Aplastic anemia and severe pancytopenia during treatment with peg-interferon, ribavirin and telaprevir for chronic hepatitis C

Table 1 Liver function and blood tests at baseline and at the development of severe pancytopenia and final outcome

	Case 1	Case 2	Case 3	Case 4	Case 5	Case 6 (LT)	Case 7 (LT)
Features at baseline
Hemoglobin (g/dL)	14.3	14.2	12.9	13.5	13.4	13.9	14
Neutrophils (mm3)	1500	1320	1900	900	3810	2880	1700
Platelets (mm3)	74000	96000	108000	101000	199000	102000	78000
ALT (IU/L)	59	77	46	96	77	120	536
Bilirubin (mg/dL)	1.3	0.93	0.6	1.1	0.5	1.4	1.2
Albumin (g/dL)	32	47	37	40	45	35	36
INR	1.1	1.1	1	1	1	1.1	1.28
Liver stiffness (kPa)	50	10.8	16	11	16.8	14.2	12
HVPG (mmHg)	16	-	-	8.5	-	8.5	-
Child-Pugh score	6	5	5	5	5	6	5
Features at diagnosis of pancytopenia
Triple therapy (wk)	10	4	7	5	16	16	8
Hemoglobin (g/dL)	7.5	7	7.8	7.6	7.2	7.9	8.5
Neutrophils (cells/μL)	400	0	250	200	400	400	300
Platelets (109/L)	5000	19000	2400	23000	12000	9000	30000
Reticulocytes (109/L)	0.2%	0.1%	0.6%	-	< 1%	< 1%	-
Bone Marrow Biopsy	Yes	Yes	Yes	-	-	-	-
Specific treatment
Treatment interruption	Yes	Yes	Yes	Yes	No	Yes	Yes
Blood transfusion (units)	14	7	NA	6	20	10	0
EPO (days of therapy)	30	60	60	6	240	90	30
GCSF (days of therapy)	30	60	30	6	90	90	45
Outcome	Death	Recovered	Death	Death	Recovered	Recovered	Recovered

LT: Liver transplantation; ALT: Alanine aminotransferase; INR: International normalized ratio; HVPG: Hepatic venous pressure gradient; AA: Aplastic anemia; EPO: Erythropoietin; GCSF: Granulocyte colony stimulating factor; NA: Not available.