I posted a question about low alk phos levels in March 2009 because my grandson, who was born with an aortic atresia and had 3 heart operations in his first 2 years of life, developed a protein losing enteropathy. The results for a series of these patients had been published (1) and they show that alkaline phosphatise levels may also fall along with the albumin levels. It is suggested that this reflects a low cardiac output and that it may be an early indicator of reduced bone growth. Another paper (2) appeared last year concerning the role of alkaline phosphatise in colitis and a link between low levels of alkaline phosphatase and inflammatory bowel disease.
At that time, a member of this discussion group replied saying that he saw low Alk Phos activities in children quite often. They are usually associated with extremes of poor nutrition and failure to grow. The evidence is not thick on the ground, but is often ascribed to zinc deficiency. This is because zinc is an essential cofactor for Alk Phos activity. It is carried in blood plasma by albumin. When Albumin is low we can infer that zinc levels will be also. Whether this is also the case in tissue is unclear. Zinc is an essential micronutrient for adequate growth, and is intimately involved in immunity by an unknown mechanism.
Regards
Elliott
1. A J Chin, P Stephens, E Goldmuntz, M B Leonard, ’ Serum Alkaline Phosphatase Reflects Post-Fontan Hemodynamics in Children ‘ Pediatr Cardiol (2009) 30:138–145
2. A Tuin, K Poelstra, A de Jager-Krikken, L Bok, W Raaben, M P Velders, G Dijkstra, ‘Role of alkaline phosphatase in colitis in man and rats’ Gut (2009);58:379–387.
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From: Clinical biochemistry discussion list [[log in to unmask]] On Behalf Of PD Dr. Michael Steiner [[log in to unmask]]
Sent: 21 January 2010 16:42
To: [log in to unmask]
Subject: Low ALT activity
Dear colleagues,
What is the importance of low ALT activity in the presence of normal AST ?
Is it just constitutional if confirmed at follow-up ?
Does it require any comment ?
Thank you very much for your input
Mike
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PD Dr. med. Michael Steiner
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Tel: +49-381-7022701
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Medizinisches Labor Rostock
Südring 81, D-18059 Rostock
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