Severe Neutropenia in Patients with Chronic Hepatitis C Not on Antiviral Therapy At the Memphis Veteran's Affairs Medical Center

Abstract 4733

Abstract: We reviewed the records of 685 patients evaluated for treatment of chronic hepatitis C virus (HCV) at the Veteran's Affairs Medical Center in Memphis, TN in 2010. We identified six cases of severe neutropenia (defined as an absolute neutrophil count <500 x10³/dL), in the absence of medications known to cause neutropenia such as interferon. None had concomitant HIV infections. Bone marrow biopsies were performed in three of the six patients and were negative for malignancy or abnormal myelopoesis. In this case series report, we compare laboratory parameters and clinical histories of these six patients to a similar cohort of chronic hepatitis C patients with at least one documented absolute neutrophil count (ANC) between 1000 x10³/dL and 1500 × 10³/dL. The two groups differed only in ANC and frequency of anti-nuclear antibody positivity. There was no significant difference in race, MELD scores, viral load, viral type, hemoglobin levels or platelet levels. Neither group suffered serious systemic infections. There was no evidence that the severe neutropenia was related to portal hypertension or splenomegaly. In our series, patients with severe neutropenia in the setting of chronic HCV had a benign course that did not lead to severe infections and responded to granulocyte colony stimulating factor. This opens the question of whether these patients may be candidates for antiviral therapy.