title: Thrombotic microangiopathy during peripheral blood stem cell mobilization.
abstract: 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.
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, College of Medicine, Rochester, Minnesota, USA. naina.harris@mayo.edu
authors.forename: Harris V K
authors.initials: HV
authors.lastname: Naina
authors.forename: Morie A
authors.initials: MA
authors.lastname: Gertz
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Elliott
mesh_terms: D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000009:adverse effects*; D019650:Hematopoietic Stem Cell Mobilization / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D008998:Monoclonal Gammopathy of Undetermined Significance / Q000628:therapy*; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects*; D057049:Thrombotic Microangiopathies / Q000209:etiology*
chemical_list: D016179:Granulocyte Colony-Stimulating Factor