This study was designed to estimate the incidence and etiology of anemia during first 4 weeks of treatment. It was conducted in co-operation between Tropical Medicine Department, Faculty of Medicine, Cairo University and Tropical Medicine Department and out patients' clinic of National Hepatology and Tropical Medicine Research Institute (NHTMRI) as a part of the national project for combating viral hepatitis in the period from June 2010 to June 2011. The current study included 300 patients who fulfilled the pre-designed inclusion criteria which were (Adult patients ≥ 18 years and less than 60 years old with clinical, biochemical and ultrasonographic criteria of chronic liver disease (Child A), positive serology for HCV antibody, HCV vireamia by PCR and Hb level ≥11gm/dl in females and ≥12gm/dl in males). All the studied cases were subjected to the following; full history taking, thorough clinical examination, laboratory investigations [complete blood count (CBC), liver function tests including: serum AST, ALT, bilirubin, albumin, prothrombin time (PT) and INR. Hepatitis Viral markers; HBsAg and HCV-Ab. Quantitative HCV-RNA by PCR, as well as glucose profile, TSH, AFP, ANA, abdominal ultrasound and liver biopsy with histopathological examination of the biopsy specimens.