis of any cause, including localized intrahepatic cholestasis that may not be otherwise apparent

Hepatic causes of elevated ALP include:

    * Extra- and intrahepatic biliary obstruction
    * Hepatocyte injury of various causes (produces local cholestasis), including viral hepatitis
    * Space-occupying lesions (tumors, abcesses, granulomas)
    * Sepsis
    * Drugs (phenytoin)
    * Primary biliary cirrhosis

Circulating ALP may also come from non-hepatic sources, and in those cases it doens not indicate hepatic disease:

    * Bone ALP is elevated when bone turnover is increased: Paget's disease of bone, hyperparathyroidism, osteoporosis, tumor metastatic to bone, and fracture healing. Bone ALP is also substantially elevated in childhood and adolescence due to bone growth. Enlarged reference ranges must be used at those times, and ALP is correspondingly less sensitive for hepatic disease in those age groups.
    * Placental ALP and bone ALP are elevated during pregnancy
    * ALP may also be elevated during active healing (granulation tissue formation) because it is present in relatively high levels in growing endothelial cells and fibroblasts
    * Benign transient elevations can occur in a variety of diseases; may be strikingly high (most common in young), but are self-limited, resolving over a month or two

Elevated ALP is typically confirmed as hepatic using a second test that is also sensitive to cholestasis Gammaglutamyltransferase (GGT))

If additional information is needed, tissue-specific ALP isoenzymes can be determined by electrophoresis (reference laboratories) and will specifically identify the tissue source of an elevation in ALP.

Good one jules, thanks for digging that up !
There are many reasons that could cause Alkaline Phosphatase to be elevated but from what I read (will provide link) this seems to be the best possible explaination since all of your other levels are in line

"Any condition that affects bone growth or causes increased activity of bone cells can affect ALP levels in the blood"

Which in my unprofessional opinion would mean it could be being caued by bone marrow trying to keep up with cell destuction caused by the meds

It is also associated with liver disease but as you said all your other levels are in line, any way enough rattling by me here is the link, you can check it out and see what you think


Did you have a high Alkaline Phosphatase  (ALP) before starting treatment? Or has this started since treating hepatitis C?
What is the Normal Range for your lab?
If is is just above the norm it may not be anything.
Ask you doctor what they think about it.

Having alkaline phosphatase higher than AST, ALT levels can be an indication of Cholestatic liver disease. Cholestasis is an impairment of bile formation and/or bile flow which may clinically present with fatigue, pruritus (itching) and, in its most overt form, jaundice (skin/eyes turning yellow).

Early biochemical markers in often asymptomatic patients include increases in serum alkaline phosphatase (AP) and c-glutamyltranspeptidase (cGT) followed by conjugated hyperbilirubinemia at more advanced stages.

How is your GGT (Gamma-glutamyl transpeptidase) level?
It is done with other tests (such as the ALT, ALP, and bilirubin tests) to tell the difference between liver or bile duct disorders and bone disease.
The normal range is 0 to 51 international units per liter (IU/L).

Serum Alkaline Phosphatase is comprised of a heterogeneous group of enzymes. Hepatic alkaline phosphatase is most densely represented near the canalicular membrane of the hepatocyte. Accordingly, diseases that predominately affect hepatocyte secretion (e.g., obstructive diseases) will be accompanied by elevations of alkaline phosphatase levels.
Bile duct obstruction, primary sclerosing cholangitis and primary biliary cirrhosis, are some examples of diseases in which elevated alkaline phosphatase levels are often predominant over transaminase level elevations. (AST, ALT)

It is apparent that infiltrative liver diseases most often result in a pattern of liver test result abnormalities similar to those of cholestatic liver disease. Differentiation often requires imaging studies of the liver. Liver imaging by ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) most often identifies infiltration of the liver by mass lesions such as tumors. Imaging by cholangiography—endoscopic retrograde cholangiography, transhepatic cholangiography, or magnetic resonance cholangiography—identifies many bile duct lesions that cause cholestatic liver disease. Liver biopsy is often needed to confirm certain infiltrative disorders (e.g., amyloidosis) and microscopic biliary disorders such as primary biliary cirrhosis.

Again, I would ask you doctor what they think about it.

Wow. I just saw all the replies. Thank you all so much for such comprehensive answers.
My Doc is a clinical studies Dr. and just says "no problem" to anything I ask him. I like him but he is not big on explanations or speculations.
Hope to get on with  S.F.'s big guns soon.
Hector, I will look up my pre tx lab results and pm you later if you have time to check it out.
Thank you all, lovies.
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