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Lab value assessment

Low alkaline phosphatase (ALP) can differentiate hypophosphatasia (HPP) from other metabolic disorders.1-3

To ensure an accurate diagnosis, include hypophosphatasia in your differential diagnosis with a routine laboratory test1,2,8 when evaluating patients with bone-mineralizing disorders.

Alkaline phosphatase reference intervals

Growth and development profoundly affect the normal interval for alkaline phosphatase9,10

The alkaline phosphatase lower limit of normal is significantly higher in children than in adults10,11

Adapted from the Canadian Laboratory Initiative in Pediatric Reference Intervals (CALIPER) project (Colantonio et al, 2012).10 Reference intervals shown were established on the Abbott ARCHITECT C8000 analyzer.

aThe adult interval was obtained from the Abbott ARCHITECT ALP product information sheet, where it is indicated for females >15 and males >20 years of age.11

Age- and gender-adjusted alkaline phosphatase reference intervals are critical to making an accurate diagnosis of hypophosphatasia.1,2

Patients with hypophosphatasia have alkaline phosphatase activity below the lower limit of normal
The alkaline phosphatase lower limit of normal is significantly higher in children than in adults10,11
Lowest normal alkaline phosphatase activity is specific to the laboratory from which the test was ordered2

Assess your patient's alkaline phosphatase level

In children, the alkaline phosphatase lower limit of normal can be 4x higher than that for adults.2

ALKALINE PHOSPHATASE CALCULATOR

To assess your patient's alkaline phosphatase level, select your patient's gender, and enter his or her age and alkaline phosphatase value.

{{testType}}
Reference intervals shown are relevant to the Abbott ARCHITECT c8000 analyzer and may vary across individual laboratories.
GENDER
Age
ALP (U/L)
You must indicate gender, age, and ALP value.
REFERENCES
References: 1. Colantonio DA, Kyriakopoulou L, Chan MK, et al. Closing the gaps in pediatric laboratory reference intervals: a CALIPER database of 40 biochemical markers in a healthy and multiethnic population of children. Clin Chem. 2012;58(5):854-868. doi: 10.1373/clinchem.2011.177741. Epub 2012 Feb 27. 2. Rockman-Greenberg C. Hypophosphatasia. Pediatr Endocrinol Rev. 2013;10(suppl 2):380-388. 3. Whyte MP. Physiological role of alkaline phosphatase explored in hypophosphatasia. Ann N Y Acad Sci. 2010;1192:190-200. 4. Shipman KE, Holt AD, Gama R. Interpreting an isolated raised serum alkaline phosphatase level in an asymptomatic patient. BMJ. 2013;346:f976 doi: 10.1136/bmj.f976. 5. Whyte MP. Hypophosphatasia. In: Glorieux FH, Pettifor JM, Juppner H, eds. Pediatric Bone: Biology & Diseases Rev. 2nd ed. San Diego, CA: Academic Press; 2012:771-794. 6. Whyte MP. Hypophosphatasia: nature’s window on alkaline phosphatase function in humans. In: Bilezikian JP, Raisz LG, Martin TJ, eds. Principles of Bone Biology. Vol 1. 3rd ed. San Diego, CA: Academic Press; 2008:1573-1598. 7. Estey MP, Cohen AH, Colantonio DA, et al. CLSI-based transference of the CALIPER database of pediatric reference intervals from Abbott to Beckman, Ortho, Roche and Siemens Clinical Chemistry Assays: direct validation using reference samples from the CALIPER cohort. Clin Biochem. 2013;46(13-14):1197-1219. doi: 10.1016/j.clinbiochem.2013.04.001. Epub 2013 Apr 8. 8. Nield LS, Mahajan P, Joshi A, Kamat D. Rickets: not a disease of the past. Am Fam Physician. 2006;74(4):619-630. 9. Simmons JH. Best practices in: recognizing and diagnosing hypophosphatasia. Clinical Endocrinology News website. http://www.clinicalendocrinologynews.com/fileadmin/content_pdf/cen/Alexion_10_11_Final_Web.pdf. Published September 30, 2013. Accessed June 26, 2015. 10. Bhan A, Rao AD, Rao DS. Osteomalacia as a result of vitamin D deficiency. Endocrinol Metab Clin North Am. 2010;39(2):321-331. doi: 10.1016/j.ecl.2010.02.001. 11. Lab Tests Online. Liver panel. https://labtestsonline.org/understanding/analytes/liver-panel/tab/test. Published February 24, 2015. Accessed September 24, 2015. 12. Mornet E, Nunes ME. Hypophosphatasia. In: Pagon RA, Bird TD, Dolan CR, Stephen K, eds. GeneReviews. Seattle, WA: University of Washington, Seattle; 1993. http://www.ncbi.nlm.nih.gov/books/NBK1150/. Published November 20, 2007. Updated August 5, 2010. Accessed June 26, 2015.

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References: 1. Rockman-Greenberg C. Hypophosphatasia. Pediatr Endocrinol Rev. 2013;10(suppl 2):380-388. 2. Mornet E, Nunes ME. Hypophosphatasia. In: Pagon RA, Bird TD, Dolan CR, Stephen K, eds. GeneReviews. Seattle, WA: University of Washington, Seattle; 1993. http://www.ncbi.nlm.nih.gov/books/NBK1150/. Published November 20, 2007. Updated August 5, 2010. Accessed March 31, 2014. 3. Mohn A, De Leonibus C, de Giorgis T, Mornet E, Chiarelli F. Hypophosphatasia in a child with widened anterior fontanelle: lessons learned from late diagnosis and incorrect treatment. Acta Paediatr. 2011;100(7):e43-e46. 4. Carpenter TO, Imel EA, Holm IA, Jan de Beur SM, Insogna KL. A clinician’s guide to X-linked hypophosphatemia. J Bone Miner Res. 2011;26(7):1381-1388. 5. Tournis ST, Giannikou PV, Paspati IN, Katsalira EA, Voskaki IC, Lyritis GP. Co-existence of X-linked hypophosphatemic rickets (XLH) and primary hyperparathyroidism: case report and review of the literature. J Musculoskelet Neuronal Interact. 2005;5(2):150-154. 6. Nield LS, Mahajan P, Joshi A, Kamat D. Rickets: not a disease of the past. Am Fam Physician. 2006;74(4):619-630. 7. Reynolds RD, Lorenc RS, Wieczorek E, Pronicka E. Extremely low serum pyridoxal 5’-phosphate in children with familial hypophosphatemic rickets. Am J Clin Nutr. 1991;53(3):698-701. 8. Lab Tests Online. ALP. Washington DC: American Association for Clinical Chemistry; 2001. https://labtestsonline.org/understanding/analytes/alp/tab/test/. Updated October 29, 2015. Accessed April 6, 2016. 9. Turan S, Topcu B, Gökçe I, et al. Serum alkaline phosphatase levels in healthy children and evaluation of alkaline phosphatase z-scores in different types of rickets. J Clin Res Pediatr Endocrinol. 2011;3(1):7-11. 10. Colantonio DA, Kyriakopoulou L, Chan MK, et al. Closing the gaps in pediatric laboratory reference intervals: a CALIPER database of 40 biochemical markers in a healthy and multiethnic population of children. Clin Chem. 2012;58(5):854-868. 11. Architect cSystems/Aeroset System alkaline phosphatase assay [package insert]. Abbott Park, IL: Abbott Laboratories; 2007.