title: Pure red cell aplasia caused by ribavirin and interferon treatment.
abstract: Anemia is a common complication of hepatitis C (HCV), and antiviral treatment can further increase this risk. We present the case of a 59-year-old man with HCV treated with ribavirin and pegylated interferon alpha (INF-α) who presented with severe anemia. Two months after initiating treatment his hemoglobin dropped from 14.2 to 5.0 g/dL. There was no evidence of bleeding or hemolysis, and a bone marrow biopsy revealed pure red cell aplasia (PRCA). Evaluations for acute cytomegalovirus and parvovirus B19 were negative. There was no evidence of malignancy or thymoma. The INF-α and ribavirin treatment were determined to have caused the PRCA, and withdrawal of the medications led to PRCA remission. INF-α and ribavirin have become the standard treatment for HCV. While these medications offer a potential cure, they are often poorly tolerated due to frequent side effects including anemia. Patients who are receiving treatment with ribavirin and INF-α warrant close monitoring for development of anemia, and PRCA should be considered in all patients in whom reticulocytopenic anemia develops.
authors.affiliation: 88th Medical Group, Department of Internal Medicine, Wright-Patterson Medical Center, 88th MDOS/SGOMI, 4881 Sugar Maple Drive, Wright-Patterson Air Force Base, OH, 45433, USA. ajskabelund@gmail.com.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Skabelund
authors.affiliation: 88th Medical Group, Department of Internal Medicine, Wright-Patterson Medical Center, 88th MDOS/SGOMI, 4881 Sugar Maple Drive, Wright-Patterson Air Force Base, OH, 45433, USA.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Hauser
authors.affiliation: 88th Medical Group, Department of Internal Medicine, Wright-Patterson Medical Center, 88th MDOS/SGOMI, 4881 Sugar Maple Drive, Wright-Patterson Air Force Base, OH, 45433, USA.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Goist
keywords: Hepatitis C; Interferon; Pure red cell aplasia; Ribavirin