treatment for hepatitis c and patient already have hemolytic anemia

Hello,
Its me Dr Nida ..... i need to ask what to do if patient is already have low levels of hemoglobin like my mother has 9.2 level of hemoglobin and she is diagnosed hepatitic c. i have to take decision whether to start  ribavirin therapy or not,as one of its sidefect is HEMOLYTIC ANEMIA or i should
first make her hemoglobin level correct then start ribavirin and interferon therpy. plz reply as soon as possible as i have to start her treatment soon. THANK YOU

[HCA]

This is the patient to patient forum so you will not get a professional opinion here.
I can reccomend the Clinical Care Options Hepatitis C site howver.
This gives treatment strategies to doctors,particlarly difficult to treat cases and you may well find the answer there.

[Marcia2202]

I am not a doctor either, but I just wanted to share my personal experience. My hemoglobin and overall iron levels were decreasing in the months prior to treatment, nothing as low as your mother though. My doctor decided that it would be a good idea to bring up the levels prior to treatment, even though my hgb was still up at 12.

[jmjm530]

Without prophylactic Procrit (epo) you may run into some real dosing issues and problems. In any event be prepared for significant anemia and monitor hgb at least weekly until it stabilizes. Treatment could potentially be difficult with potentially multiple transfusions so carefully evaluate wheter she should treat now or wait for better drugs which should shorten tx

[alagirl]

I had anemia that was procrit dependent going into treatment - anemia of unknown or chronic disease (possibly an auto-immune hemolytic anemia as it turns out).  I did treat with ribavirin and interferon, and I had a lot of difficulties with anemia.  Early on, I began taking 40,000 units of procrit (well, epogen in my case) twice a week.  It really didn't touch the anemia.  I had blood transfusions every 10 to 14 days while treating and I had a successful treatment and I am now SVR.  I am using exjade to remove the excess iron, and there are other iron removal meds as well.

If your mother does treat it is essential that she get under the care of a hematologist who is willing to support her with adequate procrit and transfusions if necessary in order to have a successful outcome.

[alagirl]

Pre-dosing with procrit would also be advisable.  Yet another reason for her to see a hematologist prior to treatment.

[jmjm530]

Alagirl talks from experience but from what I've read here my concerns are hematologists often do not have enough HCV specific experience and often make too coservative calls. The better hepatologists often act as their own hematologist and I see this as a far better and more integrated approach to treatment. Therefore make sure your mom sees a hepatologist (liver specialist) if feasible and not a gastro.