Persistently low serum alkaline phosphatase can be seen in a number of disorders.
Important conditions to identify:
(1) hereditary hypophosphatasia (due to inactivating mutations of the ALPL gene for non-tissue specific alkaline phosphatase)
(2) Wilson's disease (especially with severe liver disease and hemolytic anemia)
(3) achondroplasia
(4) hypothyroidism
A low serum alkaline phosphatase can be seen in the following conditions if they remain untreated or unresolved:
Nutritional or gastrointestinal disorders:
(1) hypophosphatemia
(2) acquired zinc or magnesium deficiency
(3) scurvy
(4) kwashiorkor/malnutrition
(5) vitamin B12 deficiency, including pernicious anemia
(6) celiac disease
(7) milk-alkali syndrome
Drugs:
(1) oral contraceptives
(2) estrogens
(3) azathioprine
(4) clofibrate
(5) trifluoperazine
(6) corticosteroids
(7) vitamin D excess
Other:
(1) severe anemia
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Specialty: Clinical Laboratory