Diagnosing Lucy with sky-high ALP

Dr Amanda Caswell
FRCPA, chemical pathologist

THE GP orders hepatitis A serology and E/LFTs.

Hepatitis A serology is negative and all the other tests come back normal except for alkaline phosphatase (ALP) which is 2800U/L (<350). Does Lucy have a liver problem or something else?

In the absence of any clinical signs of bone disease such as advanced rickets, this finding in a well child can be attributed to benign transient hyperphosphatasaemia of infancy.

Isolated elevations of ALP are nearly always due to bone disease or