This might help (?) Hope you are well, bg.
kj

"Hemoglobin concentrations decrease mainly as a result of
ribavirin-induced hemolysis"

Liver Int. 2006 May;26(4):389-98.
Definition and management of anemia in patients infected with hepatitis C
virus.
McHutchison JG, Manns MP, Longo DL.
Duke University Medical Center, Durham, NC 27710, USA.
mchut001@mc.duke.edu

Chronic infection with hepatitis C virus (HCV) can progress to cirrhosis,
hepatocellular carcinoma, and end-stage liver disease. The current best
treatment for HCV infection is combination therapy with pegylated
interferon and
ribavirin. Although this regimen produces sustained virologic responses
(SVRs)
in approximately 50% of patients, it can be associated with a potentially
dose-limiting hemolytic anemia. Hemoglobin concentrations decrease mainly
as a
result of ribavirin-induced hemolysis, and this anemia can be problematic
in
patients with HCV infection, especially those who have comorbid renal or
cardiovascular disorders. In general, anemia can increase the risk of
morbidity
and mortality, and may have negative effects on cerebral function and
quality of
life. Although ribavirin-associated anemia can be reversed by dose
reduction or
discontinuation, this approach compromises outcomes by significantly
decreasing
SVR rates. Recombinant human erythropoietin has been used to manage
ribavirin-associated anemia but has other potential disadvantages.
Viramidine, a
liver-targeting prodrug of ribavirin, has the potential to maintain the
virologic efficacy of ribavirin while decreasing the risk of hemolytic
anemia in
patients with chronic hepatitis C.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstra
ctPlus&list_uids=16629641&query_hl=56&itool=pubmed_docsum

The reduced hemoglobin is caused by the reduction of RBCs in the blood by
volume. The reduction of RBCs can be caused by both hemolytic anemia -
exploding blood cells caused by the Ribavirin, as well as reduced production -
caused by impaired bone marrow from the Interferon. Most peeps experience only
the former, some only the latter, and then there are those of us who
experience the full Monty...

The measurement you're thinking of - the amount of HGB in the average RBC - is
called Mean Corpuscular Hemoglobin - "MCH". Even while I was in the depths of
anemia (HGB ~ 8g/dl) my MCH crept up to the upper normal limit. So the amount
of HGB per cell was actually higher than normal, but because my RBC count was
so far down (at around 2.5M/mm3, roughly half the normal for males) the net
HGB in the bloodstream left me anemic as hell...

Cheers

/greyhackles