Treatment of low alkaline phosphatase. Causes of an increase in alkaline phosphatase in adults and children

The results of blood tests allow you to identify malfunctions in the body even before the onset of any symptoms. If during the examination it turns out that alkaline phosphatase is elevated, then the doctor will help you figure out whether this condition is a sign of a disease or is this a variant of the norm and no treatment is required.

One of the most informative diagnostic studies is a biochemical analysis. The material for this test is blood serum. In the process of research, the level of the content of various substances is determined, one of them is alkaline phosphatase (for brevity, this substance is often referred to as alkaline phosphatase). If a biochemical analysis shows that alkaline phosphatase is elevated, then it will be necessary to find out the causes of this condition.

What it is?

First of all, it is worth knowing what a substance is. This is a protein compound that acts as a catalyst in metabolic processes involving calcium and phosphorus. This enzyme is found in cell membranes of various tissues. Therefore, there are several fractions of alkaline phosphatase:

• bone;
• hepatic;
• placental;
• intestinal, etc.

A substance molecule is a dimeric compound, it consists of two parts, each of which has several (most often three) active nuclei.

Advice! In the blood, the substance is contained mainly in two forms - bone and liver. The ratio of these isoenzymes is approximately one to one. The content of other isoforms is insignificant.

Indications

The appointment of a blood test for the content of alkaline phosphatase is carried out in the process of diagnosing various diseases, most often, such an analysis is prescribed for suspected pathology of bone tissue and liver disease. Thus, the doctor can refer the patient to the analysis if he complains of digestive disorders, itching of the skin, pain in the right side, etc.

In addition, the analysis is assigned in the process:

• clinical examination of people working in hazardous industries;
• preparing the patient for surgery.

How is the procedure carried out?

For the study, blood samples must be taken. In order for the analysis to show objective results, it is necessary that the patient is ready for the examination. An analysis is given in the morning, and at least 12 hours must pass since the last meal. On the eve, you can not take alcoholic beverages and eat fatty foods.

Norms and deviations

Normal levels of alkaline phosphatase activity for adults is 40-130 IU/l. However, not always exceeding this indicator means the presence of pathology. In some cases, this is a variant of the norm.

Advice! Specific figures for the normal content of alkaline phosphatase can be seen in the laboratory form. The fact is that in different laboratories different methods of analysis can be applied, therefore, the values ​​\u200b\u200bof normal indicators can differ significantly.

Physiological norm

The normal content of alkaline phosphatase depends on the age of the patient. So, in a child, the level of a substance in the blood is significantly higher than in adults. This is due to the fact that during growth, more bone isoenzyme of alkaline phosphatase is synthesized, therefore, the level of total phosphatase in the blood of a child is high. With age, the growth process of the child stops, and the blood concentration of the bone isoform of the enzyme also decreases.

Advice! In girls, the level of alkaline phosphatase is compared with the indicators characteristic of adult patients by the age of majority. In guys, the bone-forming processes that cause the production of alkaline phosphatase last longer. Their indicators are equalized with "adult" norms by the age of 20-25.

In addition, an increased level of alkaline phosphatase is a physiological norm for pregnant women. In the period up to the 16th week of pregnancy, the activity of the enzyme increases due to the increased production of this substance by the placenta.

Thus, an elevated level of alkaline phosphatase is a physiological norm:

• for a child in the period of growth;
• for girls under 18 and for guys under 25;
• for pregnant women in the first trimester of pregnancy;
• for women taking hormonal contraceptives;
• for patients undergoing antibiotic treatment, taking aspirin;
• during the rehabilitation period after fractures, at this time, a callus is formed at the fracture site, so the level of bone isoenzyme is slightly higher than normal.

Pathology

However, an increase in the activity of alkaline phosphatase is not always a physiological norm; often the reasons for changes in the level of activity lie in pathological processes. Most often, the analysis allows you to identify pathologies of the liver, gallbladder, bone tissue. An increase in the level of the hepatic isoenzyme can provoke the following reasons:

In addition, the reasons for the increase in the level of the enzyme can be due to disorders of the gallbladder:

• with congestion, cholestasis may be due to blockage of the duct by a stone or squeezing of the gallbladder by a tumor;
• with neoplasms in the biliary tract;
• with biliary cirrhosis.

An increase in the level of the bone fraction of the enzyme is due to damage to the skeletal system. Possible reasons:

• rickets in a child;
• osteomalacia (pathology associated with impaired mineralization);
• bone sarcoma or bone metastases;
• osteoporosis.

An increase in the placental fraction of the enzyme in non-pregnant women may indicate the presence of a tumor in the internal genital organs (cervix, endometrium, etc.)

Advice! An increase in the level of the ALP enzyme by 2-3 times is noted in inert pathology. With lesions of the liver and biliary system, a more significant increase in enzyme activity is noted, its level may be 3-10 times higher than normal.

If the level of alkaline phosphatase in the blood is elevated, this does not mean that the patient has a pathology from those listed above. The analysis is not specific, additional studies will be required to make a diagnosis.

What to do?

What to do if the analysis showed that the activity of alkaline phosphatase is increased? First of all, do not panic and do not try to diagnose yourself. No need to try to try to lower the level of the enzyme by self-medicating.

You need to see a therapist. The doctor will also not be able to immediately make a diagnosis, since it is impossible to determine the nature of the pathology based on the results of only one analysis. The doctor will examine the patient, ask about his well-being, prescribe additional tests and examinations.

If necessary, he will issue a referral to a specialized doctor. You may need to consult a hepatologist, endocrinologist, surgeon, oncologist. Only after a complete examination is carried out, it will be possible to establish an accurate diagnosis and prescribe the appropriate treatment to the patient.

Evaluation of the results of a biochemical blood test is the business of specialists. However, patients cannot but be worried if they see obvious deviations from the norm in the analysis form. So, many people ask, what does it mean if alkaline phosphatase is elevated? Unfortunately, the results of such an examination cannot make a diagnosis.

Moreover, in some cases, an increase in the level of the hormone is a variant of the norm. Therefore, additional examinations and, possibly, consultations of narrow specialists will be required. Only after establishing the cause of the change in the activity of alkaline phosphatase, it will be possible to prescribe treatment.

Alkaline phosphatase- an enzyme-catalyst that exhibits maximum activity in an alkaline environment. Alkaline phosphatase is present in all tissues of the body, but most of all it is found in the bones, liver, intestinal mucosa, and in women, in addition, in the mammary glands. The test for determining the level of the enzyme in the blood is included in the standard study during routine examinations, preparation for operations, and even with a number of indications. The rate of alkaline phosphatase depends on the age and gender of the person, but in some cases an increase or decrease in the rate relative to the physiological norm is detected.

Decreased alkaline phosphatase in the blood

If alkaline phosphatase is lowered, then this is a signal that there are serious disorders in the body that should be treated. Among the reasons why alkaline phosphatase is lowered:

• severe degree of anemia;
• hypofunction of the thyroid gland;
• hypophosphatasia - a congenital disease leading to softening of bone tissue;
• age;
• cretinism;
• deficiency in the body of vitamin C, B6, B12, folic acid, magnesium and zinc.

In pregnant women, alkaline phosphatase is lowered with placental insufficiency. Sometimes a decrease in the level of an enzyme in the blood is a consequence of taking medications that affect the liver.

Attention! The level of alkaline phosphatase may not correspond to the norm in quite healthy people, in connection with which a comprehensive examination is carried out to make a diagnosis.

What to do if alkaline phosphatase is low?

As already noted, low alkaline phosphatase is observed in a number of diseases. To bring the indicators back to normal, conduct complex therapy aimed at treating the underlying disease. If the low level of the enzyme is the result of a deficiency of vitamins and elements, then consumption of foods rich in these substances is recommended.

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A number of enzymes included in the list under the general name "alkaline phosphatase" perform certain duties in the body, namely, they split off the residues of phosphoric acid from its organic ester compounds. In doing this work, they take part in calcium-phosphorus metabolism.

Alkaline phosphatase (AP) is a component of the cell membranes of almost all tissues of the body: bone, glandular, epithelial, however The enzyme is most active in the cells of the liver, kidneys, bone tissue and intestinal epithelium.

Phosphatase - a number of isoenzymes

Alkaline phosphatase in the human body is represented by a total of 11 isoenzymes, but the most important and often considered are:

• Hepatic;
• biliary tract;
• bone tissue;
• Intestines;
• tumors;
• placental isoenzyme.

As part of a biochemical blood test, alkaline phosphatase is often prescribed when examining children, because bone growth is accompanied by an increase in its activity ( in children, it is increased compared to the norm in adults).

The activity of alkaline phosphatase in the blood serum changes in violation of calcium-phosphorus metabolism, therefore, it serves as a kind of marker for the early detection of pathology of the skeletal system in the elderly ( osteoporosis) and is used for screening studies.

Some neoplastic processes localized in the organs of the female genital area lead to an increase in the placental fraction ( cervical cancer), which in the blood test will manifest itself as a digital increase in the activity of total alkaline phosphatase.

Enzyme activity in children and adults

The activity of alkaline phosphatase in children is normally 1.5 times higher than in adults., and since the child grows and develops intensively from birth to a certain time, the figures characterizing ALP can be very high and reach 800 U/l. However, this does not give grounds for concern, since this situation is due to the presence of not only liver, but also bone enzymes in alkaline phosphatase. In people whose skeletal system has completed its formation, the liver isoenzyme plays the main role in increasing the activity of alkaline phosphatase.

The activity of the isoenzyme is markedly increased in pregnant women.(closer to childbirth - III trimester), after all, the fetus requires its own, and in premature babies, since the child must intensively catch up with his peers. Such indicators are physiologically determined and are taken as normal values ​​corresponding to these conditions. Meanwhile, reduced activity of alkaline phosphatase in pregnant women indicates underdevelopment of the placenta, which is taken into account by the doctor observing the woman.

Table: norms of alkaline phosphatase in the blood

The activity of alkaline phosphatase is determined by various methods and at various temperature regimes of sample incubation. Above are the norms established by the optimized test at a temperature of 37 ° C 98 - 279 U / l(for 30°C there is a conversion factor). However, the reader, in search of normal values ​​of m can meet indicators of ALP activity, which differ significantly from each other. In order to avoid confusion and unnecessary worries, it can be recommended to use the reference values ​​that are indicated in the laboratory test form and help to understand whether the results obtained are within the normal range or not. In support of the foregoing, we present to the attention of the reader another table of normal values ​​of alkaline phosphatase activity:

Of course, it is not possible to predict what reference intervals the reader will find on the Internet or other sources, but he should know the main thing - it is better to ask the laboratory performing the analysis about the range of normal values.

Increase in alkaline phosphatase activity

Thus, the reason for the increase in the activity of alkaline phosphatase is the increased secretion of isoenzymes into the patient's blood: liver enzyme with changes in the hepatic parenchyma, biliary tract - with cholestasis, intestinal isoenzyme - with various inflammatory diseases of the gastrointestinal tract, bone - with metastatic lesions of the skeletal system, placental - with pregnancy, tumor processes.

Decreased secretion of isoenzymes (lowered phosphatase)

A decrease in the release of isoenzymes into the blood leads to reduced values ​​of alkaline phosphatase. Basically, this is due to a violation of phosphorus-calcium metabolism, only in a different direction. Alkaline phosphatase is lowered in the following cases:

Not to be confused with acid phosphatase

In addition to alkaline phosphatase, another indicator can be found in a biochemical blood test - acid phosphatase, the prostatic fraction of which serves as an important diagnostic indicator of prostate pathology, since it increases with tumors of this male organ. A particularly sharp increase in the level and activity of acid phosphatase is typical in cases of metastatic growth of cancer of a given localization.

Specific acid phosphatase (prostate phosphatase) is an isoenzyme that is known as prostate-specific antigen or tumor marker PSA (PSA).

Total acid phosphatase significantly increases its activity in the cancerous process localized in the prostate gland. A sharp increase in CF due to the prostatic fraction eloquently indicates the movement of the neoplastic process beyond the capsule of the gland, that is, the spread of metastatic foci to other organs.

Due to the fact that the enzyme is present on platelets - platelets and is released in accordance with their activation, the decrease in CP activity in thrombocytopenia of various origins becomes understandable.

A few words about "our smaller brothers"

The alkaline phosphatase test is a common test in veterinary medicine. Dog breeders and cat lovers may be more likely to look for the significance of this enzyme in animals than in humans, because breeding and maintaining a breed is an important and difficult matter, although some part of the population is skeptical about such experiences. But dogs also have rickets (and a thoroughbred dog needs to have a healthy skeletal system), they are haunted by diseases of the liver and gallbladder, just like people, “our smaller brothers”, are affected by malignant tumors.

Meanwhile, one should not equate the normal values ​​of the biochemical parameters of the human population with those of animals. Dogs and cats may have other norms that a specialist in this field knows. The norm of alkaline phosphatase in dogs according to one source is 24 - 85 U / l, while others allow a wider range of values ​​(from 0 to 150 U/L). What kind of analysis a particular dog has, whether it is good or bad, you need to find out in the laboratory that conducted this test (different methods, reagents and reference values).

Video: Alkaline Phosphatase Specialist

Video: Alkaline Phosphatase Presentation

Alkaline phosphatase in the blood is determined during a biochemical analysis. Although the name is not very common, however, the diagnostic significance of this indicator is very high.

A blood test for alkaline phosphatase allows you to identify problems with the liver, and you can determine the presence of hepatitis of various etiologies. It is also possible to identify primary malignant neoplasms in the liver.

According to the results of the analysis, problems with the musculoskeletal system are also revealed. This study is especially important for older people.

It is also important to use the diagnostic capabilities of alkaline phosphatase in cardiovascular diseases. In this area, this parameter has a good ability to detect problems.

Alkaline phosphatase is a group of enzymes found in many tissue and organ structures of the body. They are responsible for the cleavage and transport of the phosphate group, and also reflect the quality of the exchange of phosphorus and calcium in the body.

The term alkaline phosphatase (AP) implies that all enzymes with phosphatase activity are most effective in an alkaline environment (i.e. at a pH of 8.6 to 10.1), so alkaline phosphatase is not active in the blood, and is normally found in minimal amounts.

The presence of alkaline phosphatase is noted in many tissue and organ structures of the body. However, the largest "reserves" of this enzyme are noted in:

• osteoblasts;
• hepatocytes;
• nephrocytes;
• small intestine;
• placenta
• mammary gland during lactation.

Important. The overwhelming percentage of cases of increased levels of alkaline phosphatase in the blood is associated with diseases of the liver and bones. Least of all, alkaline phosphatase is elevated due to pathologies of the small intestine.

Normal levels of alkaline phosphatase

To obtain the most correct results, blood sampling should be carried out on an empty stomach from a vein. For research, blood serum is used. The standard turnaround time is 24 hours.

In adult men, normal values ​​range from 40 to 130 IU / L, and in women from 35 to 105 IU / L.

ALP is increased, what does it mean in an adult and in a child

Elevated alkaline phosphatase in a biochemical blood test, as a rule, indicates damage to the hepatobiliary system or bone tissue.

Alkaline phosphatase is elevated. Causes

A pronounced increase in the levels of the enzyme is observed with cholestasis (stagnation of bile). This condition develops when the lumen of the biliary tract is obstructed with a stone (GSD), as well as in the presence of a tumor or metastasis that prevents the normal outflow of bile.

More rare causes of cholestasis are postoperative strictures, primary sclerosing cholangitis (lesion of the intrahepatic ducts), and primary biliary cirrhosis, accompanied by sclerosis of the bile ducts.

Very important! In hepatitis of viral etiology, in contrast to aminotransferases, alkaline phosphatase may remain normal or increase slightly. A pronounced increase in this enzyme in a biochemical blood test in patients with viral hepatitis is a poor prognostic sign. This indicates necrosis of hepatocytes and the development of cirrhosis..

Also, an increase in the level of alkaline phosphatase in the blood occurs with hepatitis of toxic etiology (alcohol poisoning, drug-induced hepatitis). The greatest hepatotoxic effect have:

• tetracycline antibiotics,
• paracetamol,
• valproic acid,
• salicylates,
• amiodarone,
• antimalarial drugs,
• synthetic estrogens (liver damage occurs when treated with high doses, as a rule, a similar complication develops in patients with prostate cancer).

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Alkaline phosphatase in the blood rises sharply in primary malignant neoplasms of the liver, as well as when it is affected by metastases.

Attention! In women who use oral hormonal contraceptives containing estrogen and progesterone for a long time, an increase in alkaline phosphatase associated with bile stasis is possible.

In addition to damage to the hepatobiliary system, similar changes in the analyzes are observed with damage to the musculoskeletal system.

In bone tissue, ALP is located in osteoblasts - young osteo-forming cells. Therefore, when the bones are damaged, their work is activated, and, consequently, the activity of alkaline phosphatase is increased.

This picture is typical for fractures, and alkaline phosphatase increases immediately after injury (due to bone damage) and persists for the entire time of fracture healing (due to activation of osteoblasts).

Also, the level of the enzyme is sharply increased in Paget's disease. This is a pathology accompanied by increased destruction of bone tissue, bone deformity and frequent fractures, even after a minor injury. With a severe course of the disease, chronic heart failure develops. This is due to an increased load on the heart, since increased blood supply is required for the constant regeneration of damaged bone structures.

In hyperparathyroidism, alkaline phosphatase in the blood increases due to the stimulation of resorption (destruction) of bone tissue by parathyroid hormone. Also, the disease is accompanied by a pronounced violation of the exchange of Ca and P.

Other reasons for an increase in alkaline phosphatase in the blood are:

• thyrotoxicosis;
• heart attack of the lung or kidney;
• osteogenic sarcoma;
• metastasis to bone tissue;
• myeloma;
• Hodgkin's disease, accompanied by damage to bone structures.

Phosphorus mellitus Fanconi is considered a rare cause of an increase in alkaline phosphatase. This is a severe congenital disorder of the exchange of P and Ca, caused by D-vitamin resistant rickets.

In patients with Fanconi diabetes, the process of reabsorption of phosphate by the renal tubules is disrupted, calcium absorption in the intestine decreases and the function of the parathyroid glands increases. Clinically, the main manifestation of the disease is severe bone deformities, leading to severe disability.

Also, alkaline phosphatase is elevated in severe intestinal infections.

If alkaline phosphatase is elevated. Reasons for a child

Normally, an increase in alkaline phosphatase is determined during the period of active growth of bone tissue. Such a picture in the biochemical analysis of blood is observed before puberty. Further, the level of alkaline phosphatase begins to decrease.

A pathological increase in the enzyme may be due to rickets, fractures, infectious mononucleosis, intestinal infections, Fanconi diabetes. This list also includes the same reasons for the increase in alkaline phosphatase as in adults (cholelithiasis, malignant neoplasms with liver metastasis, hyperparathyroidism, etc.).

Can alkaline phosphatase be elevated during pregnancy

In pregnant women, moderately elevated levels of alkaline phosphatase are considered normal. A sharp increase in the enzyme in the analysis can be detected in severe preeclampsia (preecampsia and eclampsia).

A decrease in the activity of alkaline phosphatase is characteristic of placental insufficiency.

Elevated values ​​in cardiovascular disease

With congestive right ventricular failure, there is a pronounced overload of the right heart. Clinically, the disease is manifested by swelling of the jugular veins, high venous pressure, arterial hypotension, liver enlargement, edema (the severity of edema depends on the stage of the disease and can vary from edema in the lower extremities to anasarca).

Content

Doctors recommend even a healthy person to take an annual blood biochemistry test. Among the important indicators that will be in the decoding of the results, it is worth paying attention to the level of ALP. Experts call it the key to assessing the health of the hepatobiliary system, bones and liver. A biochemical blood test of a pregnant woman or child can often show an increase in ALP (alkaline phosphatase) - this is a physiological norm.

What is alkaline phosphatase

This term refers to a whole group of isoenzymes that are found in almost all human tissues, with the highest concentration in the liver, biliary tract, bone tissue and placenta. Phosphatase, creating an alkaline environment, splits phosphoric acid into salts (phosphates) with the release of phosphorus, which can penetrate the cell membrane. When the cells containing the enzyme are destroyed, it enters the bloodstream. Since cells are constantly renewing, there is always a certain level of enzyme concentration.

What does alkaline phosphatase show in the blood

The activity of alkaline phosphatase is associated with processes in the liver, bile ducts, and small intestine. Analysis of the enzyme level is very important in the diagnosis of liver pathologies, blockage of the bile ducts in gallbladder stones and pancreatic tumors, primary biliary cirrhosis and sclerosing cholangitis. Increased activity of bone tissue cells also affects the level of phosphatase in the blood, which is important in the diagnosis of primary or secondary bone tumors.

high

Increased activity of alkaline phosphatase (other medical abbreviations - ALP, ALKP) during pregnancy is considered the norm, and in other cases, as a rule, indicates liver disease or pathological processes in the bones. Under such conditions, some related indicators become important for diagnosis. So, a parallel increase in the levels of bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT) is likely to indicate liver damage. Changes in the levels of minerals - calcium and phosphorus - will show the pathology of bone tissue.

Low

A low level of the ALP enzyme is much less common than an increased level. Such a result can be given by taking oral contraceptives, blood transfusion, lack of magnesium and zinc in the body. In addition, a low level of bone isoenzymes is the main indicator of hypophosphatasia, a rare genetic disease characterized by impaired bone formation. If the disease manifests itself in children (juvenile form), it is characterized by frequent fractures, rickets, tooth loss.

Analysis

The level of ALP is determined by the blood serum, more often during a biochemical analysis, sometimes separately. Blood sampling is carried out from a vein, the study is carried out on an empty stomach. Indications for analysis may be patient complaints of fatigue, weakness, loss of appetite, vomiting or nausea, darkening of urine and lightening of feces, soreness of the right hypochondrium, yellowing of the skin and sclera. Doctors of various profiles are sent to the study: therapists, gastroenterologists, endocrinologists, urologists, infectious disease specialists, hematologists.

The norm of alkaline phosphatase

The normal level of alkaline phosphatase in the blood is considered to be between 20 and 140 IU/l. This is an average value, which varies greatly depending on the gender and age of the person. The highest rates are observed in children and adolescents during active growth, as they have a constant division of bone tissue. In addition, doctors identify about 200 drugs, the use of which can change the activity of the hepatic isoenzyme and affect the analysis data (usually upwards).

In men

ALP indicators for men are given below (in young people under 30 years of age, the results may be slightly above the upper limit of the norm, doctors do not attribute this to pathologies):

Among women

An abnormal level of alkaline phosphatase, not associated with the disease, in women can be observed during the third trimester of pregnancy (the reason is the placental isoenzyme released into the blood), during breastfeeding, due to excessive physical exertion. In other cases, the following norm of alkaline phosphatase in the blood of women is assumed:

In children

The most active periods of growth occur in the first year of life and transitional age. This is reflected in the test results, the increase in alkaline phosphatase in children coincides with these periods.

The norm of alkaline phosphatase in the blood in children:

Causes of an increase in alkaline phosphatase in the blood

High ALP itself is not a diagnosis, more research is needed, since the indicator can increase due to many reasons, among them:

• Hepatitis of any origin (norms increased up to 3 times).
• Infectious mononucleosis, especially the first week of illness.
• Cirrhosis of the liver is a disease in which liver tissue is replaced by connective tissue, which negatively affects its functions. ALP in a biochemical blood test will also increase with cirrhosis of any etiology, autoimmune or alcoholic.
• Liver cancer or metastases in the area of ​​this organ.
• Tumors of the pancreas or stomach, pressing on the area of ​​the bile ducts. Blockage of the bile ducts is called cholestasis.
• Primary kidney cancer.
• Stones in the gallbladder.
• Paget's disease (the norm is exceeded up to 15-20 times) is a rare disease characterized by pathological growth of bones.
• Osteosarcoma or bone metastases from other tumors.
• Osteomalacia is a pathological lack of calcium that causes softening of the bones.
• Myocardial infarction.
• Hyperparathyroidism is a thyroid disease in which calcium is washed out of the bones.
• Ulcerative colitis, since alkaline phosphatase is found in the intestinal cells.

Causes of a decrease in alkaline phosphatase

During pregnancy, a decrease in the activity of alkaline phosphatase is considered an alarming symptom, since may indicate placental insufficiency. There are other reasons for the decline:

• Hypothyroidism is an underfunction of the thyroid gland.
• Severe anemia.
• Condition after massive blood transfusion.
• Hypophosphatasia is a rare congenital disease affecting bone genesis.
• Lack of magnesium and zinc.

How to reduce alkaline phosphatase in the blood

There are a number of conditions in which a high ALKP in a biochemical blood test is not a cause for concern. For example, if there is a pregnancy or a fracture heals. In other cases, an increase in alkaline phosphatase in the blood is a reason to continue the examination by a doctor, and not to search for a universal prescription. It is necessary to understand what pathology causes an increase in ALP, and to treat this disease. Attempts to make a diagnosis and prescribe treatment on your own can be dangerous, leading to a worsening or transition of the disease to a more serious stage.

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