Biochemical diagnosis of placental infarction/damage: acutely rising alkaline phosphatase

Ann Clin Biochem 2008;45:335-338
© 2008 Association for Clinical Biochemistry


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Case Reports

L Ranganath1,
W Taylor1,
L John1 and
Z Alfirevic2

1 Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, Liverpool L7 8XP, UK;
2 Department of Foetal and Maternal Medicine, Liverpool Women’s Hospital, Liverpool L7 7SS, UK

Corresponding author: Dr L Ranganath. Email: lrang{at}

There are currently no simple tests in clinical use to detectacute placental damage. A case is described to demonstrate thata routinely used measurement such as alkaline phosphatase (ALP)can be employed to detect acute damage to the placenta. Seventeenserial blood samples, three pre-delivery, were collected froma 22-year-old primigravida who delivered a stillborn baby. Retrospectively,blood samples were analysed for total and heat-stable ALP aswell as human chorionic gonadotropin (hCG) and alpha-fetoprotein(AFP) as a measure of placental function when an unusual patternof change in ALP was noticed. Histological examination of theplacenta revealed new and old placental infarcts. Total andheat-stable ALPs as well as AFP peaked by more than eight-,19- and two-fold, respectively over 16 h. Plasma hCG fell sharplyeven before delivery of placenta by five-fold over 16 h beforefurther falling slowly to baseline. The fall in hCG is alsoconsistent with the placental damage being acute and critical.As far as we are aware this is the first description of changesin circulating proteins reflecting placental damage.

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