By: Dr.

Safinaz Hamdy El Khoulany

Lecturer of Medical Biochemistry and Molecular Biology
 Alkaline Phosphat - ase

It is stable and It removes

works best in phosphate Enzyme
an alkaline groups from
medium molecules

It dephosphorylates compounds so that the molecule can

freely diffuse into the cell
Don’t confuse Alkaline phosphatase with Acid phosphatase

Acid phosphatase :
- Works in an acidic environment
- Monitors response to treatment in prostate cancer
- Differentiate between:
- B- type acute lymphoblastic leukemia (B-ALL)
- Acid phosphatase -ve
- T- type acute lymphoblastic leukemia (T-ALL)
- Acid phosphatase +ve
 Sites of Alkaline Phosphatase

It is present in all tissues especially:

Bone liver
(especially hepatobiliary system)

Mature WBCs

Kidneys Placenta
 Sites of Alkaline Phosphatase

It is present in all tissues especially:

Bone liver
(especially hepatobiliary system)

Mature WBCs

Kidneys Placenta
 High levels Low levels

Biliary disease (cholecystitis or gallstones) Wilson disease

Liver disease (Hepatitis or Cirrhosis)
Bone diseaes with excessive bone formation (Paget
disease)
Excessive bone formation (Children and adolescents)
Kidney tumors
Pregnancy Postmenopause
Hyperthyroidism Hypothyroidism
Hyperparathyroidism

Leukomoid reaction Chronic myeloid

leukemia(CML)
 Liver Biliary
system
-ALT (SGPT)
-AST (SGOT)
ALP

Pancreas

-Amylase
-Lipase
 Leucocyte ALP (LAP) [LAP SCORE]
If WBCs are
useless “cancer”
and less mature If WBCs are
or immature It is found in Mature WBCs doing their job
and mature

They do not
uptake the stain They uptake the
for ALP into stain for ALP
their cytoplasm

Low LAP score Immature mature High LAP score

 Leucocyte ALP (LAP) [LAP SCORE]
If WBCs are
useless “cancer”
and less mature If WBCs are
or immature It is found in Mature WBCs doing their job
and mature

They do not
uptake the stain They uptake the
for ALP into stain for ALP
their cytoplasm

Low LAP score Immature mature High LAP score

 Immature mature

leukemoid reaction (not cancer):

Increased white blood cell count (> 50,000 cells/μL), which is a physiological
response to stress or infection

Leukemia (Cancer):

Malignancy arising from the bone marrow causing increased white blood
cell count (10,000 – 100,000 cells/μL) and is characterized by the presence of
immature cells (blasts)
In cancer (leukemia), there is left shifting

In Acute myeloid leukemia (AML), cells are very immture

In Chronic myeloid leukemia (CML), cells are more mature but not like
normal cells
 Leucocyte ALP (LAP) [LAP SCORE]

It is found in Mature WBCs

AML
CML leukemoid
Aplasic anemia reaction

Low LAP score Immature mature High LAP score

Aplastic anemia
is a disease in which the body fails to produce blood cells in sufficient numbers.
Blood cells are produced in the bone marrow by stem cells.

It causes a deficiency of all blood cell types: red blood cells, white blood cells, and platelets