Alkaline phosphatase is lowered in men. Why is the alkaline phosphatase level in the blood low? The effect of oral contraceptives on the level of the enzyme in the blood
Doctors often prescribe one or another biochemical blood test, but if you have heard of most of them at least once throughout your life, then an alkaline phosphatase test almost always takes you by surprise. What is it and why is it being studied? Why is alkaline phosphatase elevated in the blood?
What is alkaline phosphatase?
This is an enzyme that cleaves phosphate from a molecule of substances of organic origin. It is especially active in an alkaline environment - this is the reason for its name. A small amount of alkaline phosphatase is found throughout the body. Most of this enzyme is in the liver, bone tissue and placenta.
A small amount of the enzyme in the blood is considered the norm, since cells tend to constantly renew themselves. But if they die in large numbers, then the analysis reveals that alkaline phosphatase in the blood is elevated. The reasons for this phenomenon are varied. If the indicators differ significantly from the norm, then one can suspect the pathology of the bones, intestines, liver, or a malignant process in the body.
The norms of this enzyme depend on the age and gender of the person. In children, ALP is normally higher than in adults, and in women it is lower than in men. On average, normal levels of phosphatase in the blood range from 20 to 140 International units per liter.
When is an alkaline phosphatase test ordered?
Analysis for alkaline phosphatase may be included in the list of mandatory studies for certain categories of workers who have contact with harmful substances, and during preventive examinations. Alkaline phosphatase analysis may be prescribed in preparation for surgery. It is also determined to assess liver function or diagnose jaundice.
This study can clarify the situation with pain in the abdomen, in the right hypochondrium, itching of the skin, weakness, loss of appetite, nausea, vomiting, bone lesions. With these pathological processes, alkaline phosphatase is increased.
The influence of negative factors on alkaline phosphatase
There are factors that can affect the result of the analysis, that is, it will indicate a pathology, but in fact it may not be in the body. Circumstances leading to a false positive result include:
- period of healing of fractures;
- pregnancy;
- time of active bone growth;
- some medicinal substances that affect the activity of the enzyme: Paracetamol, antibiotics, acetylsalicylic acid;
Increased alkaline phosphatase with errors at the preanalytical stage, for example, if the blood was cooled. When taking hormonal contraceptives, the indicator may decrease.
Why is alkaline phosphatase elevated?
The results of the analyzes sometimes discourage us. Not always a person is ready to accept that he has some kind of health problem. Increased alkaline phosphatase in the blood - what does it mean? Most often, this indicates a pathology of the liver or biliary tract. The reasons include obstructive jaundice, which is associated with impaired patency of the biliary tract. If alkaline phosphatase is elevated, then this may indicate stones in the gallbladder, as well as scars of the biliary tract after surgery. A high level of the enzyme sometimes indicates cancer, cirrhosis, hepatitis, or a malignant process in the stomach.
Strongly increased alkaline phosphatase in liver cancer and metastasis in it. Among infectious diseases in which the enzyme index increases, infectious mononucleosis can be noted.
Alkaline phosphatase is also elevated in bone lesions. There is an increase in the level of this indicator in hyperparathyroidism, myocardial infarction, intestinal perforations, ulcerative colitis.
An increase in an enzyme found in bone tissue
Why is alkaline phosphatase increased in bone tissue? The fact is that the bone tissue of this enzyme contains quite a lot, so it reacts to any changes in the bones. Bone ALP is secreted by osteoblasts, which are large cells with a single nucleus. They are located directly on the surface of the bone tissue, and it is in these places that its intensive formation occurs. Most of all, alkaline phosphatase increases in Paget's disease, which is characterized by excessive growth of bone tissue and a violation of its very structure.
If osteosarcoma develops or bone metastases appear, then alkaline phosphatase also rises. When there is not enough calcium in the body, the bones begin to soften. The enzyme is sensitive to this process, which is also called osteomalacia, in connection with this, its level in the blood rises.
Bone ALP increases during bone growth and fusion, so it is significantly higher in children and adolescents than in more mature patients. Its increase is observed with fractures.
Why does hepatic alkaline phosphatase increase?
Alkaline phosphatase is found in large quantities in the liver, so any changes in its work are reflected in the levels of the enzyme in the blood serum. It begins to be released in large quantities from hepatocytes, which is reflected in the blood picture, including in the analysis for alkaline phosphatase. Quite often, an increase in the enzyme indicates damage to the liver cells or a violation of the functions of the liver itself.
Decreased alkaline phosphatase
ALP is not only increased, but also the level of this substance can be significantly reduced. It is also associated with any disease.
One such disease is hypophosphatasemia. This is a hereditary pathology, which lies in the fact that phosphatase is constantly excreted in the urine. Enhanced release of the body from this substance leads to its acute deficiency.
Hypothyroidism is another disease in which the level of alkaline phosphatase in the blood decreases. With a decrease in the activity of the thyroid gland, due to a lack of certain trace elements, the production of phosphatase also undergoes changes, which then affect human health.
Lack of vitamin B12, C, zinc or folic acid can also lead to a decrease in alkaline phosphatase. This disease is called pernicious anemia. Sometimes this substance can decrease with a lack of growth hormone in children.
Special attention is paid to the condition of the placenta during fetal maturation. If alkaline phosphatase in the blood of a pregnant woman is lowered, then this indicates that the placenta is developing defectively. It is a vital organ for the health of the child, so you need to monitor the performance of this substance in expectant mothers.
Lowered and increased alkaline phosphatase in the blood: what does this mean? We have already decided and found out what the consequences of fluctuations in this substance can be. Be healthy!
Alkaline phosphatase is an enzyme that provides metabolic processes of calcium and phosphorus in organism. The detection of this substance in the blood may indicate the presence of certain diseases. High rates are quite common, which indicates problems with the liver, kidneys and bones. There are much fewer situations in which alkaline phosphatase is lowered, but they also indicate the presence of health problems. In what situations low rates can occur and what to do about it, we will consider further.
This biochemical indicator used to assess the condition of certain organs, as well as metabolic processes of calcium and phosphorus. Alkaline phosphatase in the blood is determined using an analysis, the accuracy of the results of which can be affected by factors such as:
- Eating - the analysis should be taken on an empty stomach, since the food consumed can provoke an increase in the error in the study.
- Diet - fatty and fried foods, which put an increased burden on the liver, should be excluded. For 2-3 days before donating blood, it is recommended to follow a diet.
- Alcohol - alcoholic beverages provoke the formation of toxins, which makes the liver work several times more. For 3-4 days, any alcoholic beverages should be excluded.
- Stress and lack of proper sleep and rest - overexertion can provoke inaccuracies in the study, so you should have a good rest and sleep before donating blood.
What values are considered low?
The level of alkaline phosphatase in the blood may change with age and also depends on gender. Therefore, low rates are appropriate to consider for certain categories of patients.
In men, the results of the analysis are reduced, such as:
- 18-35 years - less than 45 units / l;
- 35-45 years - less than 40 units / l;
- 45-65 years - less than 38 units / l;
- older than 65 - less than 37.5 units / l.
For women, deviations from the norm are considered values such as:
- 18-25 years - less than 48 units / l;
- 25-35 years - less than 45 units / l;
- 35-45 years - less than 44 units / l;
- older than 45 years - less than 40 units / l.
In childhood, ALP phosphatase is considered low at such marks:
- newborns and children of the first year of life - less than 85 units / l;
- 1-5 years - less than 68 units / l;
- 5-10 years - less than 65 units / l;
- 10-15 years - less than 80 units / l.
Therefore, during this period of time, it is important to ensure that there is no decrease in phosphatase, which can lead to the development of negative consequences, both for the mother's body and for the child.
Ask your question to the doctor of clinical laboratory diagnostics
Anna Poniaeva. She graduated from the Nizhny Novgorod Medical Academy (2007-2014) and residency in clinical laboratory diagnostics (2014-2016).
Alkaline phosphatase is a group of enzymes found in almost all tissues of the body, with a predominant localization in the liver, bones and placenta. Phosphatases in cells are involved in the reactions of cleavage of the residue of phosphoric acid from its organic compounds. The activity of total alkaline phosphatase increases in a number of diseases accompanied by tissue damage to the liver, bones, kidneys and other organs.
Russian synonyms
Phosphatase is alkaline.
English synonyms
ALK PHOS, ALP, ALKP, alkaline phosphatase.
Research method
Kinetic colorimetric method.
Units
U / l (unit per liter).
What biomaterial can be used for research?
Venous, capillary blood.
How to properly prepare for research?
- Do not eat for 12 hours before the test.
- Eliminate physical and emotional overstrain 30 minutes before the study.
- Do not smoke for 30 minutes prior to the study.
General information about the study
Alkaline phosphatase is an enzyme that is found in the cells of the liver and biliary tract and is a catalyst for certain biochemical reactions in these cells (it does not work in the bloodstream). When these cells are destroyed, their contents enter the bloodstream. Normally, some of the cells are renewed, so a certain activity of alkaline phosphatase is found in the blood. If many cells die, it can rise very significantly.
Bile is produced in the liver cells and excreted through the system of intrahepatic bile ducts. They then unite to form the hepatic ducts, which extend beyond the liver and form the common bile duct, which flows into the small intestine.
Bile is necessary for the absorption of fats from food. Also, some medicinal substances are excreted through bile. It is formed constantly, but enters the intestine only during and after meals. When not needed, it accumulates in the gallbladder.
The activity of alkaline phosphatase is greatly increased when bile flow is obstructed, for example, stones in the bile ducts. This stasis of bile is called cholestasis.
In the bones, alkaline phosphatase is formed in special cells - osteoblasts, which play an important role in the formation and renewal of bone tissue. The higher the activity of osteoblasts, the higher the activity of alkaline phosphatase in the blood, therefore, in children and those who have suffered bone fractures, the activity of alkaline phosphatase is high.
Alkaline phosphatase is also found in the cells of the intestine and placenta.
What is research used for?
Typically, this test is prescribed to detect diseases of the liver or bones. In addition, alkaline phosphatase is elevated in diseases that affect the bile ducts, so this analysis helps confirm blockages in the bile ducts in bile duct stones or pancreatic tumors.
The test for alkaline phosphatase as well as gamma-glutamyl transferase is performed in order to diagnose diseases that affect the biliary tract: primary biliary cirrhosis and primary sclerosing cholangitis.
Any condition that is associated with bone growth or increased bone cell activity will increase alkaline phosphatase activity. Therefore, an alkaline phosphatase test can be used, for example, to determine that a tumor has spread beyond the primary focus to the bone.
Re-administration of alkaline phosphatase is used to monitor the activity of diseases in which it is elevated, or to evaluate the effectiveness of treatment.
When is the study scheduled?
The alkaline phosphatase test may be part of the standard diagnostic panels that are used for routine medical examinations and in preparing the patient for surgery. It is also usually included in "liver tests" used to evaluate liver function.
This study is carried out when the patient complains of weakness, fatigue, loss of appetite, nausea, vomiting, abdominal pain (especially in the right hypochondrium), jaundice, darkening of urine or lightening of feces, skin itching.
In addition, the analysis is prescribed for symptoms of bone lesions: pain in the bones, their deformation, frequent fractures.
What do the results mean?
Reference values
|
Age, gender |
Reference values |
|
|
83 - 248 U/l |
||
|
15 days - 1 year |
122 – 469 U/l |
|
|
142 - 335 U/l |
||
|
129 - 417 U/l |
||
|
57 - 254 U/l |
||
|
116 - 468 U/l |
||
|
50 - 117 U/l |
||
|
82 - 331 U/l |
||
|
55 - 149 U/l |
||
|
35 - 105 U/l |
||
|
40 - 130 U/l |
||
If other tests such as bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST) are also elevated, then the increase in blood alkaline phosphatase may be due to liver damage. If the levels of calcium and phosphorus are changed, the most likely cause of the increase in alkaline phosphatase is the pathology of the bone tissue. An increase in the activity of alkaline phosphatase almost always means damage to or involvement in the pathological process of the liver, biliary tract or bones.
Increased activities of gamma-glutamyl transpeptidase (GGT) and 5-nucleotidase indicate that the increase in ALP is due to damage to the biliary tract.
Causes of increased activity of alkaline phosphatase
1. Damage to the liver and biliary tract.
- Obstructive jaundice associated with obstruction of the bile ducts.
- Bile duct stones, bile duct scars after surgical interventions.
- Tumors of the bile ducts.
- Cancer of the head of the pancreas, cancer of the stomach with mechanical compression of the common bile duct, through which bile enters the duodenum.
- Liver cancer, metastases of tumors of other organs in the liver.
- Cirrhosis of the liver is a pathological process during which normal hepatic tissue is replaced by scar tissue, which inhibits all liver functions.
- Hepatitis of any origin (usually alkaline phosphatase because of it becomes 3 times more than normal).
- Infectious mononucleosis is an acute viral infection, manifested by fever, inflammation of the pharynx and enlarged lymph nodes. In this case, the liver is often involved in the pathological process.
- Primary biliary cirrhosis and primary sclerosing cholangitis are rare diseases that occur in adults and are associated with autoimmune damage to the bile ducts. Accompanied by extremely high activity of alkaline phosphatase and gamma-glutamyl transferase.
2. Damage to the bones.
- Particularly high activity of alkaline phosphatase (15-20 norms) is noted in Paget's disease. This is a disease that is accompanied by pathological growth of bones and a violation of their structure in certain places.
- Osteosarcoma.
- Metastases of other tumors in the bone.
- Osteomalacia is a softening of the bones caused by a lack of calcium.
3. Other reasons.
- Hyperparathyroidism is a hormonal disease associated with excessive production of parathyroid hormone by the parathyroid glands, which leads to calcium leaching from the bones.
- Myocardial infarction.
- Ulcerative colitis, intestinal perforation (since alkaline phosphatase is also found in intestinal cells).
Causes of a decrease in alkaline phosphatase activity
- Severe anemia.
- Massive blood transfusions.
- Hypothyroidism is a condition in which the function of the thyroid gland is reduced.
- Lack of magnesium and zinc.
- Hypophosphatasia is a rare congenital disorder that causes bone softening.
- A pronounced decrease in alkaline phosphatase in pregnant women is a sign of placental insufficiency.
What can influence the result?
- During pregnancy, the activity of alkaline phosphatase is normally increased, since it is contained in the placenta.
- A temporary increase in ALP activity is observed after fractures.
- In children and young men, the activity of alkaline phosphatase is higher than in adults, so they have bone growth.
- Aspirin, paracetamol, allopurinol, antibiotics and a number of other drugs can increase the activity of alkaline phosphatase.
- Taking oral contraceptives sometimes leads to a decrease in alkaline phosphatase activity.
- The activity of alkaline phosphatase may be overestimated if the blood was cooled after taking.
Important Notes
The activity of alkaline phosphatase is sometimes increased in healthy individuals, this does not necessarily indicate any pathology. In order to correctly interpret the change in ALP activity, a comprehensive assessment of the results of other tests, as well as other medical data, is needed.
- Bilirubin
Who orders the study?
General practitioner, therapist, gastroenterologist, infectious disease specialist, hematologist, endocrinologist, surgeon.
22 Sep 2014
Determination of the level of alkaline phosphatase (AP) in the blood serum is included in the standard set of biochemical studies of the function of the liver, kidneys and some other organs. In a number of diseases of the internal organs and the musculoskeletal system, the indicator of alkaline phosphatase activity is one of the most important diagnostic criteria.
What is alkaline phosphatase?
Alkaline phosphatase is a group of enzymes that provide biochemical processes in the body, resulting in the breakdown of phosphoric acid monoesters. According to the chemical structure, phosphatase is a protein, the molecule of which has a complex structure and contains several zinc atoms.
In the biochemical processes occurring inside the cell, alkaline phosphatase plays the role of a catalyst, its highest activity is determined in an alkaline environment, with a ph value of 9 to 10. Total alkaline phosphatase is not homogeneous in structure and consists of isoenzymes similar in structure, the main sources of which are:
- liver;
- bone;
- placenta;
- kidneys;
- intestinal mucosa;
- spleen.
Normally, all alkaline phosphatase in the blood is represented by the liver and bone isoenzyme, approximately in equal parts, the remaining fractions may be present in small quantities. However, under certain pathological and physiological conditions, the quantitative ratio of ALP isoenzymes in blood plasma can change significantly.
Why does the level of alkaline phosphatase in the body change?
Alkaline phosphatase ensures normal metabolism in all tissues of the human body. Therefore, when the cells of any of the organs of a mechanical, inflammatory, degenerative or neoplastic nature are damaged, some of the enzymes from the damaged tissues enter the bloodstream, and an increase in the activity of alkaline phosphatase in the blood plasma is determined. Most often, the following conditions contribute to this:
- diseases of the liver and biliary tract: obstructive jaundice, cirrhosis of the liver, viral hepatitis, Gilbert's syndrome;
- bone tissue diseases: Paget's disease, osteogenic sarcoma, rickets, osteomalacia, bone fusion after fractures;
- malignant tumors of the testicle, prostate, kidney, ovary, uterus, pancreas and lung;
- with other pathologies: hyperparathyroidism, hyperthyroidism, myocardial infarction, ulcerative colitis, chronic renal failure, rheumatoid arthritis, etc.;
- as a side effect when taking medications: phenobarbital, furosemide, ranitidine, papaverine, halothane, etc.
An increase in the level of alkaline phosphatase in the blood can also be observed in healthy people with a significant increase in the metabolism of certain organs and tissues caused by some functional conditions, the main of which are the following:
Pathological conditions are much less common in which the activity of alkaline phosphatase decreases, and its indicators in the blood are determined at a very low level. Deficiency of alkaline phosphatase is caused by the following pathologies:
- hypovitaminosis and beriberi (especially with a lack of vitamins of groups B and C);
- lack of trace elements in the body: zinc, magnesium, phosphorus (occurs during starvation and poor nutrition);
- hypervitaminosis D (with excessive consumption of foods containing large amounts of vitamin D);
- hypothyroidism with severe dysfunction of the thyroid gland;
- taking medications: statins, sulfonamides.
When is an alkaline phosphatase blood test performed?
In clinical practice, the level of alkaline phosphatase acquires an important diagnostic value only in combination with other laboratory and instrumental studies. Therefore, patients are usually prescribed a biochemical blood test, which includes the determination of the content of alkaline phosphatase. This study is indicated for all outpatients and inpatients with pathology of the liver, kidneys, digestive and endocrine systems. Currently, in most cases, they are limited to determining the total level of alkaline phosphatase, since fractional analysis, although more informative, is very expensive and is performed only in specialized laboratories.
How is the analysis for ALP done?
To obtain the correct result of the study, it is necessary to adhere to the following rules:
- blood sampling is performed in the morning from the cubital vein in the amount of 5-10 ml;
- the analysis should be performed on an empty stomach and it is best not to eat for at least 12 hours before taking blood;
- one day before blood donation, one should not engage in heavy physical labor and sports involving intense loads;
- refrain from drinking alcohol and taking medications that increase the level of alkaline phosphatase.
What is the rate of alkaline phosphatase in the blood?
Normal levels of alkaline phosphatase in blood plasma vary depending on the age and sex of the person. The norm in children is:
- newborns - 250 units / l;
- 1-9 years - 350 units / day;
- 10-15 years - 280 units / l;
- 16-19 years old - 150 units / l.
In adults, ALP indicators slightly differ depending on gender, the norm in women is 20-25 units / l lower than in men of the same age:
- 20-30 years - 85 - 105 units / l;
- 30-45 years - 95 - 115 units / l;
- 45-55 years - 100 - 125 units / l;
- 55-70 years - 130 - 145 units / l;
- over 70 years old - 165 - 190 units / l.
Alkaline phosphatase is found in small amounts in all tissues of the human body. She is assigned a leading role in phosphorus-calcium metabolism, the greatest activity of the enzyme is manifested in the tissues of the kidneys, liver, intestines and bones.
In diagnostics, it is used to obtain information about the functioning of various systems, for example, the digestive or musculoskeletal. The analysis also helps to detect cancer. What is an enzyme and what are its features?
What is alkaline phosphatase?
What is alkaline phosphatase? This is a collection of 11 isoenzymes belonging to the group of hydrolases (enzymes that hydrolyze a covalent bond). More often than other types of isoenzymes, the following localizations are used in diagnostics:
Hepatic;
bile;
bone tissue;
Intestines;
Tumors and neoplasms;
placenta.
Alkaline phosphatase is a protein with a complex chemical structure. It contains two zinc atoms. This enzyme is very active in an alkaline environment with a pH of 9-10. In biochemical processes, he is assigned the function of a catalyst.
The main sources of "natural catalyst" are:
kidneys; 
Spleen;
Placenta,
Mucous membranes.
Its purpose in our body is the separation of phosphoric acid from food and the enrichment of tissues with it. All this has a direct effect on metabolism.
If a person is healthy, then the concentration of alkaline phosphatase in the blood is equally divided into hepatic and bone fractions. It should be noted that hepatocytes are the source of the liver fraction, and the bone fraction is formed in osteoblasts. Other types are also included in the blood, but their content is minimal. With pathology and a number of physiological changes, the ratio of isoenzymes changes. This process has been successfully used in diagnostics.
The norm of the value of alkaline phosphatase in the blood by age and sex
The norms of alkaline phosphatase depend both on the sex of the person and on his age. The values are wide and depend on the research methodology. In the form-direction indicate the current standards for the selected method.
The level of alkaline phosphatase in children is normally much higher than in adults. The difference is about 150%. This is considered the norm, since they are in the stage of active growth and development, which means that metabolic processes are more intense. In the table you can trace these jumps of ALP.
| Age category | The maximum allowable limit of the reference value, U / l |
| Up to 5 days | 550 |
| From 5 days to 6 months. | 1000 |
| 6-12 months | 1100 |
| 1-3 years | 670 |
| 3-6 years old | 650 |
| 6-12 years old | 720 |
In adolescence, the body is rebuilt, then puberty occurs. The hormonal "explosion" affects the work of all life support systems, as a result, the concentration of alkaline phosphatase increases (table below).
High alkaline phosphatase is considered normal in women during pregnancy (in the third trimester), as well as in premature newborns (the body is trying to "catch up").
In the blood of women, the content of the enzyme is somewhat less than that of men. The male concentration of alkaline phosphatase is due to the activity of bone isoenzymes up to about 30 years of age. Then the situation changes and there is a sharp decrease in the level of the enzyme due to the bone fraction (after all, the skeleton is fully formed, and the activity of the enzyme decreases). Below is a table where the norm for men by age category is compared with the female.
As you can see, the difference is on average 20-25 units. Studying the table, you can notice another pattern. The older the person, the higher their level of alkaline phosphatase. This is due to the fact that the bone tissue in older people becomes fragile and light, which provokes additional release of enzymes and their entry into the blood. And since the bone type of isoenzymes is one of the leading ones, their concentration increases with age.
In what cases is a study ordered?
An alkaline phosphatase study is required for all patients suffering from diseases of the kidneys, liver, endocrine system and malfunctions of the gastrointestinal tract.
Analysis can be carried out fractionally. This is a more informative study than a biochemical blood test, but it is “biochemistry” that is used in budgetary medical institutions. This is due to the need to use expensive equipment that only specialized laboratories can afford.
Alkaline phosphatase test
A biochemical blood test for alkaline phosphatase is a study that involves taking venous blood in an amount of 5-10 ml. It is carried out only on an empty stomach, so that the breakfast eaten does not provoke an increase in concentration. Smoking less than half an hour before visiting the laboratory is also excluded.
In a biochemical blood test, a colorimetric technique is used. This means that reagents will be gradually added to the sample, and then indicators will be obtained using specialized equipment.
Elevated concentration of alkaline phosphatase
Damage of an inflammatory, mechanical, neoplastic, and degenerative nature causes the release of enzymes into the blood, thereby causing a jump in the level of alkaline phosphatase.
By the way, high alkaline phosphatase can be in a completely healthy person. The reasons for the increase in this case are as follows:
Physical exercise;
Fast digestibility of food;
The period of pregnancy (last trimester) and lactation;
Intensive growth of bones in a child.
A jump in concentration can be caused artificially:
The blood was cooled after sampling before the study;
Taking medications - antibiotics, hormonal, contraceptives, phenobarbital, papaverine, ranitidine. The list of such drugs consists of 250 items.
If a high level is considered as a symptom, then the following diseases are possible:
Liver disorders. The list of possible options is very large. They can be combined into groups: diseases of the pancreas or biliary tract, hepatitis, cirrhosis, infections;
Changes in bone structure. In disease, the tissue may soften due to calcium deficiency in the body (osteomalacia). Other injuries are rickets, fractures, bone cancer, osteosarcoma, abnormal bone growth, myeloma;
Amyloidosis;
Inflammatory process in the gastrointestinal tract;
Alcoholism;
Granulation of affected areas in the wound;
Gilbert's syndrome;
Tumors.
In addition to increasing the level of phosphatase in the blood test, other indicators also change:
The level of glucose decreases;
Cholesterol rises;
Urea decreases;
Low total protein;
high triglycerides;
Low albumin level;
