We report the finding of alkaline phosphatase-immunoglobulin complex (macro-alkaline phosphatase (macro-ALP)) in a patient with persistently increased ALP activity.The identification of macro-ALP is important Safety to rule out pathological causes of increased ALP activity and to avoid unnecessary diagnostic investigation.The patient was subsequently diagnosed with vitamin D deficiency, gallstone pancreatitis, and monoclonal gammopathy of undefined significance (MGUS).Macro-ALP can coexist with disease that can increase serum ALP activity.We report, for Wobbly Bowl the first time, a case of macro-ALP in a patient with a monoclonal protein (M-protein).