Elevated liver enzymes

Optimistic_Missouri

I didn't see any recent threads involving the topic so I'm starting a new one.

I'm trying to see if anyone has had a similar circumstance in regards to alkaline phosphatate, ALT and AST levels. My alkaline phosphatate and ALT were elevated before I started chemo. The levels were 131 (should be under 104) and 67 (should be less than 33). My AST was in range at 23 (should be under 30). I asked about it at the time, but they said since my pet scan was clear I didn't need to worry about it.

My first chemo was on 2/14 and my second was on 2/21. I have minimal side effects. On the latter visit I had a minor upper respiratory infection as well as lymph node swelling in my neck. I was given a prescription for amoxicillin. Fast forward 4 days later and I had a rash all over my body. I ended up having to go to the ER because of the fever. They about me, ran a ton of tests (all normal), and sent me home a couple of days later. By that point my temp had been within within range for over 24 hours. They decided since all of my blood work came back normal that I had developed an allergic reaction to amoxicillin. I went home and started getting fever and chills again all through the night. They told me I could take Tylenol as long as I stayed under 3 g per day.

I went in a on 3/4 for my chemo that they had pushed back from Monday. Now my liver enzymes were too high and they have me doing blood work every 3 days. On Friday my levels were 134/166/115. They felt like these numbers may be high because of the Tylenol they had me on. I went for my blood work today and the first number is about the same, the second number actually went up to 174, and the last is back down to 36 (which is just slightly high).

I don't see the doctor again until Friday which is when I'm scheduled for chemo. If my AST is still this high I don't believe they will give it to me. Has anyone dealt with anything similar, and how was it handled? The concern is my immunotherapy can have strange side effects and could cause these numbers to the elevated. I've been eating well, drinking coffee, exercising, and stopped taking any Tylenol. High AST numbers appear to be correlated with cirrhosis and fatty liver. I've never been much of a drinker so I would be surprised about cirrhosis. In the hospital I was tested for every hepatitis and they were all negative.

Has anyone had to discontinue their treatment due to elevated liver enzymes? Or know what number is too high to receive chemo and immunotherapy? I'm also wondering if I need a new pet scan because perhaps it has spread to my liver now. I get all sorts of answers whenever I Google it but I thought maybe if I could find someone who has been through this, it would be a better source.

Thank you for reading

Optimistic_Missouri

No takers? :-(

alwaysmec

I am currently on Kadcyla and my bloodwork has been up and down. I wanted to mention that the high levels in my records in my myChart portal show 38 as the high for AST/ALT and 118 for phosphates. Maybe the numbers you mentioned are the median or average? I was told that three times those numbers would be when they consider lowering my dose or either discontinuing or allowing a break to let it recover. As far as phosphates, the chemo I am on causes bone pain and it correlates with when that number increases. I had a short two week break because I caught a virus and the number went back down to near normal range. Same for my ALT/AST. Instead of quitting altogether are you able to lower your dose with the chemo you are getting, or can you take a short break to allow yourself to recover? Is the 174 the phos? I found that Claritin helps keep that number down. It helps with my bone pain.

Optimistic_Missouri

Thank you so much for responding. Looks like we have a similar diagnosis too.

Here are my numbers:

ALKALINE PHOSPHATASE (normal range 35 - 104 U/L)

1/31 (pre-treatment) level was 131
3/4 the level was 134
3/7 the level was 133

ALT (normal range >33 U/L)

1/31 (pre-treatment) level was 67
3/4 the level was 166
3/7 the level was 174

AST (normal range >33 U/L)

1/31 (pre-treatment) level was 30
3/4 the level was 115
3/7 the level was 36

As far as the normal ranges, I'm not sure why they are different than yours. Maybe it depends on other factors like age/weight/etc? I'm just copying what it says on my chart. They haven't told me exactly what number I have to be at to get any chemo, even at a reduced amount. They just said mine were too high on Friday. I guess I will find that out on my visit this Friday. If they can't figure out what is going on I may have to get a second opinion on it or possibly see a liver specialist. Any chemo would be better than nothing right now because I only had two infusions and I don't know if that's even enough to stop it from growing. I may give Claritin a try. Did they say if that helps with all of the liver enzymes, or just one?

hungryfrittata

Hi, optimistic missouri. I'm new here and just had my first chemo session last 3/12. I have stage iv breast cancer with mets to bones and liver. On 2/14, my AST was 221 and ALT 257. I was prescribed Transmetil 3x a day to try and lower them before starting treatment. On 3/11, AST was 209, ALT 185, Alkaline phosphatase 440. I was put on weekly Taxolpaclitaxel infusion. My med onco said he reversed the protocol from AC-T to T-AC bec he was afraid my liver tumors might break down too fast and cause trouble. I didn’t understand it entirely but we will be seeing a liver specialist soon and I can give you an update.

gamzu710

I was on an antibiotic (azithromycin) for an unrelated procedure just prior to starting chemo and it sent my liver enzymes skyrocketing. ALT 229, AST 160, ALK 142. 4x higher than the upper limit of normal, and 10-20x higher than they'd been on routine bloodwork with my PCP 5 months earlier.

I freaked out but the oncologist's NP looked at the list of meds I had been on and said it was probably inflammation from that and to just watch and wait. I had the same question as you, how high is too high to do chemo, because I'd seen reports on this board of people paused with numbers lower than mine and was very angry that it didn't seem like anyone had flagged mine (I was on Taxol, which can also elevate them). I was sure going ahead would send them even higher and then I'd be in the soup. But the NP was sure. So we watched and waited and within 2-3 weeks it had dropped into the normal range. I had one more episode of mildly elevated enzymes a few weeks later that coincided with being sick, but those also dropped. All kinds of dark thoughts were filling my head but it ended up OK.

I would not be surprised if the amoxicillin and the Tylenol are behind this and it will drop again in a couple weeks. Lots of medications can transiently inflame the liver and we have no idea because there are no symptoms. I saw the bloodwork right before having my port put in and gritted through the whole post-op of that with no meds at all because I was too terrified to take anything with acetaminophen in it and thought I would turn yellow and end up in the ER. In hindsight, probably an overreaction!

elderberry

Hi All: I stay away from Tylenol because of the risk to the liver. I am interested in the differing ranges given for ALP I have see 30-140, 35-104 (?!! really) My lab uses 35-120. The difference would make a DIFFERENCE in how I read my results. When should I really worry? Anyone have anything different than these three?

BevJen

Elderberry,

My understanding is that there is not an "objective" absolute for any blood measurements. I believe that's why you have to read your reports looking at the ranges reported on that report for that lab. Not playing scientist here, but I think that different labs use different assays (is that the right word?) for results in each of these numbers, so that's why they look different on different reports. The important thing is that your numbers for each item (including ALP) fall within the "normal" range for the particular lab that you are getting a report from.

My lab that I usually use is 30-120. That's a hospital lab. However, the lab at a co-owned hospital where I sometimes get my blood drawn uses 38-126. Can't get bent out of shape if you are "normal" within their lab limits.