What is the significance of an isolated alkaline phosphatase (ALP) of 161 IU/L in the absence of gallbladder, pancreas, or liver disease? Is there any correlation with a normocytic anemia? — V. Roberson, NP-C, Aiken, S.C.

ALP is present in many human tissues, including bone, intestine, kidney, liver, placenta and WBCs. An elevated ALP may be seen in disorders of any of these and is also commonly seen in neoplastic disorders.

Women in the third trimester of pregnancy can have elevated levels of ALP. Levels vary with age and increase during adolescent growth spurts and in people between the ages of 40 and 65 years, especially women.

Normocytic anemia is the most frequently encountered type of anemia, with anemia of chronic disease being the most common normocytic anemia. The evaluation of the patient with normocytic anemia and elevated ALP requires a thorough history and accurate physical exam to reveal the underlying causes of these abnormalities, which may or may not be related. — Eileen F. Campbell, MSN, CRNP (155-4)