Alkaline phosphatase (ALP) is a significant biomarker of diseases, such as osteoblastic bone cancer, hepatitis, and myeloma, and hence its determination is essential and important. MnO2/Mn2+ conversion-based magnetic relaxation sensing was developed to directly determine ALP in blood. In the presence of ALP, 2-phospho-L-ascorbic acid trisodium salt was catalyzed to produce ascorbic acid (AA), which reduced MnO2 to Mn2+, causing transverse relaxation time (T2) decay. A linear relationship of ALP from 5 mU·L−1 to 500 mU·L−1 with T2 signal and a low limit of detection (LOD) of 3.32 mU·L−1 were obtained using the optimized conditions of 200 µM of ascorbic acid-phosphate (AAP), 10 µg·mL−1 of MnO2, 37 °C, pH 7.4, and a 30 min reaction time. When directly measuring ALP in serum with the proposed method, the recoveries were from 99.2% to 101.3%, in accordance with values obtained by a commercial assay. In conclusion, a sensitive one-step method for ALP in complex samples was established which has potential for clinical applications. [ABSTRACT FROM AUTHOR]