How Hepatitis C Can Cause Anemia

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Hepatitis C is a viral infection affecting the liver caused by the hepatitis C virus. It is estimated that at least 2.4 million people in the United States are living with hepatitis C. The infection can cause significant damage to the liver, leading to cirrhosis (liver scarring) and hepatocellular cancer.

The virus is spread through contact with the blood of someone who has it. There is no vaccine available to prevent this illness. However, there are treatment options available that can cure the infection.

Treatment for hepatitis C typically consists of antiviral drugs, usually a combination of two or three medications. These are typically taken for about eight to 24 weeks. The exact medications used depend upon the genotype of the virus, the presence of cirrhosis, and if the person has been treated previously. 

Although letting hepatitis C go untreated can lead to potentially significant problems, it's important to remember that treatments have the potential to cause side effects as well.

One of the most common side effects experienced with hepatitis C treatment is anemia (decreased number of healthy red blood cells). The job of red blood cells is to carry oxygen around the body where it is needed and bring carbon dioxide back to the lungs to be breathed out.

This article will review the reasons for anemia in those with hepatitis C, its symptoms, how it is monitored, and ways to reduce the risk.

Woman in bed feeling tired, dizzy, headache with anemia

PixelsEffect / Getty Images

What Causes Anemia From Hepatitis C? 

One of the main causes of anemia associated with hepatitis C is the medications used to treat the infection. The antiviral medications themselves can sometimes affect how well the bone marrow is able to make red blood cells.

Additionally, there is a type of anemia, called hemolytic anemia, that had been associated with some of the medications, specifically Moderiba (ribavirin), used to treat hepatitis C in the past.

Hemolytic Anemia

Hemolytic anemia is a type of anemia that is caused by red blood cells being broken down too quickly, more quickly than the bone marrow can make them. 

Other Risk Factors 

Hepatitis C infection can lead to anemia in other ways. If hepatitis C is not treated, the resulting liver failure can potentially lead to kidney failure. If the kidneys are not functioning properly, they are unable to send out erythropoietin, a hormone that signals the bone marrow to make more red blood cells.

Another, more rare type of anemia called hepatitis-associated aplastic anemia, can result from hepatitis. 

Hepatitis-Associated Aplastic Anemia

Hepatitis-associated aplastic anemia (HAAA) is a complication that can appear within a few months following hepatitis infection. This is caused by bone marrow failure and severely decreased blood counts as a result of the hepatitis infection. HAAA can be life-threatening.

Recognizing the Symptoms

The symptoms of anemia, no matter the cause, are very similar. Symptoms can include:

  • Feeling tired and fatigued
  • Shortness of breath
  • Feeling cold
  • Dizziness
  • Irritability
  • Heart palpitations
  • Headache


Anemia is diagnosed through a blood test called a complete blood count (CBC). In addition to checking the number of red blood cells, white blood cells, and platelets, it reports the level of hemoglobin in the blood. Hemoglobin is the protein that carries oxygen in red blood cells.

A normal level of hemoglobin for men is 14–17 grams per deciliter (g/dL). The normal level of hemoglobin for a woman is 12–15 g/dL. A diagnosis of anemia is made when the level of hemoglobin drops below normal.

Monitoring Your Anemia 

Once anemia is diagnosed, especially when receiving medication that may make anemia worse, routine CBCs will be done. The frequency at which these are ordered is up to the treating healthcare team. Past labs can be used in comparison to evaluate the level of anemia and determine if any dose reductions for medications are needed. 

Talk to Your Healthcare Provider

If you’re experiencing any worsening symptoms of anemia, it’s important to let your healthcare provider know right away. They may want to do an evaluation of the CBC to check your hemoglobin levels.

Tips to Minimize the Risk 

There are some things that can be done to help keep your liver as healthy as possible and to feel well while undergoing treatment for hepatitis. One of the most important things to do is to avoid alcohol. Alcohol can be stressful to the liver and make liver damage worse.

Some other suggested dietary recommendations include:

  • Eat plenty of fresh fruits and vegetables.
  • Eat poultry and fish.
  • Increase legumes (lentils, beans, peanuts, soybeans).
  • Avoid uncooked or undercooked shellfish or meat.
  • Limit salt intake.

Your healthcare provider can recommend additional nutrients you may need in your diet—or foods to avoid—based on your individual experience. 


Anemia is a common finding in people being treated for hepatitis C. Anemia with hepatitis can be due to treatments or associated renal failure. Anemia may also be due to more rare conditions such as hepatitis-associated aplastic anemia.

Report any symptoms of anemia to your healthcare provider. Prompt recognition of anemia may decrease complications associated with treatment. If anemia is too severe, adjustments to hepatitis treatment may be necessary.

A Word From Verywell 

Living with a chronic disease such as hepatitis C can come with a lot of stress and confusion. It can be a lot to manage the medications prescribed to treat the disease while also managing the side effects these drugs may cause.

It is so important to talk to your healthcare provider if you’re experiencing any side effects, as your healthcare team is available and able to answer questions as they relate to you.

Frequently Asked Questions

  • Do liver problems lead to anemia?

    Liver problems can lead to anemia. In hepatitis C infection, it often is a side effect of treatment.

  • Does hepatitis reduce your iron levels?

    Hepatitis does not reduce iron levels. Hepatitis can, however, lead to elevated iron levels in the body.

  • Can hepatitis lower your red blood cell count?

    Hepatitis can lower the red blood cell count. This is most likely due to the side effects of the medications being used to treat hepatitis, however it is possible that associated kidney damage or more rare instances of anemias can be caused by hepatitis.

  • Can all types of hepatitis cause anemia?

    Yes, all types of hepatitis can cause anemia.

  • How can you tell if you have hepatitis?

    Most people who become infected with hepatitis do not have many symptoms, and may not have any symptoms until quite some time after they become infected. Some of the symptoms of hepatitis include:

    • Feeling tired
    • Dark-yellow urine
    • Nausea
    • Abdominal pain
    • Yellow eyes and skin
    • Clay-colored stool

13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Department of Health and Human Services. Viral hepatitis in the United States: data and trends.

  2. Centers for Disease Control and Prevention. Hepatitis C.

  3. Infectious Diseases Society of America. Simplified HCV treatment algorithm for treatment-naive adults.

  4. MedlinePlus. Anemia.

  5. Sung H, Chang M, Saab S. Management of hepatitis c antiviral therapy adverse effectsCurr Hepat Rep. 2011;10(1):33-40. doi:10.1007/s11901-010-0078-7

  6. National Kidney Foundation. Hepatitis C and chronic kidney disease: overview of evaluation and management.

  7. Alshaibani A, Dufour C, Risitano A, de Latour R, Aljurf M. Hepatitis-associated aplastic anemiaHematol Oncol Stem Cell Ther. 2020:S1658-3876(20)30168-0. doi:10.1016/j.hemonc.2020.10.001

  8. National Heart, Lung, and Blood Institute. Blood tests.

  9. National Institute of Diabetes and Digestive and Kidney Diseases. What should I eat and drink if I have hepatitis C?

  10. MedlinePlus. Diet-liver disease.

  11. Etiopathogenesis of anemia in chronic liver disease.

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  13. National Institute of Diabetes and Digestive and Kidney Diseases. What are the symptoms of hepatitis C?

By Julie Scott, MSN, ANP-BC, AOCNP
Julie is an Adult Nurse Practitioner with oncology certification and a healthcare freelance writer with an interest in educating patients and the healthcare community.