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Transient Hyperphosphatasaemia of Infancy: An Often Unrecognised and Thus Over-Investigated Condition
1Department of Chemical Pathology, Childrens University Hospital, Temple St, Dublin.
Irish Medical Journal
|September 30, 2016
Summary
Transient hyperphosphatasaemia of infancy (THI) is a common, benign condition causing temporary high alkaline phosphatase (ALP) levels. Recognizing THI avoids unnecessary tests and referrals for infants with elevated ALP.
Area of Science:
- Pediatrics
- Clinical Biochemistry
- Laboratory Medicine
Background:
- Transient hyperphosphatasaemia of infancy (THI) is a benign condition characterized by temporary elevations in plasma alkaline phosphatase (ALP).
- It is often incidentally discovered during routine blood tests in infants.
- Failure to recognize THI can lead to unnecessary investigations and referrals.
Purpose of the Study:
- To review the characteristics of THI.
- To evaluate clinical practice regarding isolated high plasma ALP in infants.
- To reduce unnecessary investigations and referrals for suspected THI.
Main Methods:
- Retrospective review of plasma ALP analysis requests over two years at two sites in the Republic of Ireland.
- Identification of patients with plasma ALP activity above 1000 IU/L.
- Analysis of diagnostic workups and referral patterns for patients with suspected THI.
Main Results:
- Out of 107,468 ALP analyses, 250 patients had ALP > 1000 IU/L.
- THI was considered in 62 patients.
- 15% of these patients underwent inappropriate investigations, and 13% were unnecessarily referred.
Conclusions:
- Isolated high plasma ALP in infants warrants consideration of THI.
- Repeating plasma ALP in 7-10 days and monitoring normalization over 2-3 months aids diagnosis.
- ALP isoenzyme analysis can be used for confirmation when necessary.
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