Analysis of Erythrocyte Elements in Chronic Hepatitis C Patients Receiving PegIFN Monotherapy, Dual Therapy, and Triple Therapy using in-air MicroPIXE

Background and Aim: The aim of the present study was to elucidate the pathogenesis of anemia associated with pegylated interferon (PegIFN) -based regimens using in-air micro particle-induced X-ray emission (PIXE). Methods: Four chronic hepatitis C (CHC) patients, three CHC patients receiving PegIFN monotherapy, five CHC patients receiving PegIFN+ribavirin (dual therapy), five CHC patients receiving PegIFN+ribavirin+telaprevir (triple therapy), and four healthy controls were enrolled in this study. Elemental distribution in erythrocytes was analyzed using in-air microPIXE. Results and Conclusions: Erythrocyte shrinkage was observed in CHC patients receiving triple therapy. Cl, S, and K dots spread patchily in the erythrocytes of CHC patients receiving monotherapy, and this was more prominent in CHC patients receiving triple therapy. Ca dots formed small dense granules in CHC patients receiving dual and triple therapies. Zn and Cu levels were higher in CHC patients receiving dual and triple therapies. The number of Mn dots was higher in CHC patients receiving triple therapy. In conclusion, PegIFN, ribavirin, and telaprevir may alter the membrane structure of erythrocytes, thereby contributing to anemia associated with PegIFN-based regimens. Furthermore, derangements in the distribution of Ca may play roles in ribavirin-induced anemia.