Side Effect Management : Hemolytic Anemia

•hcspFACTsheet• Hepatitis C Support Project • www.hcvadvocate.org
a series of fact sheets written
Symptoms
by experts in the field of liver
The most common symptoms of anemia include shortness
of breath, fatigue, pale skin color, chil s, rapid heart rate,
disease
depression, and reduced quality of life. If left unchecked,
hemolytic anemia can lead to jaundice, dark urine, and an
HCV Treatment
enlarged spleen. In severe cases, cardiac arrest (heart attack)
can occur. This is why it is important for people considering
Side Effect Management: pegylated interferon plus ribavirin therapy to have a physical
exam before starting treatment to rule out any potential heart
problems that could be made worse by ribavirin.
Hemolytic
Diagnosis
Anemia
A simple blood test cal ed a complete blood count (CBC)
measures various components of blood including red cel s,
white cel s, and platelets. The portion of the blood test
that measures red blood cel s and their oxygen-carrying
capacity,?hemoglobin and hematocrit,?are used to diagnose
Alan Franciscus, Editor-in-Chief
anemia.
Red blood cells (RBC) or erythrocytes carry oxygen to Normal Ranges
body tissues, producing fuel that the body needs to stay
Male Ranges
Female Ranges
healthy. The normal average life span of a red blood Hemoglobin
14.0-18.0 g/dL
12.0-16.0 g/dL
cell is about 90 to 120 days; after red blood cells have Hematocrit
42.0-52.0 %
37.0-48.0 %
worn out, the spleen removes them from circulation.
New red blood cells are produced in the bone marrow. A low hemoglobin or hematocrit measurement indicates
anemia.
It is a balancing act to make and replace red blood
cells that have been destroyed. When this balance is Treatment
There are two approaches for treating hemolytic anemia:
upset, a person can develop anemia. There are many ribavirin dose reduction and use of a growth factor hormone
different causes and types of anemia. This fact sheet (erythropoietin) to promote red blood cel production. (It
will discuss ribavirin-induced hemolytic anemia.
should be noted that ribavirin-induced hemolytic anemia
cannot be treated by eating iron rich foods or taking iron
Hemolytic anemia refers to a condition in which red supplements.)
blood cel s are destroyed faster than the body can make In general, ribavirin dose reduction or the use of red blood
enough new ones to replace them. The medications cel growth factors are recommended when the hemoglobin
used to treat hepatitis C can cause hemolytic anemia, level goes below 10 g/dL or if there is a significant drop in
hemoglobin levels over a short period of time. People with
with ribavirin being the main cause of hemolytic ane- cardiac disease should be monitored very careful y when
mia. It is estimated that up to 22% of patients taking the hemoglobin level starts to drop. Ribavirin treatment may
have to be discontinued if the drop in hemoglobin level is
pegylated interferon plus ribavirin experience hemolytic substantial. The general recommendation is to stop taking
anemia. The likelihood of anemia is related to the dose ribavirin or HCV therapy altogether if the hemoglobin level
of ribavirin taken.
drops below 8.5 g/dL.
HCSP • VERSION 2.1 • December 2008
1

---

Some medical experts believe that ribavirin dose reductions
HCSP Factsheet Series
should be avoided since maintaining the ribavirin dosage is
especial y important during the first 12 weeks of treatment
HCV Benefits and Disability Issues
to help prevent relapse and achieve a sustained virologic
•American with Disabilities Act
response (SVR).
•Getting Disability Benefits
HCV Diagnostic Tools
Erythropoietin (EPO; brand name Epogen or Procrit) promotes
•Diagnostic Tests
red blood cel production in the bone marrow. Clinical studies
•Genotype and Quasispecies
using EPO to treat HCV treatment-induced hemolytic anemia
•Grading and Staging a Liver Biopsy
have shown an average increase in hemoglobin levels of 2.0
•HCV Viral Load Tests
g/dL and an improvement in patients’ quality of life. EPO is
•Liver Biopsy
FDA-approved for chronic renal (kidney) failure, cancer che-
•Reading a Lab Report: A Basic Primer
motherapy, HIV therapy, and use before elective non-cardiac
HCV Disease Progression
surgery. Although EPO is commonly used to treat ribavirin-
•Cirrhosis
induced hemolytic anemia, it has not been approved by the
•Fibrosis
FDA for this purpose, and obtaining insurance coverage or
reimbursement may be difficult.
HCV Transmission and Prevention
•Overview
Warning: A warning has been added to the Procrit pack-
•Mother-to-Child Transmission
age insert about serious and life threatening complications
•Occupational Exposure
that may be related to the use of Procrit. To minimize these
•Personal Care
•Sexual Transmission
risks it is recommended that the lowest dose needed should
be used.
HCV Treatment – Side Effect Management
•Managing Side Effects
It is important to notify and work closely with your health-care
•Side Effect Management: Dental Hygiene
provider if you notice any signs or symptoms of anemia in
•Side Effect Management: Diarrhea
order to make your HCV treatment outcome as successful
•Side Effect Management: Hair Loss
as possible.
•Side Effect Management: Headaches
•Side Effect Management: Injection Site Reactions
For more information about hepatitis C, hepatitis B and
•Side Effect Management: Maintaining a Positive Attitude
HCV coinfections, please visit www.hcvadvocate.org.
•Side Effect Management: Nausea
•Side Effect Management: Rashes
•Side Effect Management: Weight Loss
•hcspFACTsheet•
A publication of the Hepatitis C Support Project
•Acute Hepatitis C
•Advocates and Activists Needed!
Executive Director
The information in this fact sheet is
•An Introduction to the Liver
Editor-in-Chief, HCSP Publications designed to help you understand and
•A Brief History of HCV
Alan Franciscus
manage HCV and is not intended as
•A Simple Guide to Reading an Abstract
medical advice. All persons with HCV
Design
•Depression
Paula Fener
should consult a medical practitioner for
diagnosis and treatment of HCV.
•Disclosure
Production

•Finding a Support Group
C.D. Mazoff, PhD
This information is provided by the
•Hepatitis C: The Basics
Hepatitis C Support Project • a nonprofit
•Herbs and Hepatitis C
Contact information:
organization for HCV education, support
Hepatitis C Support Project
•HIV/HCV Coinfection: What You Need to Know
PO Box 427037
and advocacy• © 2008 Hepatitis C
•Interferon
San Francisco, CA 94142-7037
Support Project • Reprint permission is
granted and encouraged with credit to
•Living with Hepatitis C
alanfranciscus@hcvadvocate.org
the Hepatitis C Support Project.
•Nutrition
•Questions to Ask Your Healthcare Professional
HCV ADVOCATE
•Testing Positive
www.hbvadvocate.org
HCSP • VERSION 2.1 • December 2008
2

---