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Thrombotic microangiopathy during peripheral blood stem cell mobilization
Author(s) -
Naina Harris V.K.,
Gertz Morie A.,
Elliott Michelle A.
Publication year - 2009
Publication title -
journal of clinical apheresis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.697
H-Index - 46
eISSN - 1098-1101
pISSN - 0733-2459
DOI - 10.1002/jca.20216
Subject(s) - medicine , thrombotic microangiopathy , apheresis , microangiopathy , peripheral , peripheral blood , stem cell , mobilization , cardiology , platelet , diabetes mellitus , endocrinology , disease , biology , genetics , history , archaeology
Granulocyte colony‐stimulating factor (GCSF) is currently the most widely used cytokine for stem cell mobilization. There are few studies suggesting GCSF administration may induce activation of both coagulation and endothelial cells that could favor the developing of thrombotic events. We report a 58‐year‐old female with vasculitis and renal impairment. She was found to have an underlying monoclonal gammopathy of unknown significance (MGUS). The monoclonal protein was felt to play a role in her underlying renal disease and peripheral neuropathy. She was considered a candidate for peripheral blood stem cell transplantation to manage the monoclonal protein. During stem cell mobilization with GCSF, she developed worsening of anemia; thrombocytopenia and worsening of renal function. She was diagnosed with thrombotic microangiopathy (TMA) which was successfully treated with therapeutic plasma exchange and rituximab. It is possible that GCSF may have directly (activating endothelial cells) or indirectly (activation of underlying autoimmune disorder) contributed to TMA in this patient. J. Clin. Apheresis 2009. © 2009 Wiley‐Liss, Inc.