Zulfiqar Ali Shaikh, Javeria Shamim, Kelash Nankani.
Ribavirin Induced Anemia: A Cross Sectional Study Among Patients With Hepatitis C, Visiting Out Patient Department Of A Major Public Sector Tertiary Care Hospital, Karachi, Pakistan.
Pak J Public Health Jan ;8(3):170-3.

Background: Hepatitis C is among one of the major global health issues; which may cause chronic liver disease, end stage liver disease, and hepatocellular carcinoma; subsequently requiring liver transplant. For HCV, standard treatment is a combination therapy of ribavirin and interferon for six months. Ribavirin fostered hemolysis is a major treatment-associated adverse effect. Our study aimed to assess ribavirin induced anemia among Hepatitis C patients visiting Civil Hospital, Karachi. Methods: A hospital-based cross-sectional study which included 106 Hepatitis C patients, of 15-60 years' age, visiting CHK, a public sector tertiary care hospital, from October 2017 to January 2018 by using non-probability convenient sampling technique. Results: Total 106 patients participated, 53 (50.0%) were males and 53 (50.0%) were females. Mean (±SD) age was 37.05 (±10.793). Mean (±SD) duration of ribavirin use was 3.03 (±1.523) months. Around 16.0% had ribavirin dose reduction. All of them experienced weakness, fatigue and light-headedness, 59.4% developed microcytic hypochromic anemia, 23.6% had severe anemia. Mean (±SD) hemoglobin level before the onset of treatment was 12.78 (±1.555). Mean hemoglobin level during treatment was 10.72g/dL. Mean reduction in hemoglobin levels was 2.07g/dL. The reduction in hemoglobin levels and the duration of therapy were correlated (p-value <0.05). The severity of anemia was related to age of the patients (p-value <0.05) but not with gender and RBC morphology. Conclusion: Ribavirin induces anemia. The duration of ribavirin therapy and initial hemoglobin levels were related to the severity of anemia, significant enough to cause dose modification and subsequently suboptimal levels affecting efficacy. In return hemoglobin reduction, dose modification and age of the patient were also related.

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