ALPL and hypophosphatasia: HPP was first described by Canadian physician John C. Rathbun in an infant who presented with rickets and seizures at 2 months of age with low ALP, which was discovered later in autopsy.6 The highest prevalence of HPP is reported among Mennonites in Manitoba, Canada, with 1 in 25 individuals as carriers of the mutation and 1 in 2500 neonates having life-threatening HPP.7 More than 300 mutations have been described in TNSALP gene that can be transmitted autosomal recessive (severe form) or dominant resulting in HPP (mild form).3