Leukocyte alkaline phosphatase

Leukocyte alkaline phosphatase

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Vendhan Ramanujam M.B.B.S [2]

Synonyms and keywords: LAP

Overview

Leukocyte alkaline phosphatase is an enzyme found within white blood cells. The blood level of leukocyte alkaline phosphatase is measured in order to help in the diagnosis of certain conditions. Higher levels of the enzyme are seen in polycythemia vera, essential thrombocytosis, primary myelofibrosis and leukemoid reaction. Lower levels are found in chronic myelogenous leukemia, aplastic anemia, paroxysmal nocturnal hemoglobinuria and acute myelogenous leukemia.

Causes of Increased Leukocyte Alkaline Phosphatase

Common Causes

• Acute leukemia
• Essential thrombocytosis
• Leukemoid reaction
• Malignant lymphomas
• Megaloblastic anemia
• Multiple Myeloma
• Myelofibrosis
• Polycythemia Vera
• Solid tumors
• Tissue necrosis

Causes by Organ System

Cardiovascular	Giant cell arteritis, hemorrhagic shock, ischemic colitis, myocardial infarction, pericarditis, subacute endocarditis, vasculitis
Chemical/Poisoning	Camphor, lead, lithium, mercury, pyrogallol, snakebite, turpentine
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	All-trans retinoic acid, arsphenamine, catecholamines , corticosteroids, dapsone, digitalis, neuroleptic malignant syndrome, oral contraceptives, phenacetin, quinidine, sulfa drugs
Ear Nose Throat	Tonsillitis
Endocrine	Cushing's disease, diabetes, diabetic coma, diabetic ketoacidosis
Environmental	Heatstroke
Gastroenterologic	Appendicitis, cholangitis, cholecystitis, gastric carcinoma, fulminant hepatic necrosis, ischemic colitis, liver abscess, liver fluke
Genetic	Congenital asplenia, congenital neutropenia , Down syndrome, familial cold autoinflammatory syndrome, Fanconi anemia, hereditary neutrophilia, hyposplenism, Klinefelter syndrome, Kostmann syndrome, leukocyte adhesion factor deficiency, Pelger-Huet anomaly, rac mutation
Hematologic	Acute lymphoblastic leukemia, acute myelogenous leukemia, agnogenic myeloid metaplasia, aplastic anemia, chronic neutrophilic leukemia, essential thrombocytopenia, Fanconi anemia, hairy cell leukemia, hemarthrosis, hemolysis, hemoperitoneum, hemorrhagic shock, Hodgkin's lymphoma, infectious mononucleosis, megaloblastic anemia, multiple myeloma, myelofibrosis, Pelger-Huet anomaly, polycythemia vera
Iatrogenic	Blood transfusion, G-CSF, GM-CSF, post splenectomy, vaccination
Infectious Disease	Actinomyces, burkholderia mallei, cellulitis, cholangitis, cholecystitis, clostridium difficile, coccidioides immitis, escherichia coli, herpes zoster, infectious mononucleosis, klebsiella pneumoniae, liver abscess, liver fluke, malaria, mycobacterium tuberculosis, neisseria gonorrhoeae, osteomyelitis, otitis media, pelvic abscess, pelvic inflammatory disease, perinephric abscess, pertussis, plague, poliomyelitis, pseudomonas aeruginosa, pyelonephritis, rabies, rickettsia, salmonella typhi, salpingitis, sepsis, septic arthritis, smallpox, spirochetes, staphylococcus aureus, staphylococcus epidermidis, streptococcus pneumoniae, streptococcus pyogenes, subacute endocarditis, tonsillitis, varicella, visceral larva migrans
Musculoskeletal/Orthopedic	Septic arthritis
Neurologic	Eclampsia, epidural hemorrhage, intracerebral hemorrhage, preeclampsia, subdural hemorrhage
Nutritional/Metabolic	Diabetic coma, diabetic ketoacidosis, uremia
Obstetric/Gynecologic	Cesarean delivery, eclampsia, pelvic inflammatory disease, preeclampsia, pregnancy, salpingitis
Oncologic	Acute lymphoblastic leukemia, acute myelogenous leukemia, agnogenic myeloid metaplasia, bronchogenic carcinoma , gastric carcinoma, hairy cell leukemia, Hodgkin's lymphoma, paraneoplastic phenomenon, renal carcinoma, squamous cell carcinoma
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	Chronic anxiety, depression, panic disorders, posttraumatic stress disorder
Pulmonary	Bronchogenic carcinoma, hemoperitoneum, klebsiella pneumoniae
Renal/Electrolyte	Perinephric abscess, pyelonephritis, renal carcinoma, renal insufficiency
Rheumatology/Immunology/Allergy	Acute gout, giant cell arteritis, rheumatic disease, rheumatoid arthritis, vasculitis
Sexual	No underlying causes
Trauma	Burns, epidural hemorrhage, hemarthrosis, hemoperitoneum, intracerebral hemorrhage, major tissue injury, subdural hemorrhage
Urologic	No underlying causes
Miscellaneous	Chronic idiopathic neutrophilia, cigarette smoking, emotional stress, insect venoms, physical stress, vigorous exercise

Causes in Alphabetical Order

• Actinomyces
• Acute gout
• Acute lymphoblastic leukemia
• Acute myelogenous leukemia
• Agnogenic myeloid metaplasia
• All-trans retinoic acid
• Antipyrine
• Aplastic anemia
• Appendicitis
• Arsphenamine
• Blood transfusion
• Bronchogenic carcinoma
• Burkholderia mallei
• Burns
• Camphor
• Catecholamines
• Cellulitis
• Cesarean delivery
• Cholangitis
• Cholecystitis
• Chronic anxiety state
• Chronic idiopathic neutrophilia
• Chronic neutrophilic leukemia
• Cigarette smoking
• Clostridium difficile
• Coccidioides immitis
• Congenital asplenia
• Congenital neutropenia
• Corticosteroids
• Cushing's disease
• Dapsone
• Depression
• Diabetes
• Diabetic coma
• Diabetic ketoacidosis
• Digitalis
• Diphtheria
• Down syndrome
• Eclampsia
• Emotional stress
• Epidural hemorrhage
• Escherichia coli
• Essential thrombocytopenia
• Familial cold autoinflammatory syndrome
• Fanconi anemia
• G-CSF

• Gastric carcinoma
• Giant cell arteritis
• GM-CSF
• Hairy cell leukemia
• Heatstroke
• Hemarthrosis
• Hemolysis
• Hemoperitoneum
• Hemorrhagic shock
• Hepatic necrosis
• Hereditary neutrophilia
• Herpes zoster
• Hodgkin's lymphoma
• Hyposplenism
• Infectious mononucleosis
• Insect venoms
• Intracerebral hemorrhage
• Ischemic colitis
• Klebsiella pneumoniae
• Klinefelter syndrome
• Kostmann syndrome
• Lead
• Leukocyte adhesion factor deficiency
• Lithium
• Liver abscess
• Liver fluke
• Major tissue injury
• Malaria
• Megaloblastic anemia
• Mercury
• Multiple myeloma
• Mycobacterium tuberculosis
• Myelofibrosis
• Myocardial infarction
• Neisseria gonorrhoeae
• Neisseria meningitidis
• Neuroleptic malignant syndrome
• Oral contraceptives
• Osteomyelitis
• Otitis media
• Panic disorders
• Paraneoplastic phenomenon
• Pelger-Huet anomaly
• Pelvic abscess
• Pelvic inflammatory disease
• Pericarditis
• Perinephric abscess

• Peritonitis
• Pertussis
• Phenacetin
• Physical stress
• Plague
• Poliomyelitis
• Polycythemia vera
• Post splenectomy
• Posttraumatic stress disorder
• Preeclampsia
• Pregnancy
• Pseudomonas aeruginosa
• Pyelonephritis
• Pyrogallol
• Quinidine
• Rabies
• Rac mutation
• Renal carcinoma
• Renal insufficiency
• Rheumatic disease
• Rheumatoid arthritis
• Rickettsia
• Salmonella typhi
• Salpingitis
• Sepsis
• Septic arthritis
• Smallpox
• Snakebite
• Spirochetes
• Squamous cell carcinoma
• Staphylococcus aureus
• Staphylococcus epidermidis
• Streptococcus pneumoniae
• Streptococcus pyogenes
• Subacute endocarditis
• Subdural hemorrhage
• Sulfa drugs
• Tonsillitis
• Trauma
• Turpentine
• Uremia
• Vaccination
• Varicella
• Vasculitis
• Vigorous exercise
• Visceral larva migrans

Causes of Decreased Leukocyte Alkaline Phosphatase

Common Causes

• Anemia
• Chronic Myelogenous Leukemia
• Hemolysis
• Iron deficiency anemia
• Sideroachrestic anemia (SA)

Causes by Organ System

Cardiovascular	No underlying causes
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal/Orthopedic	No underlying causes
Neurologic	No underlying causes
Nutritional/Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	No underlying causes
Rheumatology/Immunology/Allergy	No underlying causes
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	No underlying causes

Causes in Alphabetical Order

• Abetalipoproteinemia
• Acetazolamide
• Acquired hemolytic anemia
• Acute myelogenous leukemia
• Acute respiratory alkalosis
• Addison's disease
• Albuterol
• Alcohol
• Amyloidosis
• Aplastic anemia
• Atherosclerotic heart disease
• Atopic dermatitis
• Atypical chronic myeloid leukemia
• Bacterial overgrowth
• Bariatric surgery
• Beta thalassemia
• Blind loops
• Blood transfusion
• Burns
• Calcitonin
• Carcinoid syndrome
• Carcinoma of pancreas
• Celiac disease
• Chronic eosinophilic leukemia
• Chronic fatigue
• Chronic myelogenous leukemia
• Chronic myelomonocytic leukemia
• Chronic pancreatitis
• Chronic renal failure
• Citrated blood sample
• Collagen vascular diseases
• Crohn's disease
• Cystic fibrosis
• Degenerative arthritis
• Dementia
• Diabetes mellitus
• Dopamine
• EDTA blood sample
• Eosinophilic gastroenteritis
• Epinephrine
• Erythroblastosis fetalis
• Essential thrombocythemia

• Fanconi syndrome
• Fibromyalgia
• Fish tape worm
• Fluoride blood sample
• Gastrectomy
• Giardia lamblia
• Glucagon
• Granulocyte colony-stimulating factor
• Hepatic failure
• Hereditary hyperphosphatasia
• Hereditary hypophosphatemia
• Hereditary hypophosphatemic rickets
• Hereditary vitamin D-resistant rickets
• Histoplasmosis endocarditis
• HIV
• Hookworm
• Hungry bone syndrome
• Hyperparathyroidism
• Hypertension
• Hyperthyroidism
• Hypoparathyroidism
• Hypophosphatemia
• Hypothyroidism
• Idiopathic hypereosinophilic syndrome
• Idiopathic thrombocytopenic purpura
• IgG monoclonal gammopathy
• Inadequate phosphate intake
• Infectious mononucleosis
• Insulin
• Intestinal tuberculosis
• Iron deficiency anemia
• Lactose intolerance
• Lead
• Malignant diseases
• Malignant histiocytosis
• Malignant lymphoma
• Mustard gas
• Myeloid metaplasia
• Myeloproliferative variants of hypereosinophilic syndrome
• Neonatal infection
• Niacin
• Non hodgkins lymphoma

• Old blood samples
• Oncogenic osteomalacia
• Osteo arthritis
• Osteomalacia
• Oxalate blood sample
• Paget's disease
• Panic attacks
• Paroxysmal nocturnal hemoglobinuria
• Pernicious anemia
• Post renal transplant
• Primary bile acid diarrhea
• Primary myelofibrosis
• Radiation enteritis
• Recurrent Neutropenia
• Refeeding syndrome
• Refractory anemia with ringed sideroblasts
• Refractory thrombocytopenia
• Respiratory alkalosis
• Rheumatoid arthritis
• Roundworm
• Salicylate
• Sarcoidosis
• Short bowel syndrome
• Sickle cell disease
• Sideroachrestic anemia
• Sideroblastic anemia
• Subacute myeloid leukemia
• Sucrose intolerance
• Systemic corticosteroids
• Systemic lupus erythematosus
• Systemic sclerosis
• Terbutaline
• Thoracic ganglioneuroma
• Thrombocytopenic purpura
• Traveller's diarrhoea
• Tricuspid atresia
• Trilineage dysplasia
• Tropical sprue
• Uremia
• Vagotomy
• Whipple's disease