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Thrombotic microangiopathy during peripheral blood stem cell mobilization
Harris V K Naina1, Morie A Gertz, Michelle A Elliott
1Division of Hematology, Department of Internal Medicine, Mayo Clinic, College of Medicine, Rochester, Minnesota, USA. naina.harris@mayo.edu
Journal of Clinical Apheresis
|October 31, 2009
Summary
Granulocyte colony-stimulating factor (GCSF) may trigger thrombotic microangiopathy (TMA) in patients with underlying conditions. This case highlights a potential risk of GCSF during stem cell mobilization, necessitating careful patient monitoring.
Area of Science:
- Hematology
- Nephrology
- Immunology
Background:
- Granulocyte colony-stimulating factor (GCSF) is a standard cytokine for stem cell mobilization.
- GCSF may activate coagulation and endothelial cells, potentially increasing thrombotic event risk.
- Monoclonal gammopathy of unknown significance (MGUS) can be associated with renal impairment and neuropathy.
Observation:
- A 58-year-old female with vasculitis and renal impairment had MGUS.
- She underwent stem cell mobilization with GCSF for her condition.
- During GCSF treatment, she experienced worsening anemia, thrombocytopenia, and renal function decline.
Findings:
- The patient was diagnosed with thrombotic microangiopathy (TMA).
- TMA was successfully treated with therapeutic plasma exchange and rituximab.
- GCSF might have contributed to TMA development, either directly or by exacerbating an autoimmune disorder.
Implications:
- This case suggests a potential link between GCSF administration and TMA development.
- Physicians should consider the risk of TMA in patients receiving GCSF, especially those with pre-existing conditions.
- Further research is warranted to elucidate the mechanisms and clinical significance of GCSF-induced TMA.
