Anemia

Anemia is a very predictable complication of therapy, usually due to ribavirin. Ribavirin causes a hemolytic anemia, damaging red blood cells, which are later removed from the body resulting in the anemia. Symptoms of anemia include increasing fatigue, shortness of breath, lightheadedness, and dizziness. A significant complication of anemia is myocardial ischemia, which can lead to heart failure or a heart attack. For this reason, anemia is treated aggressively.

Reducing the dose of ribavirin usually results in a rise in hemoglobin and improvement in the anemia. This dose reduction in ribavirin may jeopardize the final result of therapy and a lack of viral clearance. It has been generally accepted to treat the anemia without reducing the dose of ribavirin. This is accomplished by making use of erythropoietin.

Erythropoietin is a protein naturally made in the body, which regulates red blood cell production in the bone marrow. It has been successfully manufactured nearly identical to the form in the human body and used in an assortment of conditions for the past 10 years. It is safe and well tolerated. It is very effective in treating the anemia seen with ribavirin use.

The use of erythropoietin not only increases hemoglobin, but also improves upon the fatigue reported in these patients. In most situations, the dose of ribavirin can be maintained, increasing the likelihood of clearing the virus. Blood transfusion is rarely required, but may be an option. Monitoring the effects of erythropoietin requires more frequent blood tests, usually on a weekly basis. Once erythropoietin is used, it is generally used the entire duration of therapy. It is given by weekly injection similar to the interferon.