Anemia and thrombocytosis induced by ribavirin monotherapy in patients with chronic hepatitis C

Journal of Gastroenterology, 04/18/2012

Ribavirin (RBV) monotherapy induced anemia and affected thrombocytosis in patients with chronic hepatitis C (CHC). Elevated endogenous erythropoietin (EPO) may stimulate platelet production.


  • Patients with CHC (n = 30) received RBV monotherapy for 4 weeks.
  • The RBV dose was determined on the basis of body weight.
  • Complete blood count, and serum erythropoietin (EPO) and thrombopoietin (TPO) levels were assessed.
  • The associations between these parameters and the ITPA SNP (rs1127354) were analyzed.


  • Over the 4 weeks, the median hemoglobin level of all patients decreased significantly, from 13.6 (10.5-16.6) to 11.7 (9.4-14.9) g/dl (P < 0.001), and the platelet counts increased, from 14.0 × 104 (8.9-37.4 × 104) to 15.8 × 104 (10.2-40.6 × 104) /mm3 (P = 0.003).
  • At week 4, hemoglobin levels differed between patients with the ITPA CC genotype and those with the AA or AC genotypes [11.1 (9.4-13.5) vs. 12.9 (12.5-14.9) g/dl, P = 0.001].
  • The platelet change ratio (i.e., platelet count at week 4/platelet count at baseline) in the patients with developing anemia was correlated with the increase in the serum EPO level over 4 weeks (r = 0.88, P = 0.002), but not with the increase in the serum TPO level over 4 weeks.

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