Leukocyte alkaline phosphatase

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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

↑ Brook J, Dreisbach PB (1977). "Leukocyte alkaline phosphatase levels in multiple myeloma". J Lab Clin Med. 90 (1): 114–7. PMID 406335.
↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
↑ 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)
↑ 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)
↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
↑ ^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)
↑ ^9.0 ^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)

Template:WH Template:WS

[pmid406335-1] 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

[Gaasbeek-2005-4] 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)

[TANAKA-1960-5] 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

[Sharma-1980-8] 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)

[Lokich-1977-9] 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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Leukocyte alkaline phosphatase

Overview

Causes of Increased Leukocyte alkaline phosphatase

Life Threatening Causes

Common Causes

Causes by Organ System

Causes in Alphabetical Order

Causes of Decreased Leukocyte Alkaline Phosphatase

Life Threatening Causes

Common Causes

Causes by Organ System

Causes in Alphabetical Order

References

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