Healthcare professionals have experience recognising elevated ALP activity, but low ALP activity is not always recognised (Rockman-Greenberg 2013; Whyte 2013). ALP activity levels vary with patient age and gender, with the lower limit of normal ALP activity being significantly higher in children than in adults (Colantonio et al., 2012). The use of inappropriate reference ranges and failure to report low ALP activity levels may lead to HPP being missed in some patients (Bishop et al., 2016; Rockman-Greenberg 2013; Saraff et al., 2016; Whyte 2013). The KiGGS and CALIPER initiatives provide independent sources of age‑ and gender‑adjusted paediatric reference ranges for ALP activity (Colantonio et al., 2012; Robert Koch-Institut 2009). The use of appropriate age- and gender-adjusted reference ranges is critical for the detection of low ALP activity and for the accurate diagnosis of HPP (Bishop et al., 2016; Rockman-Greenberg 2013; Saraff et al., 2016; Whyte 2013).
The ALP lower limit of normal is significantly higher in infants and children than in adults (Colantonio et al., 2012; Robert Koch-Institut 2009).
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