J Gandhara Med Dent Sci

April - June 2026

ORIGINAL ARTICLE

ABSTRACT

OBJECTIVES

This study aimed to determine the frequency of cytopenias among patients

receiving hepatitis C therapy and to examine their relationship with dierent

treatment regimens

METHODOLOGY

RESULTS

The mean age of participants was 40.1 ± 9.0 years, with a male

predominance (55.8%). The overall SVR rate was 80.5%, with the highest

response observed in patients treated with sofosbuvir/velpatasvir (90.8%;

95% CI: 82.1-96.2). Cytopenias were observed in a considerable proportion

of patients, with anemia being the most common (23.9%; 95% CI: 16.1-31.7),

followed by Thrombocytopenia (9.7%), leukopenia (8.8%), and pancytopenia

(6.2%).

A statistically signicant association was found between treatment regimen

and cytopenias (p < 0.001), with a strong eect size for anemia (Cramer’s V

= 0.768). Multivariate analysis identied treatment regimen as the only

independent predictor of anemia. Patients receiving sofosbuvir/velpatasvir

had signicantly lower odds of anemia than those receiving conventional

therapy (AOR = 0.006; 95% CI: 0.001-0.054; p < 0.001).

CONCLUSION

Direct-acting antiviral therapy, particularly sofosbuvir/velpatasvir, is

associated with high virological response and a lower frequency of

cytopenias. However, given the observational design, ndings should be

interpreted cautiously. Further multicenter studies are recommended.

KEYWORDS: Hepatitis C, Direct-acting antivirals, Ribavirin, Cytopenias,

SVR.

How to cite this article

Date of Submission: 12-03-2026

Date Revised: 16-03-2026

Date Acceptance: 17-03-2026

Assistant Professor, Department of

General Internal Medicine, Medical C

Unit, MTI, Lady Reading Hospital,

Peshawar

Correspondence

Shadman Ahmad Jan, Post Graduate

Resident, General Internal Medicine,

Medical C Unit, MTI, Lady Reading

Hospital, Peshawar

+92-331-9379720

shadman788@gmail.com

INTRODUCTION

Hepatitis C virus is one of the major health concerns

among bloodborne viral infections, aecting

approximately 71 million people worldwide, with a

prevalence of 2.8%.

The burden of HCV has been

reported to be higher in low-and middle-income

countries. Cytopenias, a deciency of mature blood

cells resulting in anemia, leukopenia, and

Thrombocytopenia, are major complications associated

with HCV infection, especially during antiviral

therapy.

Thrombocytopenia, aecting up to 37% of

HCV patients, is the rst abnormality detected in

routine laboratory tests, way before diagnosis of

cirrhosis.

The risk is reportedly associated with disease

progression and is aected by interferon-based antiviral

treatment.

As the burden of HCV in Asia is

significantly higher, prevalence in Egypt, India, and

Pakistan is among the highest worldwide.

The second-

highest burden of HCV disease is reported in Pakistan,

with a prevalence of 4.5% to 8.2%. The overall

prevalence of Thrombocytopenia is reported to be

23.5%-37% in HCV patients.

Risk is higher in patients

with prolonged illness and associated comorbidities,

including thalassemia, end-stage renal disease patients

who are dialysis dependent, with a prevalence of 32%-

46% Cytopenias continue to be a major clinical

dilemma among the health care providers in the high-

ASSESSING THE FREQUENCY OF CYTOPENIAS IN PATIENTS WITH HEPATITIS C THERAPY:

Shadman Ahmad Jan

, Naveed Iqbal

, Ilyas Muhammad

, Zahid Ullah

, Ijaz Hussain

AN ANALYTICAL DESCRIPTIVE OBSERVATIONAL STUDY

This analytical descriptive observational study was conducted over six

months (May-October 2024) at the Department of Medicine and

Gastroenterology, Lady Reading Hospital, Peshawar. A total of 113 patients

aged 20-70 years with chronic hepatitis C receiving antiviral therapy were

included using consecutive sampling. Data were collected at the 12-week

follow-up. Hematological parameters and sustained virological response

(SVR) were assessed. Data were analyzed using SPSS version 25. Chi-square

test, Cramer’s V, and multivariate logistic regression were applied. A p-value

≤0.05 was considered statistically signicant.

Jan S A,Iqbal N,Muhammad I,

Ullah Z, Hussain I. Assessing the

Frequency of Cytopenias in Patients

with Hepatitis C Therapy: An Analytical

Descriptive Observational Study.

J Gandhara Med Dent Sci.2026;13(2):

50-60.

https://doi.org/10.37762/jgmds.13-2.892

J Gandhara Med Dent Sci

April - June 2026

burden, low and middle-income nations such as

Pakistan.

The severity of Cytopenias inuences the

treatment advancements of HCV, leading to a high rate

of morbidity and antiviral therapy discontinuation.

The

need for area-based data on the frequency,

determinants, and risk factors of cytopenias in patients

receiving antiviral therapy for HCV is important for

mapping prevention strategies, improving patient

management, reducing morbidity, and enhancing

treatment outcomes. Routine hematologic tests will

assist health professionals in tracking and identifying

patients at risk, managing treatment regimens, and

allocating resources.

This study aims to assess the

frequency of cytopenias in patients on hepatitis C

therapy after a 12-week follow-up visit at Lady Reading

Hospital in Peshawar (LRH).

METHODOLOGY

This analytical cross-sectional study was conducted at

the Department of Medicine and Gastroenterology,

Lady Reading Hospital (LRH), Peshawar. Ethical

approval was obtained from the Institutional Review

Board of LRH (ERC#156/LRH/MTI). The study was

carried out over a period of six months from 20

May

2024 to November 2024. Written informed consent was

obtained from all participants, and the study adhered to

the Declaration of Helsinki. A total of 113 adult

patients diagnosed with chronic hepatitis C and

receiving antiviral therapy were included in the study.

A consecutive non-probability sampling technique was

used to recruit eligible participants who had attended

the medical or gastroenterology outpatient or inpatient

departments after completing 12 weeks of hepatitis C

treatment. Consecutive, non-probability sampling

technique was used. The sample size was calculated

using the WHO sample size formula for proportion

estimation: n = Z² × p × (1−p) / d²

where Z = 1.96 at a 95% condence level, p = 0.32

(expected prevalence of anemia among patients with

hepatitis C based on previous regional studies) and d =

0.08 (margin of error).

The calculated sample size was

approximately 113 participants, and all eligible patients

meeting the inclusion criteria during the study period

were included in the nal analysis. These included

patients aged 20-70 years who had conrmed hepatitis

C infection and were under antiviral therapy using

direct-acting antivirals (DAAs) or a conventional

regimen. The study excluded patients with an acute

case of hepatitis C infection, fulminant hepatitis,

cytopenias that had been previously diagnosed before

treatment, hematological malignancies,

myeloproliferative disorders, multiple myeloma,

decompensated chronic liver disease, liver transplant

patients, or hepatocellular carcinoma. Data were

collected using a pre-structured questionnaire

consisting of three sections. The rst section recorded

demographic characteristics, including age, gender,

residence, socioeconomic status, and occupation. The

second section included clinical variables such as

hepatitis C infection duration, treatment regimen, and

sustained virological response (SVR). The third section

included laboratory investigations, including complete

blood count (hemoglobin, white blood cell count, and

platelet count), liver function tests (ALT and AST), and

HCV RNA PCR results. Cytopenias were dened using

standardized laboratory criteria. Anemia was dened

according to World Health Organization thresholds as

hemoglobin <12 g/dL in females and <13 g/dL in

males, while leukopenia and Thrombocytopenia were

defined as white blood cell count <4.0 ×10⁹/L and

platelet count <150 ×10⁹/L respectively, based on

established hematological reference ranges.

Pancytopenia was dened as a simultaneous reduction

in all three cell lines.

The 12-week follow-up visit was

conducted to obtain blood samples from eligible

patients. This time point was selected as it corresponds

to the standard assessment of sustained virological

response (SVR12) and allows evaluation of early

hematological adverse eects of antiviral therapy.

Sustained virological response (SVR) was established

by demonstrating HCV RNA levels below the limit of

detection in qualitative and quantitative PCR analysis

following therapy. This study was conducted and

reported in accordance with the STROBE guidelines.

All collected data were entered and analyzed using

Statistical Package for Social Sciences (SPSS) version

25. The quantitative variables, including age, the period

of hepatitis C infection, the period of therapy, and the

laboratory measures, were reported as the mean ±

standard deviation. Categorical variables included

gender, residence, treatment regimen, and the presence

of cytopenias (anemia, leukopenia, Thrombocytopenia,

and pancytopenia), and were also expressed as

frequencies and percentages. Associations between

treatment regimens and study outcomes, including SVR

and cytopenias, were evaluated using the Chi-square

test. The strength of association was assessed using

Cramer’s V. A p-value ≤ 0.05 was considered

statistically signicant.

RESULTS

A total of 113 patients receiving hepatitis C antiviral

therapy were included in the nal analysis. The mean

age of participants was 40.1 ± 9.0 years (95% CI: 38.4-

41.8), indicating a predominantly middle-aged

population. There was a slight male predominance, with

63 (55.8%) males and 50 (44.2%) females. Most

participants resided in urban areas (69.0%), and over

Assessing the Frequency of Cytopenias in Patients

J Gandhara Med Dent Sci

April - June 2026

half belonged to the moderate socioeconomic class

(51.3%). The mean duration of hepatitis C infection

was 29.6 ± 10.1 months, while the mean duration of

therapy was 12.3 ± 1.3 weeks. A statistically signicant

association was observed between treatment regimen

and sustained virological response (SVR) (χ² = 23.31, p

< 0.001). Patients receiving SOF/VEL achieved the

highest SVR rate (90.8%; 95% CI: 82.1-96.2), followed

by SOF+RBV (72.0%; 95% CI: 50.6-87.9), whereas

conventional therapy demonstrated the lowest response

(33.3%; 95% CI: 9.9-65.1). The eect size was

moderate (Cramer‘s V = 0.454), indicating a clinically

meaningful association between treatment regimen and

virological response. At the 12-week follow-up,

hematological parameters revealed a mean hemoglobin

level of 11.36 ± 1.64 g/dL (95% CI: 11.06-11.67). The

mean white blood cell count was 4.91 ± 1.38 ×10⁹/L

(95% CI: 4.65-5.16), while the mean platelet count was

169.96 ± 52.96 ×10⁹/L (95% CI: 160.09-179.83).

Biochemical assessment showed a mean ALT level of

49.18 ± 24.59 IU/L (95% CI: 44.59-53.76) and a mean

AST level of 39.98 ± 17.83 IU/L (95% CI: 36.66–

43.31). Cytopenias were observed in a notable

proportion of patients. Anemia was the most frequent

abnormality (23.9%; 95% CI: 16.1-31.7), followed by

Thrombocytopenia (9.7%; 95% CI: 4.2-15.2),

leukopenia (8.8%; 95% CI: 3.6-14.0), and pancytopenia

(6.2%; 95% CI: 1.8-10.6). There was a statistically

significant association between treatment regimen and

cytopenias. Anemia was most prevalent among patients

receiving SOF+RBV (64.0%) and conventional therapy

(83.3%), while it was rare in the SOF/VEL group

(1.3%) (χ² = 66.73, p < 0.001). The eect size was

strong (Cramer‘s V = 0.768), indicating a substantial

clinical dierence across treatment groups. Similarly,

leukopenia was highest in the conventional therapy

group (50.0%), followed by SOF+RBV (8.0%) and

SOF/VEL (2.6%) (χ² = 28.86, p < 0.001).

Thrombocytopenia was more frequent in SOF+RBV

(20.0%) and conventional therapy (25.0%) compared to

SOF/VEL (3.9%) (χ² = 9.08, p = 0.011). Pancytopenia

was observed only in RBV-containing and conventional

regimens, further highlighting the improved

hematological safety profile of SOF/VEL. To address

potential confounding, multivariate logistic regression

analysis was performed. The overall model was

statistically signicant (χ² = 74.78, p < 0.001) and

demonstrated good t (Hosmer–Lemeshow test p =

0.946). The model explained 72.6% of the variance

(Nagelkerke R² = 0.726) and correctly classied 90.3%

of cases. Treatment regimen emerged as the only

independent predictor of anemia. Patients receiving

SOF/VEL had signicantly lower odds of developing

anemia than those receiving conventional therapy

(AOR = 0.006; 95% CI: 0.001-0.054; p < 0.001),

indicating a strong protective eect. Although

SOF+RBV was associated with increased odds of

anemia (AOR = 4.10; 95% CI: 0.61-27.60), this

association did not reach statistical significance (p =

0.147). Other variables, including age, gender, duration

of hepatitis C infection, and duration of therapy, were

not significantly associated with anemia.

Table 1: Demographic Characteristics of Patients (n = 113)

Variable Category Frequency (%) /

Mean ± SD

Age (years)

40.1 ± 9.0

Duration of Hepatitis

C (months)

29.6 ± 10.1

Duration of Therapy

(weeks)

- 12.3 ± 1.3

Gender Male 63 (55.8%)

Female 50 (44.2%)

Residence Urban 78 (69.0%)

Rural 35 (31.0%)

Socioeconomic Status Low 43 (38.1%)

Moderate 58 (51.3%)

High 12 (10.6%)

Occupation Laborer 41 (36.3%)

Housewife 26 (23.0%)

Table 2: Association between Treatment Regimen and SVR

(n = 113)

Treatment

Regimen

SVR

Yes

n(%)

SVR

No n

(%)

Tot

χ² P-value

Cramer’s

SOF/VEL

(90.8%)

(9.2%)

76 23.

<0.001 0.454

SOF+RBV

(72.0%)

(28.0

Conventio

nal

(33.3%)

(66.7%)

Table 3: Laboratory Parameters at 12-week followup (n=113)

Parameter Mean ± SD Mini

mum

Maxi

mum

95% CI

Hemoglobin

(g/dL)

11.36 ±

1.64

7.50 15.00 11.06–11.67

WBC (×10⁹/L) 4.91 ± 1.38 2.00 8.34 4.65–5.16

Platelets

(×10⁹/L)

169.96 ±

52.96

57 322 160.09–

179.83

ALT (IU/L) 49.18 ±

24.59

10 113 44.59–53.76

AST (IU/L) 39.98 ±

17.83

10 95 36.66–43.31

Table 4: Overall Frequency of Cytopenias (n = 113)

Cytopenia Frequency (n) %age 95% CI

Anemia 27 23.9 16.131.7

Leukopenia 10 8.8 3.6–14.0

Thrombocytopenia 11 9.7 4.2–15.2

Pancytopenia 7 6.2 1.8–10.6

Assessing the Frequency of Cytopenias in Patients

J Gandhara Med Dent Sci

April - June 2026

Table 5: Frequency of Cytopenias by Treatment Regimen

(n = 113)

Cytope

nia

SOF/

VEL

(n=76)

SOF+R

(n=25)

Conve

ntional

(n=12)

χ²

value

Cram

er’s V

Anemi

(1.3%)

(64.0%)

(83.3%)

66.

<0.0

0.768

Leukop

enia

(2.6%)

(8.0%)

(50.0%)

28.

<0.0

0.505

Throm

bocyto

penia

(3.9%)

(20.0%)

(25.0%)

9.08

0.011

0.283

Pancyt

openia

0 (0%)

(24.0%)

(8.3%)

18.

<0.0

0.407

Table 6: Multivariate Logistic Regression for Predictors of

Anemia

Variable AOR 95% CI p-value

Age 1.01 0.93–1.10 0.810

Gender 0.33 0.07–1.55 0.161

Duration

HCV

1.02 0.94–1.10 0.700

Duration

Therapy

0.69 0.43–1.11 0.123

SOF+RBV vs

Conventional

4.10 0.61–27.60 0.147

SOF/VEL vs

Conventional

0.006 0.001–0.054 <0.001

DISCUSSION

This study evaluated the frequency of cytopenias and

treatment outcomes among patients receiving hepatitis

C antiviral therapy in a tertiary care setting. The

findings demonstrate that direct-acting antiviral (DAA)

regimens, particularly sofosbuvir/velpatasvir

(SOF/VEL), are associated with signicantly higher

sustained virological response (SVR) rates and a

markedly lower incidence of hematological

complications compared to ribavirin-containing and

conventional therapies. The overall SVR rate observed

in this study (80.5%) is consistent with real-world data

from low- and middle-income countries, although

slightly lower than the >90% rates reported in

controlled clinical trials. Patients treated with SOF/VEL

achieved the highest SVR (90.8%), consistent with

recent studies demonstrating the high ecacy of pan -

genotypic DAA regimens across diverse populations. A

multicenter study by Mushtaq et al. reported SVR rates

exceeding 90% with SOF/VEL in genotype 3 patients,

supporting the eectiveness observed in our cohort.

Similarly, a large meta-analysis published in the Journal

of Hepatology conrmed superior virological outcomes

with interferon-free DAA regimens compared to older

therapies.

A key nding of this study is the

signicant association between treatment regimen and

cytopenias, with a particularly strong eect size

observed for anemia (Cramer‘s V = 0.768). The strong

effect size indicates a clinically meaningful dierence,

determinant of hematological toxicity. This indicates a

substantial clinical impact of treatment choice on

hematological outcomes. Patients receiving ribavirin-

containing regimens demonstrated markedly higher

rates of anemia, consistent with the well-established

mechanism of ribavirin-induced hemolysis. Ribavirin

accumulates in erythrocytes, leading to oxidative

membrane damage and premature red cell destruction.

Previous clinical and pharmacological studies have

consistently demonstrated this mechanism and its

association with treatment-related anemia.

In contrast,

the SOF/VEL regimen demonstrated a signicantly

lower frequency of cytopenias, particularly anemia

(1.3%), highlighting its favorable safety prole. This

finding is strongly supported by contemporary

evidence, including a systematic review by Zoratti et

al., which concluded that pangenotypic DAA regimens

are associated with minimal hematological toxicity.

The markedly reduced odds of anemia observed in our

multivariate analysis (AOR = 0.006) further emphasize

the protective eect of SOF/VEL, even after adjusting

for potential confounders. Leukopenia and

Thrombocytopenia were also more prevalent among

patients receiving conventional or ribavirin-containing

regimens. These ndings are consistent with previous

reports indicating bone marrow suppression associated

with interferon-based therapies. A recent study by Xia

H et al. (2020) demonstrated similar trends, with

significantly higher rates of cytopenias in patients

treated with older antiviral regimens compared with

those treated with modern DAAs.

The variability

observed across treatment groups in our study may also

be inuenced by baseline disease severity, nutritional

status, and liver function, factors that were not fully

adjusted in this analysis. The multivariate logistic

regression analysis identied treatment regimen as the

only independent predictor of anemia, whereas

demographic and clinical variables such as age, gender,

and disease duration were not signicantly associated.

This nding underscores the dominant role of

pharmacological factors over patient-related

characteristics in determining hematological toxicity

during hepatitis C treatment. Similar observations have

been reported in recent real-world studies evaluating

predictors of adverse effects in DAA-treated

patients.

17,18

Nevertheless, this study provides important

real-world evidence from a high-burden setting,

highlighting both the ecacy and safety advantages of

modern DAA regimens. The ndings support current

global recommendations favoring ribavirin-sparing

regimens and emphasize the need for routine

hematological monitoring, particularly in patients

receiving ribavirin or older therapies.

19,20

suggesting that the treatment regimen is a major

Assessing the Frequency of Cytopenias in Patients

J Gandhara Med Dent Sci

April - June 2026

LIMITATIONS

It was conducted in a single tertiary care center, which

may limit the generalizability of ndings. Baseline

hematological parameters and liver disease severity

(e.g., brosis stage, cirrhosis status) were not included

in the regression model, potentially confounding the

observed associations. The relatively small sample size

in the conventional therapy group may have aected

the precision of estimates. Additionally, longer follow-

up beyond 12 weeks would be valuable to assess late-

onset hematological complications.

CONCLUSIONS

Direct-acting antiviral regimens, particularly

sofosbuvir/velpatasvir, are associated with higher

sustained virological response rates and a lower

frequency of cytopenias compared to ribavirin-

containing and conventional therapies. The treatment

regimen emerged as the primary determinant of

hematological outcomes. However, given the

observational design and limited adjustment for

confounders, these ndings should be interpreted with

caution. Further multicenter studies with larger sample

sizes and comprehensive clinical data are recommended

to validate these results.

CONFLICT OF INTEREST: None

FUNDING SOURCES: None

REFERENCES

1. Tariq EB, et al. Frequency of Thrombocytopenia in patients

infected with hepatitis C virus in a tertiary care hospital. J

Health Rehabil Res. 2024;4(3):1-9.

https://doi.org/10.61919/jhrr.v4i3.1250

2. Ayaz QUA, et al. Pattern and burden of Thrombocytopenia in

chronic hepatitis C virus patients at a tertiary care hospital. Pak

J Pathol. 2024;35(1):39-43.

https://doi.org/10.55629/pakjpathol.v35i1.796

3. Laursen TL, et al. Liver-related eects of chronic hepatitis C

antiviral treatment. World J Gastroenterol. 2020;26(22):2931-

47. https://doi.org/10.3748/wjg.v26.i22.2931 PMID: 32587445.

4. Wong YJ, et al. Real-world treatment outcome with protease

inhibitor direct-acting antiviral in advanced hepatitis C

cirrhosis: REAL-C study. Hepatol Int. 2023;17(5):1150-61.

https://doi.org/10.1007/s12072-023-10547-4 PMID: 37414569.

5. Iida J, et al. CCL19/MIP-3β as a mediator in anti-GPIIb/IIIa

antibody-producing B cells in chronic hepatitis C. Cytokine.

2025;190:156915. https://doi.org/10.1016/j.cyto.2025.156915

(PMID not yet indexed)

6. Salama II, et al. Impact of direct-acting antivirals on hepatic and

extrahepatic manifestations of hepatitis C virus infection. World

J Hepatol. 2022;14(6):1053-73.

https://doi.org/10.4254/wjh.v14.i6.1053 PMID: 35795664.

7. Amin R, et al. Seroprevalence and risk factors of hepatitis C in

Nowshera District, Pakistan. Sci Rep. 2024;14(1):25613.

https://doi.org/10.1038/s41598-024-76677-3 PMID: 39101084.

8. Akhtar S, Nasir JA, Hinde A. Prevalence of hepatitis C virus

infection in β-thalassemia patients in Pakistan: a systematic

review and meta-analysis. BMC Public Health. 2020;20(1):587.

https://doi.org/10.1186/s12889-020-8414-5 PMID: 32366274.

9. Piracha ZZ, et al. Prevalence and clinical prole of hepatitis C

virus infection in multitransfused thalassemic patients in

Pakistan. Braz J Biol. 2024;84. (DOI/PMID not indexed)

10. Sood AK, et al. Epidemiology of hepatitis C virus infection in a

tertiary care hospital. Med J Armed Forces India.

2020;76(4):443-50. https://doi.org/10.1016/j.mja.2019.08.003

PMID: 33223588.

11. Cappellini MD, Motta I. Anemia in clinical practice: denition

and classication. Semin Hematol. 2015;52(4):261 -9.

https://doi.org/10.1053/j.seminhematol.2015.07.006 PMID:

26404438.

12. Mushtaq S, et al. Ecacy and safety of sofosbuvir plus

daclatasvir and sofosbuvir/velpatasvir in HCV genotype 3

patients: real-world outcomes from Pakistan. Front Pharmacol.

2020;11:550205. https://doi.org/10.3389/fphar.2020.550205

PMID: 32982917.

13. Lampertico P, et al. Eectiveness and safety of

glecaprevir/pibrentasvir in chronic HCV infection: a meta-

analysis. J Hepatol. 2020;72(6):1112-21.

https://doi.org/10.1016/j.jhep.2020.01.025 PMID: 32068127.

14. Margusino-Framiñán L, et al. Inuence of drug–drug

interactions on direct-acting antivirals for hepatitis C. Eur J

Hosp Pharm. 2021;28(1):16-21.

https://doi.org/10.1136/ejhpharm-2019-001889 PMID:

31704894.

15. Zoratti MJ, et al. Pangenotypic direct-acting antivirals for

chronic hepatitis C: a systematic review and meta-analysis.

EClinicalMedicine. 2020;18:100237.

https://doi.org/10.1016/j.eclinm.2019.12.007 PMID: 31993549.

16. Xia H, et al. Ecacy and safety of direct -acting antivirals in

chronic hepatitis C: real-world study from China. Front

Pharmacol. 2020;11:710.

https://doi.org/10.3389/fphar.2020.00710 PMID: 32581977.

17. Dietz C, Maasoumy B. Direct-acting antiviral agents for

hepatitis C virus infection. Viruses. 2022;14(6):1325.

https://doi.org/10.3390/v14061325 PMID: 35743864.

18. Schulte B, et al. Outcomes of direct-acting antivirals in patients

on opioid agonist treatment. Open Forum Infect Dis.

2020;7(8):ofaa317. https://doi.org/10.1093/od/ofaa317 PMID:

32766265.

19. European Association for the Study of the Liver. EASL

recommendations on treatment of hepatitis C: nal update. J

Hepatol.2020;73(5):1170-218.

https://doi.org/10.1016/j.jhep.2020.08.018 PMID: 32956768.

20. World Health Organization. Guidelines for the screening, care

and treatment of persons with hepatitis C infection. Geneva:

WHO; 2014.

Assessing the Frequency of Cytopenias in Patients

J Gandhara Med Dent Sci

April - June 2026

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Shadman Ahmad Jan - Concept & Design; Data Acquisition;

Data Analysis/Interpretation; Drafting Manuscript; Critical

Revision; Final Approval

Naveed Iqbal - Concept & Design; Data Acquisition; Data

Analysis/Interpretation; Drafting Manuscript; Critical

Revision; Supervision; Final Approval

Ilyas Muhammad - Concept & Design; Data Acquisition; Data

Analysis/Interpretation; Drafting Manuscript; Critical Revision;

Supervision; Final Approval

Zahid ullah - Concept & Design; Data Acquisition; Data

Analysis/Interpretation; Drafting Manuscript; Critical Revision;

Supervision; Final Approval

Ijaz Hussain - Concept & Design; Data Acquisition; Data

Analysis/Interpretation; Drafting Manuscript; Critical Revision;

Supervision; Final Approval

AUTHORS CONTRIBUTION

The authors accept responsibility for all aspects of the work

and will ensure that any concerns regarding the accuracy or

integrity of any part are properly investigated and resolved.

Assessing the Frequency of Cytopenias in Patients