Leukocyte Alkaline Phosphatase

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Contents 1 Indications 2 Reference-interval 3 Increases 4 Decreases 5 Methods 6 Specimen 7 More General Terms 8 Additional Terms 9 References

Indications

• principal utility is in distinguishing chronic myelogenous leukemia ( CML) from leukemoid reactions & other myelo- proliferative disorders

Reference-interval

• 15-40 mg of phosphorous liberated/hour per 10E10 cells
• score 13-130 per 100 neutrophils & band forms (score determined by individual laboratory)

Increases

• clinical disorders

• polycythemia rubra vera (highest values)
• leukemoid reactions
• agnogenic myeloid metaplasia
• idiopathic thrombocytopenic purpura
• Down's syndrome
• stress
• pregnancy
• myeloproliferative disorders
• acute lymphoblastic leukemia
• Hodgkin's disease
• aplastic anemia [3]
• bacterial infection

• pharmaceutical agents

• in vivo effects

• ACTH

• * In remission of CML, LAP may return to normal & may be elevated with CML in blast crisis [3]
• alkaline phosphatase-L (liver/ kidney/bone) or tissue-nonspecific alkaline phosphatase

Decreases

• (Low or absent in)

• clinical disorders

• chronic myeloid leukemia ( CML)*
• paroxysmal nocturnal hemoglobinuria ( PNH)
• infectious mononucleosis
• aplastic anemia [1, 2]
• sideroblastic anemia
• idiopathic thrombocytopenic purpura ( ITP)
• connective tissue disorders
• acute myeloid leukemia
• acute monocytic leukemia
• cirrhosis
• congestive heart failure with passive liver congestion
• diabetes mellitus
• gout
• pernicious anemia (increases after treatment)
• hereditary hypophosphatemia
• sarcoidosis

• pharmaceutical agents

• chemical interference

• EDTA

Methods

• Kaplow
• napthol AS- BI phosphate
• fast red-violet LB

Specimen

• finger-stick preferred
• collect venous blood in heparin or oxalate; do NOT use EDTA
• fix slides in formalin/ methanol within 30 minutes or keep in dessicator until fixed

More General Terms

• clinical hematology test

Additional Terms

• alkaline phosphatase-L (liver/kidney/bone, tissue-nonspecific alkaline phosphatase, ALPL)

References

1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 433, 435
2. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
3. Clinical Guide to Laboratory Tests, 3rd ed. Teitz ed., W.B. Saunders, 1995

leukocyte alkaline phosphatase (LAP)