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Dangers of anemia?
Maybe this is a stupid question, but I got anemic on my first treatment and had to stop early. I don't want that to happen again, so let's talk about tolerability. I plan to double dose Peg and up the Riba. I hear that there are dangers. What, specifically are the dangers of anemia besides fatigue? What if procrit was was administered prior to tox? Can we get proactive on this regimen? And what are the long term effects of severe anemia?
"...Reversal of cirrhosis (after SVR) has been described in 49% of patients..."
http://www.medscape.com/viewarticle/475417_2
(Free Medscape Registration may be required).
http://www.medscape.com/viewarticle/475417_2
(Free Medscape Registration may be required).
The problem with "ramping up the ribavirin" is that studies suggest that being on full-dose (peg and riba) -- especially during the first 12 weeks -- gives you a better chance of SVR (cure). Current thought among leading hepatologists is to hit the virus fast and hard, to achieve RVR which is associated with SVR. This particular doctor goes against this accepted approach by not only ramping up the riba but also ramping up the peg. He also often recommends extending treatment far beyond what leading hrepatologists do. From many reports, he's probably one of the nicest and most compassionate doctors around -- but the bottom line is that his approach is non-coventional, and at least to me, non-conventional not in a positive way.
-- Jim
-- Jim
The danger of ramping Riba is that virus can develop a resistance to it's ability to inhibit replication.
As for healing, Stage IV often is permanent and rarely has been observed to be healed. It may go into remission, but most seem to agree that progression eventually does occur. So it's not a matter of "if" but "when" it progresses.
As for healing, Stage IV often is permanent and rarely has been observed to be healed. It may go into remission, but most seem to agree that progression eventually does occur. So it's not a matter of "if" but "when" it progresses.
I was reading through hepatitisdoctor.com earlier tonight, and this Dr. gradually ramps up the Ribavirin dosage at the start of TX to help avoid anemia:
"Ribavirin does not make the intererferon work, but it reduces the chance of relapse after treatment is completed. I start with 600 mg per day in most patients. Patients with genotype 2 or 3 will usually take 800 mg per day after the first month. Patients with other genotypes with usually gradually go up to 1,000 or 1,200 mg per day. If you raise the dose too quickly, the red blood cell count will fall too low causing anemia, fatigue and shortness of breath. If the patient is not responding I usually stop treatment. If you cure the infection, the liver will heal itself."
That was the first time I've heard of induction dosing Riba to help avoid anemia...
"Ribavirin does not make the intererferon work, but it reduces the chance of relapse after treatment is completed. I start with 600 mg per day in most patients. Patients with genotype 2 or 3 will usually take 800 mg per day after the first month. Patients with other genotypes with usually gradually go up to 1,000 or 1,200 mg per day. If you raise the dose too quickly, the red blood cell count will fall too low causing anemia, fatigue and shortness of breath. If the patient is not responding I usually stop treatment. If you cure the infection, the liver will heal itself."
That was the first time I've heard of induction dosing Riba to help avoid anemia...
I hope you got answers to your questions, or at least pointed in the right direction to obtain them. I wish you well in your attempt to re-treat and hopefully slay the dragon this time around.
Anemia is term used to describe a medical condition. One may arrive at the condition differently, but the physical condition ones body experiences remains the same. Therefore, the definition is applicable in describing this medical condition called "anemia". What may differ though is how the condition is "treated" and that is where the cause of the condition plays a role.
The type of anemia one often, but not always, sees during HCV tx is commonly refered to as a chemically induced anemia that is quite common in many chemo therapies. Chemically induced anemia is most often treated with Epoetin-Alfa (i.e Procrit is one brand name for this medication, Epogen is another). This is a slow acting medication that can take anywhere from 2-6 wks before it has a noticable effect upon a patients system.
Because it is slow acting, many doctors monitor their patients Hgb levels closley during start of HCV tx in order to prescribe the medication in time for it to stave off a very severe anemic condition. Some use a threshould rule of tumb (i.e. Hgb < 10.5) before prescribing, while others watch the rate of decrease to begin the regimen sooner in order to help the patient suffer less from the physical effects felt with the onset of anemia. How much and how often epoetin is prescribed varies from individual to individual depending upon how they are being affected by their meds and how the respond to the epoetin.
As far as administering it prior to tx, you would have to discuss it with your doctor. It does not seem like it is typically done becuase it is so variable between patients, and the risk of severe cardio damage and medical conditions (i.e. heart attacks, thyrombosis, and/or strokes to mention a few) that can be brought on if one's Hgb goes too high.
In fact, there was quite a buzz in the community several months ago when the FDA increased the severity of a warning it had issued last year with respect to the use of epoetin. But my understanding is that the warning was targeted at those receiving it when Hgb was not excessively below the normal range and/or sports enthusiasts who use it to enhance their abilities (i.e. the doping reported being done by bicyclists which has been the center of discussion for various Tour De France winners).
Starting at 20,00 U SQ per week early in my tx last year and end at 100,000 U SQ per week for the last several months of my 40 week tx attempt to clear the virus had me doing a lot of research upon it. I too have continued it on the off chance that I am allowed another opportunity to see if tx can help me slay the dragon and like gauf have questioned the possiblity of addressing the anemia proactively should that opportunity present itself to me.
But hey, don't simply take my word for it on Procrit. Here is a link to the U.S. government site which describes the medication that I found to be one of the better most complete w/o bias to any particular pharmaceutical manufacturer:
http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a692034.html
For more information on the FDA warning for epoetin, and other medications, issued this year see:
http://www.fda.gov/medwatch/safety/2007/safety07.htm
The type of anemia one often, but not always, sees during HCV tx is commonly refered to as a chemically induced anemia that is quite common in many chemo therapies. Chemically induced anemia is most often treated with Epoetin-Alfa (i.e Procrit is one brand name for this medication, Epogen is another). This is a slow acting medication that can take anywhere from 2-6 wks before it has a noticable effect upon a patients system.
Because it is slow acting, many doctors monitor their patients Hgb levels closley during start of HCV tx in order to prescribe the medication in time for it to stave off a very severe anemic condition. Some use a threshould rule of tumb (i.e. Hgb < 10.5) before prescribing, while others watch the rate of decrease to begin the regimen sooner in order to help the patient suffer less from the physical effects felt with the onset of anemia. How much and how often epoetin is prescribed varies from individual to individual depending upon how they are being affected by their meds and how the respond to the epoetin.
As far as administering it prior to tx, you would have to discuss it with your doctor. It does not seem like it is typically done becuase it is so variable between patients, and the risk of severe cardio damage and medical conditions (i.e. heart attacks, thyrombosis, and/or strokes to mention a few) that can be brought on if one's Hgb goes too high.
In fact, there was quite a buzz in the community several months ago when the FDA increased the severity of a warning it had issued last year with respect to the use of epoetin. But my understanding is that the warning was targeted at those receiving it when Hgb was not excessively below the normal range and/or sports enthusiasts who use it to enhance their abilities (i.e. the doping reported being done by bicyclists which has been the center of discussion for various Tour De France winners).
Starting at 20,00 U SQ per week early in my tx last year and end at 100,000 U SQ per week for the last several months of my 40 week tx attempt to clear the virus had me doing a lot of research upon it. I too have continued it on the off chance that I am allowed another opportunity to see if tx can help me slay the dragon and like gauf have questioned the possiblity of addressing the anemia proactively should that opportunity present itself to me.
But hey, don't simply take my word for it on Procrit. Here is a link to the U.S. government site which describes the medication that I found to be one of the better most complete w/o bias to any particular pharmaceutical manufacturer:
http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a692034.html
For more information on the FDA warning for epoetin, and other medications, issued this year see:
http://www.fda.gov/medwatch/safety/2007/safety07.htm
That's why riba induced anemia cannot be treated with iron. It's not like regular anemia.
In general it was right definition and it applies to HCV treatment.
The best person to answer this question would be your MD not a nurse.
Sevier anemia if not treated will result into organ damage. Anemia tolerance will depend on your body type and level of metabolic processes.
(example: ...lets say you are a body builder and your muscles use to oxygen, so at this point you will get more damage from anemia compare to person who has very slow metabolic processes and able to keep same body wait without significant amount of food …)
The best person to answer this question would be your MD not a nurse.
Sevier anemia if not treated will result into organ damage. Anemia tolerance will depend on your body type and level of metabolic processes.
(example: ...lets say you are a body builder and your muscles use to oxygen, so at this point you will get more damage from anemia compare to person who has very slow metabolic processes and able to keep same body wait without significant amount of food …)
that definition does not apply to Ribavirin based anemia - I had my Hep Nurse expalin it to me this morning
From the definition of Anemia at the US Dept. of Health and Human Services National Heart Lung and Blood Institute definition which says, "the lack of oxygen in the blood can cause serious and sometimes fatal damage to the heart and other organs of the body."
For the full definition go to:
http://www.nhlbi.nih.gov/health/dci/Diseases/anemia/anemia_whatis.html
For the full definition go to:
http://www.nhlbi.nih.gov/health/dci/Diseases/anemia/anemia_whatis.html
I asked that question to my Liver Doc - She assured me the only risk is severe fatique - Please, if anyone has any papers or studies that state organ damage, heart attack or stroke I would love to see it - My hemoglobin is lower than most in here that are on Procrit, and I am not taking any boosters..
I best I can recall, the real danger is damage to your Cardio-vascular system. Stroke and heart attacks can result from Hgb levels above or below target level.
Since Hgb is also responsible for carrying oxygen to your entire body, I believe there is also risks to irreparable damage to other organs if anemia is either not treated or treated properly.
Since Hgb is also responsible for carrying oxygen to your entire body, I believe there is also risks to irreparable damage to other organs if anemia is either not treated or treated properly.
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