Background: The Red cell distribution width (RDW) shows a significant increase both in the hepatitis C virus (HCV) infection and hepatocellular carcinoma (HCC). Treatment of HCV has changed following the introduction of direct-acting antivirals (DAAs) with a higher sustained virological response rate (SVR). However, HCC is still developed after DAAs therapy. Aim: The study aimed to assess the changes of RDW in HCC patients with HCV viremia and after SVR12 to DAAs. Methods: This work is based on a retrospective cohort study including 120 patients allocated into 3 groups, 40 / each. Group 1: patients with HCV-related liver cirrhosis without HCC and not treated with DAAs, group 2: patients with liver cirrhosis and HCC without DAAs and group 3: patients with liver cirrhosis and developed HCC following SVR12 to DAAs. Liver profile, International Normalized Ratio (INR) and creatinine indices were measured with an assessment of Child class CBC for measurement of RDW and RDW/Platelet ratio (RPR) were done. Results: The red distribution width (RDW) was mildly elevated in group 3 compared to group 2. The ratio of RDW/Platelet was almost similar in group 2 and group 3. RDW increased in group 3 relative to group 2 in all Child classes with a significantly higher level in Child A and B. Conclusion: Clearance of HCV following DAAs did not have a major impact on RDW in HCC patients after DAAs therapy which is not different from viremic patients with HCC.