alk phos

1. ALKALINE PHOSPHATASE: DISTINGUISHING BETWEEN TUBERCULOUS AND NON TUBERCULOUS PLEURAL EFFUSION BY DR KARTIK SOOD JUNIOR RESIDENT DEPARTMENT OF PULMONARY MEDICINE ELMCH ORIGINAL ARTICLE-LUNG INDIA VOL-26,ISSUE 3,SEPT 2009 JAYASHREE SUHAS ASHISH JADHAV

4. Fungal infections

5. Viral infections

8. Sarcoidosis

9. Uremia

10. Meigs' syndrome

11. Yellow nail syndrome

12. Drug-induced pleural disease

13. Nitrofurantoin

14. Dantrolene

15. Methysergide

16. Bromocriptine

17. Procarbazine

18. Amiodarone

19. Trapped lung

20. Radiation therapy

21. Post-cardiac injury syndrome

22. Hemothorax

23. Iatrogenic injury

24. Pericardial disease

25. Chylothorax

27. Pleural fluid protein/serum protein >0.5

28. Pleural fluid LDH/serum LDH >0.6

29. Pleural fluid LDH more than two-thirds normal upper limit for serum

30. Modified light’s criteria:

31. Pleural fluid cholesterol level > 60mg/dl

33. These include: Pleural fluid(PF) adenosine deaminase, PF lysozyme, PF gamma interferon, PF alpha 1 antitrypsin,PF protease inhibitors,PF CA 125, PF tumor necrosis factor, PF interleukin-1,PF polymerase chain reaction,and reported to be elevated in tuberculous pleural effusionAlkaline phosphatase (ALP) is one of the biochemical markers found in pleural effusion. Previous studies have used ALP to differentiate between exudates and transudates.

35. VALUES PF ALP level greater than 71 was observed in 27 out of 30 cases of tuberculous pleural effusion and six out of 30 cases of nontuberculous pleural effusion . PF/S ALP ratio greater than 0.51 was observed in 27 out of 30 cases of tuberculous pleural effusion and 4 out of 30 of non tuberculous pleural effusion

36. DISCUSSION Result confirms that alkphsactivity is useful in differentiating tuberculous and non tuberculous effusion a cut-off value of ≥71 IU/L for pleural alkaline phosphatase activity; and a cut-off value of ≥0.51 for pleural fluid/serum alkaline phosphatase ratio.