Alkaline Phosphatase (ALP) test is a routine laboratory blood test whose purpose is to measure the amount of alkaline phosphatase enzyme in blood. The enzyme is very important in breaking down proteins and is found mainly in the liver, bones, kidneys, and bile ducts. High concentrations of ALP can be secondary to bone or liver disease or other disorders.

The test can be ordered as a battery of liver function test or when the clinical picture is one of suspicion of liver or bone disease. Patient education on what an ALP test is, why the test is done, and how the results are interpreted is the most vital foundation of early diagnosis and proper treatment.

What is an ALP Test?

The Alkaline Phosphatase (ALP) test, or ALP blood test, is a blood test for the blood level of the enzyme alkaline phosphatase present in the blood. alkaline phosphatase liver is involved in protein degradation and is important in many body functions, notably in bones and liver.

Alkaline phosphatase is produced in different tissues of the body like the liver, bones, intestines, and kidneys. The liver and bones are the most common organs to release ALP into the bloodstream, although.

Why is the ALP Test Done

Alkaline phosphatase test purpose is that doctors order the ALP test for numerous reasons, most of which are bone and liver disorders. You can get this test done to determine the reason for pain in your abdomen, weakness, nausea, jaundice (yellowish coloration of your eyes or skin), or bone pain without a definite reason.

Common Conditions Tested using ALP Test

  • Liver Abnormalities: ALP is very high in conditions such as hepatitis, cirrhosis, liver cancers, and obstruction of bile ducts. ALP is also raised in fatty liver and liver abscess.
  • Bone Diseases: Diseases such as Paget's disease, osteomalacia, rickets, and metastasis to bone are expected to raise the level of ALP due to increased cellular activity of bones.
  • Gallbladder Disease: Cholangitis or cholelithiasis may cause an increase in ALP level.
  • Cancer Metastasis: ALP can increase in a few metastatic cancer to bone or liver, e.g., breast or prostate cancer.
  • Hyperparathyroidism and Vitamin D Deficiency: These are bone and calcium metabolism disorders that can cause abnormal results on ALP.
ALP test is not done only for bone disorders diagnosis but forms part of total testing and is helpful in deciding the next step of medical evaluation.

Preparation for an ALP Test

ALP test preparation is generally straightforward, but following a few precautions will help in obtaining accurate results:
Fasting: Fasting 8-12 hours before the test is usually recommended, especially if the test is included in a liver function panel.
Medications: Let your doctor know about any drug or supplement that you are taking. Oral contraceptives, anti-epileptics, antibiotics, and steroids influence the levels of ALP.
Diet and Activity: Do not eat greasy foods and work out vigorously before taking the test. Muscle or bone activity will help to raise the ALP for a short time.
Hydration: Stay well-hydrated to have no trouble drawing blood and not get dehydrated or lightheaded.
Clothing: Dress in a roll-up sleeve shirt so it will be simple to roll them up for a simpler blood draw.
By doing this easy thing, the test will be more precise and your process more casual.

ALP Test Procedure

The ALP test is not painful and easy. It is carried out as follows:

Preparation: You will be asked to sit or recline. The phlebotomist will prepare the puncture site, typically the inner elbow or back of the hand.
Application of Tourniquet: A tourniquet is applied around your upper arm to make the veins prominent.
Venipuncture or Blood Extraction: A sterile needle is passed through a vein, and blood is sucked up into a test tube or vial.
Labelling: The sample is labeled and sent to an analytical lab for examination.
Aftercare: The needle is pulled out and the site is pressed to avoid bleeding. A bandage is applied.

Once the test has been completed, all individuals are generally fine to go on with their day normally immediately. There are some minor side effects which may be experienced though:

  • Bruising: There is a small bruise at the point where puncture occurs that will heal in a few days' time.
  • Soreness: There is some soreness or swelling.
  • Light-headedness: Some are drowsy or weak, especially those who are needle phobic or have fasted.
To recover fast:

  • Wear the dressing for a few hours.
  • Avoid using the arm upon which blood is drawn.
  • Drink plenty of water and have a light meal if fasting was necessary.

Read More: What You Must Know About Mean Corpuscular Hemoglobin Test


Interpreting ALP Test Results

To interpret ALP test results, know what is ALP normal range vs abnormal range:
Normal ALP Range:

  • Adults: 44 to 147 IU/L (international units per liter)
  • Children and Adolescents: Greater than in adults because of bone growth
  • Pregnant Women: Naturally higher because placental synthesis of ALP

Elevated ALP Levels:

Causes of high ALP are:


  • Diseases of the liver such as hepatitis or cirrhosis
  • Blockage of bile ducts
  • Bone diseases like osteomalacia, Paget's disease
  • Cancer or bone metastasis of some cancers
  • Healing of fractures
  • Hyperthyroidism
Low Levels of ALP:
Low alkaline phosphatase causes:

  • Malnutrition
  • Hypothyroidism
  • Deficiency in zinc level or magnesium deficiency
  • Wilson's disease (inherited disorder)
  • Congenital hypophosphatasia (inherited bone disorder)
ALP is generally assessed in combination with other tests such as ALT, AST, bilirubin, calcium, and phosphate to gain a complete picture of the bone and liver.

Conditions Detected by ALP Test

Liver-Related Conditions:

  • Viral and autoimmune hepatitis
  • Cirrhosis
  • Obstruction of bile ducts
  • Liver cancer
  • Alcoholic liver disease
Bone Disorders:

  • Paget's disease of the bone
  • Osteomalacia and rickets (Vitamin D deficiency)
  • Bone metastases in cancer
  • Healing of fractures
Other Conditions:

  • Inflammatory bowel diseases
  • Sarcoidosis
  • Bone or liver infections

ALP Isoenzymes

If the cause is not known when the total ALP is elevated, doctors will order an ALP isoenzymes test. The test separates the different types of ALP enzymes in the body to know from where the increase is originating:

  • Liver Isoenzyme: Indicates liver or bile duct disease
  • Bone Isoenzyme: Indicates bone disease or injury
  • Placental Isoenzyme: Present in pregnancy
  • Intestinal Isoenzyme: Rare, can indicate intestinal disease or cancer

ALP Test vs. Alk Test

Both ALP test and Alk test are also hospital name synonymous general hospital. Both are also synonyms of the same test which is done to test alkaline phosphatase in blood. "Alk" is simply a shortened version of "alkaline." A laboratory might or might not use ALP or Alk, but the motive to do the test, how to do the test, and interpretation of the test result is the same.

ALP Test Cost in Pakistan

An ALP test cost in Pakistan varies with the city and clinic:

  • Stand alone ALP Test: PKR 250 - PKR 1,200
  • Liver Function Test (LFT) Panel: PKR 1,000 - PKR 2,500
  • Government Hospitals: Free or subsidized tests as a rule
  • Private Labs: More expensive but offer faster turnaround and online reports
ALP test is very reliable when done in a certified lab. Results are to be interpreted in the context of other diagnostic tests in order to draw proper conclusions.

Book lab tests from the best-certified labs in Lahore, Karachi, Islamabad, and all major cities of Pakistan through InstaCare, and get a discount of up to 35%. For assistance, call our helpline at 03171777509 to find the right lab test for your health needs.