Hepatitis C and Anemia: Symptoms, Treatment, and More

Medically reviewed by Steve Kim, MD on January 22, 2016Written by Stephanie Watson on January 22, 2016

Hepatitis C is a viral infection that attacks the liver. This infection can cause symptoms such as:

  • fatigue
  • a fever
  • abdominal pain
  • jaundice
  • nausea
  • vomiting

Although medicines used to treat hepatitis C can be very effective, they can also cause a number of unwanted side effects, such as anemia.

Anemia occurs when you don’t have enough hemoglobin in your blood. Hemoglobin is a substance that helps your red blood cells carry oxygen to the rest of your body’s cells. Without enough oxygen, your cells can’t work as well. This can cause you to feel tired, weak, or it can make you unable to think clearly.

Interferon and ribavirin are two drugs that have been used to treat hepatitis C for many years. They’ve been proven to cause anemia in more than 20 percent of people who take them. Some of the newer drugs used to treat hepatitis C also have this side effect.

What Are the Symptoms of Anemia?

When your cells are deprived of oxygen, they can’t work as well as they should. As a result, you may feel tired and cold.

You may experience any of the following symptoms:

  • chest pain
  • chills
  • dizziness
  • fainting
  • a headache
  • chronic fatigue
  • a rapid heart rate
  • pale skin
  • shortness of breath
  • difficulty sleeping
  • difficulty thinking clearly
  • weakness

If it’s left untreated, anemia can lead to more serious conditions. The possibilities include jaundice, which is a yellowing of the skin and the whites of the eyes, and an enlarged spleen. Anemia can also make conditions you already have worse, such as coronary artery disease or chronic obstructive pulmonary disease (COPD). In rare cases, people with anemia can develop cardiac arrest, which occurs when the heart stops beating.

Who Gets Anemia from Hepatitis C?

Drugs used to treat hepatitis C, particularly interferon and ribavirin, can cause anemia. Interferon suppresses the production of new red blood cells in bone marrow. Ribavirin destroys red blood cells by causing them to break open, or rupture.

Newer hepatitis C drugs such as boceprevir (Victrelis) also have anemia as a side effect. Taking Victrelis with interferon and ribavirin can lead to even more severe drops in hemoglobin levels.

You’re also more likely to develop anemia if you have one of these conditions:

  • bleeding in the GI tract from a peptic ulcer
  • blood loss from an injury
  • cirrhosis of the liver
  • HIV
  • kidney disease
  • sickle cell anemia
  • not enough vitamin B12, folic acid, or iron in your diet

How to Get Your Anemia Under Control

While you take medicine to treat hepatitis C, your doctor will likely order blood tests every two to four weeks to check your hemoglobin level. If you’re at high risk for anemia, you may need blood testing every week.

After a couple of months on treatment, your hemoglobin levels should stabilize. Once you go off the drugs, the anemia will likely go away.

In the meantime, if anemia symptoms bother you, your doctor may lower your dose of ribavirin. Your doctor may stop the drug altogether if your hemoglobin level dips too low.

Your doctor may also prescribe injections of the hormonal medicine epoetin alfa (Epogen, Procrit) to relieve symptoms of anemia. Epoetin alfa stimulates your bone marrow to produce more red blood cells. More red blood cells can bring additional oxygen to your body. Possible side effects from these medicines include chills, sweating, and muscle aches.

Although anemia can make you feel tired and cold, it isn’t entirely bad. A drop in hemoglobin level has been linked with a sustained virologic response (SVR), which means no trace of the hepatitis C virus is detectable in your blood six months after you finish treatment. Essentially, SVR means a cure.

Speaking with Your Doctor About Hepatitis-Related Anemia

During treatment for hepatitis C, your doctor should do regular blood tests to check for anemia. If you do have anemia and the symptoms bother you, ask the doctor about the best way to treat it.

Hepatitis C: Self-Care Tips

You should also ask your doctor about things you can do in addition to medicine that may help you feel better. You can combat fatigue from anemia by taking frequent breaks and naps throughout the day. Ask friends and family for help with shopping, cleaning, and other everyday tasks. You should also a well-balanced diet that contains all the vitamins and minerals your doctor recommends to keep you healthy.

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