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Knee pain and headache. Blood test showed low alkaline phosphatase and wbc level. Worrisome

Answered by
Dr. Michelle Gibson James

General & Family Physician

Practicing since :2001

Answered : 16042 Questions

Posted on Tue, 5 Feb 2013 in Headache and Migraines
Question: My 7 year old son had blood work done 3 days ago.. He presented with Knee pain and Dr. ordered it as a precaution. His Alkaline Phosphatase came back below the normal range and so did his WBC. They immediately assigned him to a Pediatric specialist at the hospital. He has some speech issues and has complained of a headache but is otherwise well. The Dr told me they never see low ALP and are concerned and must get to the bottom of it. Of course I am concerned because My 16 year old daughter just got diagnosed with MS last month so I am more than a little worried.
Answered by Dr. Michelle Gibson James 3 hours later
Hi, thanks for using healthcare magic

Alkaline phosphatase is one of the enzymes normally seen in the body. It is responsible for removing phosphates (which is a combination of phosphorus and oxygen) from different molecules.
It is concentrated in the liver, bile ducts (these are present in the liver ), kidney and bone.

A low ALP is uncommon. There are a number of potential causes for a low ALP such as deficiency in zinc or magnesium, nutritional deficiency, low levels of thyroid hormone, aplastic anemia, hypophosphatasia and vitamin c deficiency,pernicious anemia. It can also occur in some leukemias but in that case the white cell count is more likely to be elevated.

Aplastic anemia is a condition where the bone marrow does not produce enough cells and it results in low blood count, low white cell count and low platelets since all of these are made in the marrow.
Hypophosphatasia is a condition where is there an error in the gene that is suppose to order/make alkaline phosphatase. It would present with a history of loss of delayed walking, early loss of the baby teeth and bone pain.
Pernicious anemia is a condition where there is failure to absorb vitamin b 12.

It may be a lab error and the doctor may likely repeat the labs to ensure that they are accurate.
If the repeat values are also similarly abnormal then further investigations would be conducted.
The blood tests would include magnesium, zinc, thyroid hormone levels, calcium (this would be high in hypophosphatasia), phosphorus , creatinine(checks the kidneys)

The low white cell may occur aplastic anemia which was mentioned earlier and in some vitamin deficiencies like vitamin b 12 deficiency.

The exact treatment would depend on the cause.

I hope this helps, feel free to ask any other questions
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Michelle Gibson James 13 hours later
He has had thyroid tests all came back normal, His vitamin B is normal as well. He has an opthamology appt this week to start investigation - as well as urinalysis, full blood panel and xrays. How rare is wilsons disease? This is our second time dealing with ALP when he was 2 his ALP level reached almost 6000 then returned to normal after a few weeks. Nothing since though.
Answered by Dr. Michelle Gibson James 11 hours later
Hi, sorry about the late reply
XXXXXXX disease is a condition related to the break down of copper, it results in copper being deposited in different parts of the body such as the liver, brain and other tissues.

Wilson's disease is found in 1 out of 30 000 persons. In general the upper limit for considering it is 40 and the lower limit is age 5.
It would be diagnosed by history and examination showing rings in the eyes, blood test showing a decreased level of ceruloplasmin (this carries copper) and possibly a liver biopsy to show increased level of copper deposited.

In most persons it is associated with an increase in liver enzymes

Feel free to ask any additional questions
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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