Riba And Anemia - Does It Happen in Most Cases?

[RobertBeWell]

Unable to find any studies on this online that discuss statistics on this. I know it's a very COMMON side effect, but does Ribavirin lead to anemia in the majority of patients? That is... if I start treatment, can I pretty much count on being anemic at some point?

Thanks

[fretboard]

Welcome to the forum.  Just an fyi here, if you want better responses your question, start your own thread, just go where it says "Post a Question"=amber colored box.  Alot of people will see this old thread and simply bypass it as something older.  This will bump you up for a minute.  I can't help with your Procrit question, never been on it.  good luck

[JG458]

Hello, I hae been on riba going into 6th. wwek along with incivek and interferon. My dr. told me blood count was low last week and put me on iron. I had blood tested again this week and its even lower. He is now suggesting I take a shot called procuit. I was also taking antibiotics while I was taking the iron. I really don't want to take any more into my system, but does anyone know of any side affects from taking procuit?
Thanks,
JG

[billm57]

anemia cant be an indication of treatment success - only 30 some % get anemia - that would mean only 30%svr

[RobertBeWell]

LOL, now I'm really confused. It appears I want anemia, but I don't want it either :-/

As I'm sure we all are, I try to keep myself busy and productive each day with work, hobbies, business, personal relationships, etc. The thought of being wiped out from anemia really turns me off.

Guess I'll just have to wait and see what develops. On the bright side, I'm a pretty resilient guy with no apparent health issues other than HCV, so I'm hoping I'll somehow "be above all that". I know, famous last words right?

We shall see!

Robert

[Bill1954]

Robert, I took 1800 to 2000 mg riba daily for three years, and never even approached the need for treatment intervention; the lowest hemoglobin result I had during that time was 11.2 /dL.

And I’m now SVR, by the way.

I concur with a poster above that roughly 30% of those on therapy will eventually require some form of intervention during the course of their treatment, although I say this as an observation rather than something I can deliver a study on--

Bill

[bowyer2002]

Like Kristina538 experienced, I have been taking vitamin b (energy drink) and staying on my viatmins and food supplements and I have felt A LOT better - even though my HGB is currently 10.4 and I am in week 19 of Tx.
Just my personal experience but worked for me!

[Bali05]

i started out wth HGB 15,4  by week 4  it was 11.8 and 11.1 @ week 12.
predosed  5.5 wks 1400-1600 was not enough , the week leading up
to wk4 I took 2400 and got a 1 g drop in one week.
so far if I go back to 1200 my HGB will go up again so my current
dose is 1600.
My hepatologist confirmed @week 12 meeting that HGB drop is an indicator
for tx response and that mine was good.
what he does not know is what it took me to get there.....

there is data showing correlation between Riba dosage and SVR rates

[pcds]

I had a 2 log drop before week 12 and went from HGB of 14- to just under 10, still detected at week 12, so tx was stopped.  I'm 125 lbs and was on 1000 riba.

[Trinity4]

" I think anyone treating should monitor their HGB and if not a 2 log drop early on I would talk to doc about increasing the riba."

You betcha copyman.  If only I knew back then what I know now.  I actually argued against that point with a former member back in the day who as it turned out was correct.  Don't want to scare anyone into thinking that just because they don't get a 2 point hgb drop early on or don't have hemolytic anemia and need procrit that they won't SVR because people do.  It's just that as much as it s-ucks to have low hgb, it's a very good indicator that things are going the way they're supposed to.

Trin

[copyman]

I knew there were studies done on the correlation between anemia & SVR. I didn't think it was an "extremely crude indicator".

Actually it is quite the opposite and a very good indicator of treatment success. I think anyone treating should monitor their HGB and if not a 2 log drop early on I would talk to doc about increasing the riba.

This is another reason why everyone should get copies of their lab reports. I would not leave my health up to a nurse or some of these inept doctors that know nothing about latest protocols on HCV treatment.

[Kristina538]

You will feel the effects of Riba, not only if it drops too low, but also if it drops too fast.   Historically, they would lower your Riba if your Hbg dropped too fast in any one month, but I believe now they just keep an eye on it.    I felt the effects of it dropping quickly about Week 6 (Riba is accummulative).   I started taking a strong B-complex with extra B6 which, I read, can help in 25% of the cases.  My hbg stabilised and didn't drop further so I was lucky.  

[nygirl7]

development of severe anemia before week 12 was more closely
associated with the EVR as compared with a decline in hemoglobin level between the pretreatment level and the level at week 8 or 12. The
final average dose of ribavirin was significantly correlated with the
time of hemoglobin below 10 g/dl during antiviral therapy (r=0.884,
P<0.001). There was a significant linear correlation between the SVR
rate and the time of hemoglobin <10 g/dl during therapy (r=0.774,
P=0.003), especially among genotype 1 patients (r=0.960, P<0.001), "

That seems the most significant to me.  Therefore it is a good thing if your hemo tanks to UNDER 10 BEFORE week 12 but after not so much - thus our "maintaining full riba especially during the first 12 weeks" comes into play. Well sensible because if you don't get UND before 12 then .............

[Trinity4]

Here's a few links:

http://www.hivandhepatitis.com/2009icr/easl/docs/052209_a.html

http://www.medscape.com/viewarticle/550731_4

Viramidine is not being used much, if at all, these days so
doubt the results were validated or confirmed in later
studies.but for what it's worth this suggests that anemia
can be minimized and maintain SVR.

http://www.clinicaloptions.com/login.aspx?item=%2fhepatitis%2fconference+coverage%2fboston+2006%2ftracks%2fhcv+treatment%2fcapsules%2f1133&user=extranet%5cAnonymous&site=website&qs=Track%3dHCV

Trinity

[Cory255]

Hemoglobin is the protein molecule in RED blood cells which carries oxygen from the lungs to the body's tissues and returns carbon dioxide from the tissues to the lungs.  HBG values levels will flutuate and decrease during tx.  

NORMAL value ranges vary by laboratory; generally speaking:
Males 13.8-17.2 gm/dL          or   Adult males 14-18 gm/dL
Females 12.1-15.1 gm/dL       or   Adult women 12-16 gm/dL
Note: gm/dL = grams per deciliter

A LOW hemoglobin value level is commonly referred to as anemia.  Epogen/Procrit is a drug used to treat anemia which is low red blood cell count.  A CBC is a complete blood count which measures the concentration of white blood cells, red blood cells, and platelets in the blood and aids the diagnosis of conditions such as anemia, malignancies, and immune disorders.

Cory.

[nygirl7]

No Robert it's not a foregone conclusion but seriously even though it stinks you DO want to experience it.  If you do not it most likely means you are not metabolizing enough of the riba. There are studies out there which I no longer have but believe me....I did enough riba because of them so much that I should have glowed at night from space.  THAT was stupid in hindsight (shouldn't have almost/doubled it) but making sure you have at LEAST your body weight in dosage is crucial. If you don't experience a healthy reduction you will know you need to add more or add more fat or something to make sure you do get the full benefit. Interferon therapy is not the same as inf/riba. It has to be there.

[RobertBeWell]

Ok, so it would appear it's not a foregone conclusion. Yet, apparently it's something you WANT to see. I just hope it's not debilitating to the point of extreme. Would like to see it working, just don't want to get floored.

Thanks for the info guys!

[Trinity4]

I don't have time to provide the studies but they're out there.  Maybe someone else has more time to access them.  It's not a crude indicator desert.  It's been well established for some time now.

Trinity

[Diane12855]

My doctor was glad to see that my hgb was down to 10.3 by my 4th week. He said it was a good sign, even though I felt rotten. When I was UND by week 12 I figured he knew what he was talking about.

While it is a drag to always feel like it is extra hard to do everything, it is worth it to get rid of this virus that is attacking my liver.

Diane

[desrt]

Anemia is, at best, an extremely crude indicator of riba absorbtion. I'd be interested to read any studies linking anemia to SVR.

[copyman]

this does happen in most cases. as trinity posted this is a good indication that the riba is working. you actually want to see some anemia early on. seems the people that have anemia have the best success treating.

[desrt]

A reduction in hemoglobin concentrations by > 4 g/dl was observed in 30 % of patients treated with
REBETOL* and peginterferon alfa-2b and 37 % of patients treated with REBETOL* + interferon alfa-2b.
Hemoglobin levels dropped below 10 g/dl in up to 14 % of patients treated with REBETOL* in combination
with either peginterferon alfa-2b or interferon alfa-2b.

http://fulfordindia.com/pdf/Rebetol.pdf

[Trinity4]

As Andiamo said, your hgb will drop but not everyone gets hemolytic anemia. I didn't but in hindsight I wish I had because it's a very good indication your body is metabolizing the ribarvirin effectively and allowing the drug to do what it's supposed to do.

As you know, there's procrit to pull the hgb up to an acceptable level which helps with the fatigue associated with anemia.  I'm not sure but I'd say about a third of those who treat end up having to use one of the rescue drugs so that leaves many people who don't use rescue drugs that complete treatment with low values and do just fine.

Trinity

[Andiamo1]

I think your Hgb will drop.  The only question is how much and how you will feel.  Some people can deal with it and others need procrit or one of the other drugs that increase Hgb.  

There are plenty of ways to help you get through this.
Best of luck,
Eric