Alkaline Phosphatase Isoenzymes and Score

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Clinical Relevance/Interpretation of the Results Derived from the Semi-quantitative NAP Method NAP is not easily detected in the human serum of healthy persons; however its activity increases in cases of bacterial infection. A leukemoid reaction is an excessive reactive outpouring of leukocytes that involves the appearance of immature forms (eg, blast cells, myelocytes, and metamyelocytes); however, this reaction is distinct from leukemia. The leukemoid reaction appears in response to infection, as well as to toxic, inflammatory, and neoplastic disorders. It may also appear in acute or chronic form with numerous granulocytes; it rarely appears with numerous lymphocytes, [6]. The major pathologic manifestations associated with leukemoid reaction are acute or chronic infections, especially in children; severe hemolysis and various solid tumors (especially of the breast, kidney, and lung, as well as metastatic cancers) and other illnesses borne on arrival at the point-of-care department. In leukemoid reaction the total leukocyte count is increased, typically in values of 50 000 to 100 000 per/ mm³, and the granulocytes, observed via optic microscopy using May-Grüunwald/Giemsa staining, display predominant toxic granulation (eg, Döohle bodies). Absence of the Philadelphia chromosome, or an extremely, low score NAP, in chronic myeloid leukemia (CML), is usually sufficient to distinguish that this malignant disease to be distinguished from a leukemoid reaction, which involves with very high NAP activity. Increased NAP activity is in some myeloproliferative diseases, such as Hodgkins`s lyimphoma and polycythemia vera (PV). NAP is substantially decreased in hematopoietic stem cell disorders such as CML, acute myelocytic leukemia (AML), and paroxysmal nocturnal hemoglobinuria (PNH) [27]. In myelopoiesis, NAP production in neutrophils is induced by GCS-F, and NAP is released into the bloodstream, perhaps through leakage of ALP from damaged or dead neutrophils. Fossa et al. [28]. reported leukocytosis and increased serum ALP in response to GCS-F treatment. They suggested that increased serum ALP activity was related to release of the enzyme resulting from the increased leukocyte count. In experiments in which GCS-F was administered to rats, reported by Tsuruta et al [29], increased serum ALP activity was traced to neutrophils. Also NAP activity allows the health care professional to distinguish between among) the following types of acute leukemia (in the absence of cortisol medications): acute myeloblastic leukemia (AML), in which NAP has low activity or is absent in mature neutrophils;, acute lymphoblastic leukemia (ALL), in which NAP activity is decreased in mature neutrophils;, hairy cell leukemia (HCL) with severe neutropenia, in which NAP activity is very high; and non-Hodgkin lymphoma (NHL), in which NAP activity is decreased. In children diagnosed with the diagnosis of trisomy 21 (eg. Down syndrome), NAP activity is increased due to surplus chromosomesal. NAP values are useful in distinguishing between PV (increased NAP activity) and secondary polycythemia (decreased NAP activity). CONCLUSION Laboratory results that quantify ALP activity, which are obtainable via different methods, help clinician doctors, to make the correct decisions concerning treatment of hospitalized patients with benign or malignant diseases. Interpretation of ALP results, using appropriate references of populations, is particularly important in children. Isoenzymes testis is crucially before an accurate diagnosis can be made; and this should be considered when the signs and symptoms of certain diseases fail to provide a clear answer that explains clinical and laboratory features in acute or chronic diseases.

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