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{{CMG}}; {{AE}} {{VR}}


{{EH}}
{{SK}} LAP


== Overview ==   
== Overview ==   
* Alkaline phosphatase is an enyzme present throughout the body
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]], [[myelofibrosis|primary myelofibrosis]] and [[leukemoid reaction]]. Lower levels are found in [[chronic myelogenous leukemia]], [[aplastic anemia]], [[paroxysmal nocturnal hemoglobinuria]] and [[acute myelogenous leukemia]].
* Alkaline phosphatase functions optimally at pH 8.6
* '''Leukocyte alkaline phosphatase''' is a test that tests the level of enzyme within the white blood cells
* Sometimes referred to as '''LAP'''


== Differential Diagnosis ==  
==Causes of Increased Leukocyte alkaline phosphatase==
===Life Threatening Causes===
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.


In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
*[[Appendicitis]]
*[[Blood transfusion]]
*[[Burns]]
*[[Diabetic coma]]
*[[Diabetic ketoacidosis]]
*[[Eclampsia]]
*[[Epidural hemorrhage]]
*[[Hemorrhagic shock]]
*[[Fulminant hepatic necrosis|Hepatic necrosis]]
*[[Venom|Insect venoms]]
*[[Intracerebral hemorrhage]]
*[[Ischemic colitis]]
*[[Myocardial infarction]]
*[[Osteomyelitis]]
*[[Pelvic abscess]]


=== Decreased ===
===Common Causes===
* [[Anemia]]
*[[Acute leukemia]]
* [[Chronic Myelogenous Leukemia]]
*[[Essential thrombocytosis]]
* [[Hemolysis]]
*[[Leukemoid reaction]]
* [[Iron deficiency anemia]]
*[[Malignant lymphoma]]
* [[Sideroachrestic anemia]] (SA)
*[[Megaloblastic anemia]]
*[[Multiple Myeloma]]<ref name="pmid406335">{{cite journal| author=Brook J, Dreisbach PB| title=Leukocyte alkaline phosphatase levels in multiple myeloma. | journal=J Lab Clin Med | year= 1977 | volume= 90 | issue= 1 | pages= 114-7 | pmid=406335 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=406335  }} </ref>
*[[Myelofibrosis]]
*[[Polycythemia Vera]]
*[[Tumor|Solid tumors]]
*[[Necrosis|Tissue necrosis]]<ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref><ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
 
===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Giant cell arteritis]], [[hemorrhagic shock]], [[ischemic colitis]], [[myocardial infarction]], [[pericarditis]], [[subacute endocarditis]], [[vasculitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical/Poisoning'''
|bgcolor="Beige"| [[Camphor]], [[lead]], [[lithium]], [[mercury]], [[pyrogallol]], [[snakebite]], [[turpentine]]
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[All-trans retinoic acid]], [[arsphenamine]], [[catecholamines]], [[corticosteroids]], [[dapsone]], [[digitalis]], [[neuroleptic malignant syndrome]], [[oral contraceptives]], [[phenacetin]], [[quinidine]], [[sulfa drugs]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| [[Tonsillitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| [[Cushing's disease]], [[diabetes]], [[diabetic coma]], [[diabetic ketoacidosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| [[Heatstroke]]
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Appendicitis]], [[cholangitis]], [[cholecystitis]], [[gastric carcinoma]], [[fulminant hepatic necrosis]], [[ischemic colitis]], [[liver abscess]], [[liver fluke]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[Asplenia|Congenital asplenia]], [[neutropenia|congenital neutropenia]], [[Down syndrome]], [[familial cold urticaria|familial cold autoinflammatory syndrome]], [[Fanconi anemia]], [[hereditary neutrophilia]], [[hyposplenism]], [[Klinefelter syndrome]], [[Kostmann syndrome]], [[Leukocyte adhesion deficiency|leukocyte adhesion factor deficiency]], [[Pelger-Huet anomaly]], [[rac|rac mutation]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| [[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]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| [[Blood transfusion]], [[G-CSF]], [[GM-CSF]], [[splenectomy|post spleenectomy]], [[vaccination ]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Abscess]], [[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]], [[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 ]]
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| [[Septic arthritis]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| [[Eclampsia]], [[epidural hemorrhage]], [[intracerebral hemorrhage]], [[preeclampsia]], [[subdural hemorrhage]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| [[Diabetic coma]], [[diabetic ketoacidosis]], [[uremia]]
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| [[Cesarean delivery]], [[eclampsia]], [[pelvic inflammatory disease]], [[preeclampsia]], [[pregnancy]], [[salpingitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| [[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]]
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| [[Anxiety|Chronic anxiety]], [[depression]], [[panic disorders]], [[posttraumatic stress disorder]]
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| [[Bronchogenic carcinoma]], [[hemoperitoneum]], [[klebsiella pneumoniae]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| [[Abscess]], [[pyelonephritis]], [[renal carcinoma]], [[renal insufficiency]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| [[Gout|Acute gout]], [[giant cell arteritis]], [[rheumatic disease]], [[rheumatoid arthritis]], [[vasculitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| [[Burns]], [[epidural hemorrhage]], [[hemarthrosis]], [[hemoperitoneum]], [[intracerebral hemorrhage]], [[tissue|major tissue injury]], [[subdural hemorrhage]]
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| [[neutrophilia|Chronic idiopathic neutrophilia]], [[cigarette smoking]], [[emotional stress]], [[Venom|insect venoms]], [[Stress|physical stress]], [[Exercise|vigorous exercise]]
|-
|}
 
===Causes in Alphabetical Order===
{{col-begin|width=80%}}
{{col-break|width=33%}}
*[[Abscess]]
*[[Actinomyces]]
*[[Gout|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]]
*[[Anxiety|Chronic anxiety]]
*[[Neutrophilia|Chronic idiopathic neutrophilia]]
*[[Chronic neutrophilic leukemia]]
*[[Cigarette smoking]]
*[[Clostridium difficile]]
*[[Coccidioides immitis]]
*[[Asplenia|Congenital asplenia]]
*[[Neutropenia|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 urticaria|Familial cold autoinflammatory syndrome]]
*[[Fanconi anemia]]
*[[G-CSF]]
{{col-break|width=33%}}
*[[Gastric carcinoma]]
*[[Giant cell arteritis]]
*[[GM-CSF]]
*[[Hairy cell leukemia]]
*[[Heatstroke]]
*[[Hemarthrosis]]
*[[Hemolysis]]
*[[Hemoperitoneum]]
*[[Hemorrhagic shock]]
*[[Fulminant hepatic necrosis|Hepatic necrosis]]
*[[Hereditary neutrophilia]]
*[[Herpes zoster]]
*[[Hodgkin's lymphoma]]
*[[Hyposplenism]]
*[[Infectious mononucleosis]]
*[[Venom|Insect venoms]]
*[[Intracerebral hemorrhage]]
*[[Ischemic colitis]]
*[[Klebsiella pneumoniae]]
*[[Klinefelter syndrome]]
*[[Kostmann syndrome]]
*[[Lead]]
*[[Leukocyte adhesion deficiency|Leukocyte adhesion factor deficiency]]
*[[Lithium]]
*[[Liver abscess]]
*[[Liver fluke]]
*[[Tissue|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]]
{{col-break|width=33%}}
*[[Peritonitis]]
*[[Pertussis]]
*[[Phenacetin]]
*[[Stress|Physical stress]]
*[[Plague]]
*[[Poliomyelitis]]
*[[Polycythemia vera]]
*[[Splenectomy|Post splenectomy]]
*[[Posttraumatic stress disorder]]
*[[Preeclampsia]]
*[[Pregnancy]]
*[[Pseudomonas aeruginosa]]
*[[Pyelonephritis]]
*[[Pyrogallol]]
*[[Quinidine]]
*[[Rabies]]
*[[Rac|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]]
*[[Exercise|Vigorous exercise]]
*[[Visceral larva migrans]]
{{col-end}}
 
==Causes of Decreased Leukocyte Alkaline Phosphatase==
===Life Threatening Causes===
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.


=== Increased ===
*[[Burns]]
* [[Acute leukemia]]
*[[Epinephrine]]
* [[Aplastic Anemia]]
*[[Respiratory alkalosis]]
* Idiopathic thrombocythemia
*[[Salicylate|Salicylate toxicity]]
* [[Malignant lymphoma]]s
*[[Terbutaline|Terbutaline toxicity]]
* [[Megaloblastic anemia]]
* [[Multiple Myeloma]]
* [[Osteomyelofibrosis]]
* [[Polycythemia Vera]]
* Solid [[tumors]]
* Tissue [[necrosis]]


== References ==
===Common Causes===
{{Reflist}}
* [[Aplastic anemia]]
* [[Chronic myelogenous leukemia]]
* [[Hypophosphatemia]]<ref name="Gaasbeek-2005">{{Cite journal  | last1 = Gaasbeek | first1 = A. | last2 = Meinders | first2 = AE. | title = Hypophosphatemia: an update on its etiology and treatment. | journal = Am J Med | volume = 118 | issue = 10 | pages = 1094-101 | month = Oct | year = 2005 | doi = 10.1016/j.amjmed.2005.02.014 | PMID = 16194637 }}</ref>
* [[Iron deficiency anemia]]
* [[Paroxysmal nocturnal hemoglobinuria]]
* [[Systemic lupus erythematosus]]<ref name="TANAKA-1960">{{Cite journal  | last1 = TANAKA | first1 = KR. | last2 = VALENTINE | first2 = WN. | last3 = FREDRICKS | first3 = RE. | title = Diseases or clinical conditions associated with low leukocyte alkaline phosphatase. | journal = N Engl J Med | volume = 262 | issue =  | pages = 912-8 | month = May | year = 1960 | doi = 10.1056/NEJM196005052621804 | PMID = 13836802 }}</ref><ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref><ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref><ref name="Sharma-1980">{{Cite journal  | last1 = Sharma | first1 = SC. | title = Leucocyte alkaline phosphatase in neonatal infections. | journal = Postgrad Med J | volume = 56 | issue = 657 | pages = 485-7 | month = Jul | year = 1980 | doi =  | PMID = 7443603 }}</ref><ref name="Lokich-1977">{{Cite journal  | last1 = Lokich | first1 = JJ. | title = Leukocyte alkaline phosphatase activity in patients with malignant disease. | journal = Cancer | volume = 40 | issue = 3 | pages = 1202-5 | month = Sep | year = 1977 | doi =  | PMID = 902237 }}</ref>


{{SIB}}
===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |  [[Histoplasmosis | Histoplasmosis endocarditis]],  [[tricuspid atresia]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical/Poisoning'''
|bgcolor="Beige"| [[Mustard gas]]
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| [[Atopic dermatitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Acetazolamide]],  [[albuterol]],  [[dopamine]],  [[epinephrine]],  [[glucagon]],  [[granulocyte colony-stimulating factor]],  [[insulin]], [[salicylate]], [[corticosteroids|systemic corticosteroids]],  [[terbutaline]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| [[Addison's disease]],  [[calcitonin]],  [[diabetes mellitus]],  [[Parathyroidectomy|hungry bone syndrome]],  [[hyperparathyroidism]],  [[hyperthyroidism]],  [[hypoparathyroidism]],  [[hypothyroidism]]
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Bacterial overgrowth]], [[bariatric surgery]], [[blind loop syndrome]], [[carcinoid syndrome]],  [[carcinoma of pancreas]],  [[celiac disease]],  [[chronic pancreatitis]],  [[Crohn's disease]],  [[cystic fibrosis]],  [[eosinophilic gastroenteritis]],  [[Diphyllobothrium | fish tapeworm]],  [[giardia lamblia]],  [[hepatic failure]],  [[hookworm]],  [[Tuberculosis | intestinal tuberculosis]],  [[lactose intolerance]],  [[Bile acid malabsorption|primary bile acid diarrhea]],  [[radiation enteritis]],  [[refeeding syndrome]],  [[roundworm]],  [[short bowel syndrome]],  [[sucrose intolerance]],  [[traveler's diarrhea]],  [[tropical sprue]],  [[Whipple's disease]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[Abetalipoproteinemia]],  [[beta thalassemia]],  [[cystic fibrosis]],  [[hyperphosphatasia|hereditary hyperphosphatasia]],  [[X-linked_hypophosphatemia | hereditary hypophosphatemia]],  [[Autosomal dominant hypophosphatemic rickets | hereditary hypophosphatemic rickets]],  [[Vitamin D resistant rickets|hereditary vitamin D-resistant rickets]],  [[Monoclonal gammopathy of undetermined significance | IgG monoclonal gammopathy]],  [[malignant histiocytosis]],  [[hypereosinophilic syndrome|myeloproliferative variants of hypereosinophilic syndrome]],  [[paroxysmal nocturnal hemoglobinuria]],  [[Myelofibrosis | primary myelofibrosis]],  [[dysplasia|trilineage dysplasia]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| [[Acute myelogenous leukemia]],  [[aplastic anemia]],  [[Chronic myelogenous leukemia |atypical chronic myeloid leukemia]],  [[beta thalassemia]],  [[blood transfusion]],  [[chronic eosinophilic leukemia]],  [[chronic myelogenous leukemia]],  [[chronic myelomonocytic leukemia]],  [[erythroblastosis fetalis]],  [[essential thrombocythemia]],  [[fanconi syndrome]],  [[hemolysis]],  [[idiopathic hypereosinophilic syndrome]],  [[idiopathic thrombocytopenic purpura]],  [[iron deficiency anemia]],  [[hypereosinophilic syndrome|myeloproliferative variants of hypereosinophilic syndrome]],  [[non-Hodgkin lymphoma]],  [[paroxysmal nocturnal hemoglobinuria]],  [[pernicious anemia]],  [[Myelofibrosis | primary myelofibrosis]], [[Thrombocytopenia | refractory thrombocytopenia]],  [[sickle cell disease]],  [[sideroachrestic anemia]],  [[sideroblastic anemia]],  [[thrombocytopenic purpura]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| [[Bariatric surgery]],  [[blood transfusion]],  [[gastrectomy]],  [[vagotomy]]
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"|  [[Diphyllobothrium |fish tapeworm]],  [[giardia lamblia]],  [[Histoplasmosis |histoplasmosis endocarditis]],  [[HIV]],  [[hookworm]],  [[infectious mononucleosis]],  [[Tuberculosis | intestinal tuberculosis]],  [[roundworm]], [[traveler's diarrhea]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"|  [[Osteoarthritis | degenerative arthritis]],  [[Autosomal dominant hypophosphatemic rickets |hereditary hypophosphatemic rickets]],  [[oncogenic osteomalacia]],  [[osteoarthritis]],  [[osteomalacia]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| [[Dementia]],  [[ganglioneuroma |thoracic ganglioneuroma]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| [[Bacterial overgrowth]],  [[bariatric surgery]],  [[blind loop syndrome]],  [[celiac disease]],  [[chronic pancreatitis]],  [[chronic renal failure]],  [[Crohn's disease]],  [[gastrectomy]],  [[X-linked_hypophosphatemia |hereditary hypophosphatemia]], [[vitamin D resistant rickets|hereditary vitamin D-resistant rickets]],  [[Parathyroidectomy|hungry bone syndrome]],  [[hypophosphatemia]],  [[Bile acid malabsorption|primary bile acid diarrhea]],  [[radiation enteritis]],  [[refeeding syndrome]],  [[respiratory alkalosis]],  [[short bowel syndrome]],  [[sucrose intolerance]],  [[tropical sprue]],  [[Whipple's disease]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| [[Acute myelogenous leukemia]],  [[Chronic myelogenous leukemia |atypical chronic myelogenous leukemia]],  [[carcinoid syndrome]],  [[carcinoma of pancreas]],  [[chronic eosinophilic leukemia]],  [[chronic myelogenous leukemia]],  [[chronic myelomonocytic leukemia]],  [[malignant diseases]],  [[malignant lymphoma]],  [[non-Hodgkin lymphoma]],  [[oncogenic osteomalacia]],  [[ganglioneuroma|thoracic ganglioneuroma]]
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"|  [[Chronic fatigue syndrome]],  [[dementia]],  [[panic attacks]]
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| [[Cystic fibrosis]],  [[Respiratory alkalosis |respiratory alkalosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| [[Chronic renal failure]],  [[renal transplant]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| [[Blood transfusion]],  [[collagen vascular diseases]],  [[fibromyalgia]],  [[pernicious anemia]],  [[renal transplant]],  [[sarcoidosis]],  [[systemic lupus erythematosus]],  [[systemic sclerosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| [[Burns]]
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| [[Alcohol]],  [[amyloidosis]],  [[citrate|citrated blood sample]],  [[EDTA |EDTA blood sample]],  [[fluoride|fluoride treated blood sample]],  [[phosphate|inadequate phosphate intake]],  [[blood|old blood samples]],  [[oxalate|oxalate blood sample]]
|-
|}


{{WikiDoc Help Menu}}
===Causes in Alphabetical Order===
{{WikiDoc Sources}}
{{col-begin|width=80%}}
{{col-break|width=33%}}
*[[Abetalipoproteinemia]]
*[[Acetazolamide]]
*[[Acquired hemolytic anemia]]
*[[Acute myelogenous leukemia]]
*[[Addison's disease]]
*[[Albuterol]]
*[[Alcohol]]
*[[Amyloidosis]]
*[[Aplastic anemia]]
*[[Atherosclerotic heart disease]]
*[[Atopic dermatitis]]
*[[Chronic myelogenous leukemia |Atypical chronic myelogenous leukemia]]
*[[Bacterial overgrowth]]
*[[Bariatric surgery]]
*[[Beta thalassemia]]
*[[Blind loop syndrome]]
*[[Blood transfusion]]
*[[Burns]]
*[[Calcitonin]]
*[[Carcinoid syndrome]]
*[[Carcinoma of pancreas]]
*[[Celiac disease]]
*[[Chronic eosinophilic leukemia]]
*[[Chronic fatigue syndrome]]
*[[Chronic myelogenous leukemia]]
*[[Chronic myelomonocytic leukemia]]
*[[Chronic pancreatitis]]
*[[Chronic renal failure]]
*[[Citrate|Citrated blood sample]]
*[[Collagen vascular diseases]]
*[[Crohn's disease]]
*[[Cystic fibrosis]]
*[[Osteoarthritis | Degenerative arthritis]]
*[[Dementia]]
*[[Diabetes mellitus]]
*[[Dopamine]]
*[[EDTA | EDTA blood sample]]
*[[Eosinophilic gastroenteritis]]
*[[Epinephrine]]
*[[Erythroblastosis fetalis]]
*[[Essential thrombocythemia]]
{{col-break|width=33%}}
*[[Fanconi syndrome]]
*[[Fibromyalgia]]
*[[Diphyllobothrium |Fish tapeworm]]
*[[Fluoride|Fluoride treated blood sample]]
*[[Gastrectomy]]
*[[Giardia lamblia]]
*[[Glucagon]]
*[[Granulocyte colony-stimulating factor]]
*[[Hepatic failure]]
*[[Hyperphosphatemia|Hereditary hyperphosphatasia]]
*[[X-linked_hypophosphatemia|Hereditary hypophosphatemia]]
*[[Autosomal dominant hypophosphatemic rickets|Hereditary hypophosphatemic rickets]]
*[[Vitamin D resistant rickets|Hereditary vitamin D-resistant rickets]]
*[[Histoplasmosis|Histoplasmosis endocarditis]]
*[[HIV]]
*[[Hookworm]]
*[[Parathyroidectomy|Hungry bone syndrome]]
*[[Hyperparathyroidism]]
*[[Hypertension]]
*[[Hyperthyroidism]]
*[[Hypoparathyroidism]]
*[[Hypophosphatemia]]
*[[Hypothyroidism]]
*[[Idiopathic hypereosinophilic syndrome]]
*[[Idiopathic thrombocytopenic purpura]]
*[[Monoclonal gammopathy of undetermined significance | IgG monoclonal gammopathy]]
*[[Phosphate|Inadequate phosphate intake]]
*[[Infectious mononucleosis]]
*[[Insulin]]
*[[Tuberculosis | Intestinal tuberculosis]]
*[[Iron deficiency anemia]]
*[[Lactose intolerance]]
*[[Lead]]
*[[Malignant diseases]]<ref name="Lokich-1977">{{Cite journal  | last1 = Lokich | first1 = JJ. | title = Leukocyte alkaline phosphatase activity in patients with malignant disease. | journal = Cancer | volume = 40 | issue = 3 | pages = 1202-5 | month = Sep | year = 1977 | doi =  | PMID = 902237 }}</ref>
*[[Malignant histiocytosis]]
*[[Malignant lymphoma]]
*[[Mustard gas]]
*[[Myeloid metaplasia]]
*[[Hypereosinophilic syndrome|Myeloproliferative variants of hypereosinophilic syndrome]]
*[[Infection|Neonatal infection]]<ref name="Sharma-1980">{{Cite journal  | last1 = Sharma | first1 = SC. | title = Leucocyte alkaline phosphatase in neonatal infections. | journal = Postgrad Med J | volume = 56 | issue = 657 | pages = 485-7 | month = Jul | year = 1980 | doi =  | PMID = 7443603 }}</ref>
*[[Niacin]]
{{col-break|width=33%}}
*[[Non-Hodgkin lymphoma]]
*[[Blood|Old blood samples]]
*[[Oncogenic osteomalacia]]
*[[Osteoarthritis]]
*[[Osteomalacia]]
*[[Oxalate|Oxalate treated blood sample]]
*[[Paget's disease]]
*[[Panic attacks]]
*[[Paroxysmal nocturnal hemoglobinuria]]
*[[Pernicious anemia]]
*[[Bile acid malabsorption|Primary bile acid diarrhea]]
*[[Myelofibrosis | Primary myelofibrosis]]
*[[Radiation enteritis]]
*[[Neutropenia|Recurrent neutropenia]]
*[[Refeeding syndrome]]
*[[Thrombocytopenia | Refractory thrombocytopenia]]
*[[Respiratory alkalosis]]
*[[Renal transplant]]
*[[Rheumatoid arthritis]]
*[[Roundworm]]
*[[Salicylate]]
*[[Sarcoidosis]]
*[[Short bowel syndrome]]
*[[Sickle cell disease]]
*[[Sideroachrestic anemia]]
*[[Sideroblastic anemia]]
*[[Myeloid leukemia|Subacute myeloid leukemia]]
*[[Sucrose intolerance]]
*[[Corticosteroids| Systemic corticosteroids]]
*[[Systemic lupus erythematosus]]
*[[Systemic sclerosis]]
*[[Terbutaline]]
*[[ganglioneuroma| Thoracic ganglioneuroma]]
*[[Thrombocytopenic purpura]]
*[[Traveller's diarrhoea]]
*[[Tricuspid atresia]]
*[[Dysplasia|Trilineage dysplasia]]
*[[Tropical sprue]]
*[[Uremia]]
*[[Vagotomy]]
*[[Whipple's disease]]
{{col-end}}


==References==
{{Reflist|2}}


[[Category:Crowdiagnosis]]
[[Category:Blood tests]]
[[Category:Blood tests]]
[[Category:Up-To-Date]]
{{WH}}
{{WS}}

Latest revision as of 14:35, 20 August 2013

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: 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

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

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 spleenectomy, vaccination
Infectious Disease Abscess, 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, 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 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

Causes of Decreased Leukocyte Alkaline Phosphatase

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Causes by Organ System

Cardiovascular Histoplasmosis endocarditis, tricuspid atresia
Chemical/Poisoning Mustard gas
Dental No underlying causes
Dermatologic Atopic dermatitis
Drug Side Effect Acetazolamide, albuterol, dopamine, epinephrine, glucagon, granulocyte colony-stimulating factor, insulin, salicylate, systemic corticosteroids, terbutaline
Ear Nose Throat No underlying causes
Endocrine Addison's disease, calcitonin, diabetes mellitus, hungry bone syndrome, hyperparathyroidism, hyperthyroidism, hypoparathyroidism, hypothyroidism
Environmental No underlying causes
Gastroenterologic Bacterial overgrowth, bariatric surgery, blind loop syndrome, carcinoid syndrome, carcinoma of pancreas, celiac disease, chronic pancreatitis, Crohn's disease, cystic fibrosis, eosinophilic gastroenteritis, fish tapeworm, giardia lamblia, hepatic failure, hookworm, intestinal tuberculosis, lactose intolerance, primary bile acid diarrhea, radiation enteritis, refeeding syndrome, roundworm, short bowel syndrome, sucrose intolerance, traveler's diarrhea, tropical sprue, Whipple's disease
Genetic Abetalipoproteinemia, beta thalassemia, cystic fibrosis, hereditary hyperphosphatasia, hereditary hypophosphatemia, hereditary hypophosphatemic rickets, hereditary vitamin D-resistant rickets, IgG monoclonal gammopathy, malignant histiocytosis, myeloproliferative variants of hypereosinophilic syndrome, paroxysmal nocturnal hemoglobinuria, primary myelofibrosis, trilineage dysplasia
Hematologic Acute myelogenous leukemia, aplastic anemia, atypical chronic myeloid leukemia, beta thalassemia, blood transfusion, chronic eosinophilic leukemia, chronic myelogenous leukemia, chronic myelomonocytic leukemia, erythroblastosis fetalis, essential thrombocythemia, fanconi syndrome, hemolysis, idiopathic hypereosinophilic syndrome, idiopathic thrombocytopenic purpura, iron deficiency anemia, myeloproliferative variants of hypereosinophilic syndrome, non-Hodgkin lymphoma, paroxysmal nocturnal hemoglobinuria, pernicious anemia, primary myelofibrosis, refractory thrombocytopenia, sickle cell disease, sideroachrestic anemia, sideroblastic anemia, thrombocytopenic purpura
Iatrogenic Bariatric surgery, blood transfusion, gastrectomy, vagotomy
Infectious Disease fish tapeworm, giardia lamblia, histoplasmosis endocarditis, HIV, hookworm, infectious mononucleosis, intestinal tuberculosis, roundworm, traveler's diarrhea
Musculoskeletal/Orthopedic degenerative arthritis, hereditary hypophosphatemic rickets, oncogenic osteomalacia, osteoarthritis, osteomalacia
Neurologic Dementia, thoracic ganglioneuroma
Nutritional/Metabolic Bacterial overgrowth, bariatric surgery, blind loop syndrome, celiac disease, chronic pancreatitis, chronic renal failure, Crohn's disease, gastrectomy, hereditary hypophosphatemia, hereditary vitamin D-resistant rickets, hungry bone syndrome, hypophosphatemia, primary bile acid diarrhea, radiation enteritis, refeeding syndrome, respiratory alkalosis, short bowel syndrome, sucrose intolerance, tropical sprue, Whipple's disease
Obstetric/Gynecologic No underlying causes
Oncologic Acute myelogenous leukemia, atypical chronic myelogenous leukemia, carcinoid syndrome, carcinoma of pancreas, chronic eosinophilic leukemia, chronic myelogenous leukemia, chronic myelomonocytic leukemia, malignant diseases, malignant lymphoma, non-Hodgkin lymphoma, oncogenic osteomalacia, thoracic ganglioneuroma
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric Chronic fatigue syndrome, dementia, panic attacks
Pulmonary Cystic fibrosis, respiratory alkalosis
Renal/Electrolyte Chronic renal failure, renal transplant
Rheumatology/Immunology/Allergy Blood transfusion, collagen vascular diseases, fibromyalgia, pernicious anemia, renal transplant, sarcoidosis, systemic lupus erythematosus, systemic sclerosis
Sexual No underlying causes
Trauma Burns
Urologic No underlying causes
Miscellaneous Alcohol, amyloidosis, citrated blood sample, EDTA blood sample, fluoride treated blood sample, inadequate phosphate intake, old blood samples, oxalate blood sample

Causes in Alphabetical Order

References

  1. ↑ Brook J, Dreisbach PB (1977). "Leukocyte alkaline phosphatase levels in multiple myeloma". J Lab Clin Med. 90 (1): 114–7. PMID 406335.
  2. ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  3. ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
  4. ↑ Gaasbeek, A.; Meinders, AE. (2005). "Hypophosphatemia: an update on its etiology and treatment". Am J Med. 118 (10): 1094–101. doi:10.1016/j.amjmed.2005.02.014. PMID 16194637. Unknown parameter |month= ignored (help)
  5. ↑ TANAKA, KR.; VALENTINE, WN.; FREDRICKS, RE. (1960). "Diseases or clinical conditions associated with low leukocyte alkaline phosphatase". N Engl J Med. 262: 912–8. doi:10.1056/NEJM196005052621804. PMID 13836802. Unknown parameter |month= ignored (help)
  6. ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  7. ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
  8. ↑ 8.0 8.1 Sharma, SC. (1980). "Leucocyte alkaline phosphatase in neonatal infections". Postgrad Med J. 56 (657): 485–7. PMID 7443603. Unknown parameter |month= ignored (help)
  9. ↑ 9.0 9.1 Lokich, JJ. (1977). "Leukocyte alkaline phosphatase activity in patients with malignant disease". Cancer. 40 (3): 1202–5. PMID 902237. Unknown parameter |month= ignored (help)

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