High Liver Function tests and fevers with GEMZAR/XELODA+NEULASTA

Hi Kavita,

I also had a resection of the bile ducts and gallbladder with a reconstruction of the bile duct from a section of the small bowel. Following this, I was on a combination of gemzar and cisplatin. In the second month of chemotherapy, I developed elevated liver fuction tests, AST, ALT and particularly high ALP. My oncologist believed these elevated LFTs were likely caused by the manner in which my liver was metabolizing the chemo agents. A bit later in chemotherapy I also had elevated bilirubin. I had an ERCP and we discovered the cause of this was a narrowing in one of the ducts coming out of the liver which restricted the flow of bile out of the liver. The GI doctor who did the ERCP was able to open this narrowed area and bile flow was restored.The ERCP also identified an area of residual infection at one of the sites where a duct coming from the liver was connected to the reconstructed common bile duct. This was also cleaned out during the procedure. The ERCP resolved my bilirubin problem. The elevated AST and ALT have resolved once I completed my chemotherapy cycles. My oncologist is not too concerned with the elevated ALP.

By the way, for someone who has altered anatomy such as your mom has following a resection, an ERCP must be done with a relatively new endoscopic device which is a fair bit longer than the standard device used for an ERCP.

Since your mom is on Neulasta, it would be common for her to have a high WBC since the drug ramps up the production of white blood cells. As far as the low hemoglobin, this is amemia and is also a fairly common side effect of chemotherapy. I had the same response. Some patients require blood transfusions to elevate the red blood cells if the hemoglobin and hematocrit drop low enough.

You should talk to your mom’s oncologist about these reactions and find out what he/she thinks.

Best of Luck,
Bill