Two Case Reports of an Abnormally High Alkaline Phosphatase in Pregnancy

Alkaline phosphatases are enzymes that can be released by liver, bile ducts, intestine, bone, kidney, placenta, and leukocytes .The normal range in adults is between 85 and 110 IU/L .During pregnancy and due to placental contribution and fetal growth the ALP can increase by 2 folds. Here we describe two case reports of very high ALP during pregnancy where the level jumped upto 20 folds .In both situations the level fell to normal post delivery . The first lady was a 33 year old Her routine blood by her doctor at 34 weeks of gestation showed an ALP of 1336 which continued to rise to 2224 U/L at 37 ..The second lady was 34 year old who was admitted due to the fact that her routine GP blood showed ALP of 1884 which jumped to 2512 during her admission .Both patients were asymptomatic and were initially sent to hospital for further workup and,observation.The scans showed no hepatic or biliary tree abnormalities and all the non invasive liver screening was normal. Serial fetal growth scan for the first lady demonstrated fall of fetal growth and AFI at 3 6 weeks .yet she was delivered expectantly by caeserian section at 37 weeks and the product was a baby with good APGAR score.. Serial growth scan for the second lady showed a macrosomic baby and reduced AFI at 34 weeks of gestation .Patient attended the emergency department with reduced fetal movement at 34 weeks of gestation and was delivered by emmergency caeserian section. The outcome was a male baby with good APGAR score (9/10).In both situations the ALP isoenzymes pattern showed placenatal and bone isonenzyme only... Our cases demonstrate an extremely high level of ALP in the setting of normal pregnancy but reduced AFI and some placental abnormalities in histopathology.

Keywords: Alkaline Phosphatse (ALP), High Alkaline Phosphatse in Pregnancy, Placental ALP, Cholestatsis in Pregnancy, Case Report, Expectant Management, Pregnancy.