highly elevated alkaline phosphatase post lobectomy

[SINGER5000]

My chemo MD is confused as to why my alkaline phosphatase is elevated >420 w/ bilirubin 1.2.  I had a lobectomy (right) 5 weeks ago and an HAI pump installed at the time.  My chemo MD is not sure whether to fill the pump with FUDR while the enzymes are still high and trending higher.  ideas?

[Kevin Pho, MD]

I am not an oncologist, and cannot comment on your chemotherapy regimen.

Regarding the elevated alk phos - it normally can come either from the bone or liver.  A GGT test can help determine this (i.e. it would be elevated if coming from the liver).  If this is the case, an right upper quadrant ultrasound, as well as an AMA (anti-mitochondrial antibody) would be reasonable as an initial screen for liver/gallbladder disease as well as primary biliary cirrhosis respectively.  

If the GGT is normal, then studies should be considered looking for bony disease (i.e. possible metastasis).  A bone scan would be a reasonable option if this is the case.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[SINGER5000]

I had the ultrasound last week and there was no bile duct dilation (radiologist called it "dilitation") .    The only thing remarkable on the ultrasound was "quite alot of fluid" around the liver.

Could this fluid possiblly be pressing on something that causes the alk phos to rise?


Also, I have had low grade fevers for the past few weeks (just under 38) Could the abovementioned fluid be infected?

thanks in advance

[Dixxyman]

I am an MD who receives Hepatic Infusion FUDR and Leucovorin and dexamethasone to protect my bile caniliculi every month for 10 days. After the first couple of infusions my AP went to 850 and I became jaundiced. I was pretty sick but recovered in about 6 weeks. After stopping the FUDR the jaundice subsided and I was palced on a lower dose and 10 days instead of 14 every month. I have had no problems since. The AP is a marker for development of jaundice/chemical hepatitis. The other liver function test are not as predictive as AP.If it keeps rising you probably shold wait until the AP falls to around 150 and then go with a reduced doseage and length of infusion.
Al T

[SINGER5000]

Thanks. That is what my ONC decided.  wait until the alk phos comes down to restart the FUDR. So saline/hep for now in the pump.

My big question is this.  My alk phos has been elevated ever since my liver resection surgery and was elevated before I did FUDR/LV/dex.  What made it elevated?  there is no bile duct obstruction.  

I had a procedure to drain the fluid pressing on my liver. The fluid was blood not bile. (but now the fluid has come back- so another draining procedure is scheduled.  do you think this could be the cause of elevated Alk phos and bili?

By the way, did you get a bit wired from the cortisone in the pump?

[Dixxyman]

AP is a pain as it can be elvated in a number of conditions,(lovingly called Alkaline phosphstasemia meaning that the AP is elevated in the blood specemin but the cause remains unknown) however the most common causes are liver disease and bone, even after a bone fracture. We used to do a heat fractionation to separate the AP from the liver and that from the bone. Since that was 20 yrs ago I don't know if it is still done.
The dexamethasone doesn't bother me. I get 10 mgms in the pump which has a 30 day reservoir and since it only runs 10 days I get 3.3 mgm dexamethasone a trip. Enough to probably wire some. Email me at ***@**** if you have further questions.