High liver enzymes

[mnsnyl]

Hello dear AA family, I have been using 200mg sandimmune for 17 months and my counts are still improving. But the day before I had severe tummy pain and went to a gastroenterolog, she made some tests. My liver enzymes were sooooo high;

ALT 216 (0-33)
AST 294 (0-31)
GGT 79 (0-31)
total bilirubin 3.42 (0-2,1)
direk biluribin 1.73 (0-0.3)

the doc said " while trying to recover your marrow, don't lose your liver." and cyclosporine was cut off now. I am so worried about this sudden cut off. What if my blood levels falls again? If I continue taking cyclosporin what happens to my liver? By the way a 40*48mm overian cyst was found in my rigth over. Also because of the tummy pain, my doc suspected if it can be ulcer or gastritist, I am waiting their test results. I am just 22 years old and I really don't know how to overcome with all these

[Marlene]

Did your Hematologist take you off the Sandimmune? So many things can cause liver enzymes to be elevated so I if you haven't already, call your hematologist so they can work with you on all of this. I assume your doc was running a chem panel each month so find out what your prior labs were. Were the liver enzymes trending up or was this a sudden spike.

A blocked bile duct can cause both pain and liver enzyme problems. So make sure they checked out your gall bladder and pancreas ( they share the duct going into the digestive track and if they get blocked, cause pain and bile to back up)

Don't panic about the ovarian cyst just yet. Most will resolve within one to three cycles. Did they tell you what type of cyst it is. Every cycle, during ovulation, small cyst can and do occur on the ovary that is getting ready to release an egg. And for some, when the egg breaks free from the ovary, it may bleed a little and can cause anywhere from abdominal discomfort to pain. The abdominal cavity does not tolerate blood well. There are times when the process does not complete and the cyst remains.

So the most important thing is to get with your hematologist to address the drugs and liver enzymes.

[mnsnyl]

Firstly thanks for your reply Marlene. The gastroentrolog took me off sandimmune, I still couldn’t contact with my hema as he is in abroad. I had my last liver test 3 months ago, it was normal at that time. Gall bladder and pancreas were checked, there was no problem with them. But today I learned that I had helicobacter pylori in my tummy. In treatment of it 3drugs are given together, of them are 2 antibiotics. I am really really worried now about how can my body tolarete them.

[Marlene]

Doesn't your hematologist have someone else covering for him? They really need to be involved in these decisions. By chance, did the gastro consult with him or another hematologist?

If the answer is no to these, you may want to find another hematologist or get in to see your GP for guidance.

This is my take on h-pylori. Look up the three drugs on rxlist.com so that you know what you are taking and potential side effects. I assume the third medicine is for reducing the acid in your stomach. You have two concerns here. One - the effect on the liver; and Two - the effect on your bone marrow. Pretty much, all antibiotics can negatively impact the BM. Some, however, are more dangerous. So look up the drugs.

Another to ask is: Can you hold off on treating the h-pylori until the liver calms down or until you consult with your hematologist. My thinking is it can wait. But if you have an active ulcer, I wouldn't wait long. If you just have the bacteria, then I think you have time. This is just my opinion. There are some natural approaches you do in the meantime that can help.

I tend to take a slower, less aggressive approach in some aspects of treatment especially since you just came off your cylco, I would be hard pressed to muddy the waters by adding new drugs.

That being said, I would be remiss if I didn't mention that they have found links between h-pylori and blood disorders. So it would be good to deal with it in very near future.

Bottom line....I feel working closely with your hematologist to address these issues is critical. You'll want close monitoring of your blood during all of this and I doubt the gastro is in a position to do this for you.

These diseases are difficult to navigate. Just when you think you have everything under control, something else rears its ugly head. You just have to push forward and know you'll get through this too. Every doctor John saw for medical issues not related to his bone marrow, consulted with his hematologist before they treated him. I think they were afraid of the SAA since they never treated anyone with it.