is lower red cell count is a good thing?

[aprildone]

I'm on ribavirin. I have read on here that lower red cell is a good thing. I've boosted my b-12 dosage, meat, egg yolk, bean, leafy green intake to help keep mine up. am I helping or hurting my recovery by trying to keep red cell count \ up?

[aprildone]

you're quite correct. I looked it up and our range is specific by sex

[flyinlynn]

Looks like your lab uses a different scale than mine. Or maybe because you are male.

Normal min for HGB on my lab is 11.1 - 15.9 g/dL my doctor said as long as I stay above 10 it was ok. But then I dropped down to 9.3

I guess the anemia as far as I could find only effects about 20% of patients.

Good luck on treatment

[aprildone]

hey lynn, my cbc after 3 weeks, 4 days there are 3 pages of info:

WBC 6.47 K/cmm 3.9-11

RBC 4.5  M/cmm  4.1-5.8

HGB 13.6    gm/dL  13.1-17.5

HCT 39.9  %  39.3-52.5  

MCV  89.7  FL  8--97

[flyinlynn]

Hi

For me the Riba is an add on just to my Harvoni add extra kick and not a required part of tx.

Also epotin is not an option my doctor is interested in pursuing so dose reduction it is. So far we reduced from 1200 mg to 1000 mg we will see if that helps enough

Lynn

[AWorriedMom]

Thanks for trying to educate me on this.....but I am still finding it difficult to understand. All I know is right now I am happy that ribavirin is playing a much lesser role in SVR for the majority of treating patients.

[neptune235]

It takes just a bit of Googling to uncover more info on this.  

From http://www.ncbi.nlm.nih.gov/pubmed/17168855:

"Ribavirin (RBV) is an antiviral nucleoside analogue commonly used in combination with interferon for the treatment of chronic hepatitis C. Severe anemia develops in about 10% of treated patients, and requires close monitoring of hemoglobin and often RBV dose reduction, which may compromise sustained virologic response. Anemia is likely related to extensive RBV accumulation in erythrocytes subsequent to active unidirectional transmembraneous transport. RBV exerts its toxicity through an inhibition of intracellular energy metabolism and oxidative membrane damage, leading to an accelerated extravascular hemolysis by the reticulo-endothelial system. Concentration-dependent toxicity and improvement of anemia upon dose-reduction point towards the importance of pharmacokinetic factors for RBV-induced anemia. On the other hand, pronounced variability in the correlation between RBV concentration and Hb reduction limits the prediction of anemia based on plasma or erythrocyte concentrations in individual patients and points towards additional factors determining individual susceptibility to RBV-induced anemia. Recent studies suggest that erythrocyte oxidative defense mechanisms may play an important role in RBV-induced anemia. Clinical risk factors for severe RBV-induced anemia include impaired renal function, high age, high dose per body weight and female gender. Determination of RBV concentrations has little value in the management of anemia. The only proven effective prevention of RBV-induced anemia is the concomitant administration of erythropoietin. Future research on RBV pharmacokinetics and pharmacodynamics, as well as erythrocyte antioxidant defense mechanisms may improve safety and efficacy of RBV therapy and guide the development of new treatments for RBV-induced anemia and alternative antiviral agents."

[AWorriedMom]

I don't think that the mechanism of ribavirin induced anemia is known. We do know it accumulates in red cells. But when does that happen? is it in the bone marrow where the cells originate or does it happen later on? I am not saavy enough to understand much about this.

[neptune235]

I believe that RBV induced hemolytic anemia is caused by red cell death, bot bone marrow suppression.  Interferon definitely, but not RBV.  The only way to raise the hemoglobin and hematocrit is Procrit.

Dose reduction also has this effect, but I think relapse rates increase as RBV dose decreases.  Perhaps more so back in the interferon days...

[flyinlynn]

My last CBC after 3 weeks on Riba1200 mg

RBC       3.03       3.77-5.28
HGB       9.3       11.1-15.9
HCT     29.0       34.0-46.6

I am now taking 1000 mg riba we will see what next week brings

[AWorriedMom]

Deb, thanks for your correction. I read "red" count and responded about the white count. Hemoglobin is the protein that carries oxygen in the red cell. Sorry if I confused anyone.

[Ekkiemom]

Hi AD...The Riba will lower RBC's which carry oxygen as well, you might feel some fatigue, light headedness, if it gets real bad call the doc, he can adjust your meds. Don't worry if they lower the RIBA  these meds are strong enough to work with the adjustment.
I was the same way and they lowered it 200mgs and I was fine.
Don't worry and great job
Peace
Deb

[aprildone]

thank you worriedmom.

[aprildone]

thanks dee! I'm leaving b12 the same and eating better

[aprildone]

thanks! my pharm and heap are aware of my b-12 supplements as I have been on them for years .  my question that you answered was whether I should increase from the dosage that I am on. I will leave everything as is. i'll get new lab results and share next week. blessings to you

[AWorriedMom]

All are correct. When the Ribavirin is working it lowers your hemoglobin, not necessarily your red count. They are two different measures. Because the hemoglobin is lowered due to ribavirin suppressing your bone marrow, there is nothing you can take to elevate your hemoglobin. This kind of anemia is not the same as an iron deficiency. In fact taking iron is contraindicated for HCV patients. Eating foods rich in iron is better than supplementing but it will not work on anemia from bone marrow suppression.

[Dee1956]

Hey there! I have heard the same as Kim, low Hemoglobin indicates the medication is working.  Of course asking your doctor is a good idea
Take Care
Dee