There's lots of discussion about anemia while on treatment, but this question is about anemia after/off treatment, especially for any Stage 4s:
Does anyone have any familiarity with cirrhosis-induced anemia? I understand that there are many abnormal blood markers that are consistent with cirrhosis, ie. low platelets, high bilirubin, low albumin, etc... but is low hemoglobin common with cirrhosis?
My husband has been off hcv treatment for more than 8 weeks now, and he continues to be anemic (8.1)... have any folks out there with cirrhosis experienced occasional or persistent anemia while not on tx, and if so, how low, and for how long? Did docs intervene at any point? All the specialists have pointed out the anemia, but everyone's deferring to his PCP, who is AWOL at the moment... any feed back appreciated! Thanks. ~eureka
Joe's last reading was 12.2 HgB. This is good for him . Over the years it has been lower than this but not as low as 8.1 while not on TX. The PA did tell me the cirrhosis is what causes Joe's to stay under par. His white cells were only 2.6 last time. Wish we were starting TX with a few more spares.
I have to go to work now but tomorrow, I will send you a link for the blood disorders protocol at Life Extension Foundation. I have found their website very valuable over the years. The page is generally geared towards people whos bone marrow suppression is caused by chemo, but you might find something helpful. Folic acid is one thing I think I read but I read way too much of these things and get my wires get crossed. I will find it tomorrow.
I am not sure about the low hgb while not on treatment, but after reading the last answer I wanted to add that my NP told me to take folic acid while on treatment to keep the hgb levels up, so maybe folic acid is something that will help.
I have been keeping up with your posts regarding your husband I want to say that y'all are in my thoughts and prayers. Since I have already developed cirrhosis at 32, I know that if I don't attain SVR status this go round, it is a long road ahead. I feel very grateful for my UND status at week 4. My afp has steadily increased a little each time it is checked over the past few years, and I know that this can mean nothing more than active HCV, but I have also seen studies that show a steadily increasing afp can be an indicator that something can show up at some point. I stay on top of those 6 month CT scans for sure.
I just wanted to say good luck and I wish you and your husband the best.
Although anemia isn't a common complication of cirrhosis. This article explains how portal hypertension can cause anemia.
The spleen normally acts as a filter to remove older red blood cells, white blood cells, and platelets (small particles that are important for the clotting of blood.). The blood that drains from the spleen joins the blood in the portal vein from the intestines. As the pressure in the portal vein rises in cirrhosis, it increasingly blocks the flow of blood from the spleen. The blood "backs-up" and accumulates in the spleen, and the spleen swells in size, a condition referred to as splenomegaly. Sometimes, the spleen is so swollen that it causes abdominal pain.
As the spleen enlarges, it filters out more and more of the blood cells and platelets until their numbers in the blood are reduced. Hypersplenism is the term used to describe this condition, and it is associated with a low red blood cell count (anemia), low white blood cell count (leucopenia), and/or a low platelet count (thrombocytopenia). The anemia can cause weakness, the leucopenia can lead to infections, and the thrombocytopenia can impair the clotting of blood and result in prolonged bleeding."
There so much that gets compromised with cirrhosis, and lots of information about other stuff, but I'm not finding a whole lot about anemia, other than the generality that it does happen. "Starting tx with a few more spares..." I'm feeling exactly the same way at the moment... the new med expected tomorrow comes with warnings against ischemia, so I wouldn't mind them giving him some blood (neither would he, at this point), but so far they've been dragging their feet. I'll be wishing Joe good response and few side effects ... !
Thanks for that tip too, and I had to smile at the first thought that came to mind about Folic Acid... I know they add lots of it to ... Prenatal Vitamins! :) Well, hubby might LOOK a little pregnant, but that's just NOT gonna fly with him. I'll definitely have to check on that as a possibility... things being what they are, I have to run all supplements and meds by my husband's docs. I'm so glad that you reached undetected at week 4... a great response that hopefully will mean complete suppression of virus and regression of cirrhosis! Definitely stay right on top of those 6 month ultrasounds and AFPs... and get copies EVERY time! The hope is that with SVR you can breathe much easier about those tests... wishing you best of luck as well!
Good info to know... the confounding thing is that his WBCs and even his platelets are now in normal range and have been since about 4 weeks post, which we're thrilled about, certainly, so it makes one wonder if the spleen is being 'selective'...? Certainly no rhyme or reason as to which complications happen to which people, but I'm not finding any good explanation for hubby's persistent anemia. The question was tossed about by his docs a little about Inf induced bone-marrow suppression, but no calls on cause or solution as yet. Thanks for helping me in the dig. ~eureka
Joe seems to fit in well with what Hector posted. Reds whites and platelets are all low with him and he has had to have varicies banding because of portal pressure. With only the Hgb being affected, it sounds like your husband is experiencing something else.
Breathing a prayer,
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