Granulocyte colony-stimulating factors
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Splenic rupture in a patient with factor X deficiency?: case report A 51-year-old woman with factor X deficiency experienced spontaneous splenic rupture following administration of a granulocyte colony-stimulating factor [G-CSF; specific drug not stated]; she subsequently died. The woman was diagnosed with systemic amyloidosis with cardiac and renal involvement and associated factor X deficiency and autologous stem cell transplantation was scheduled. She received a 5-day course of SC G-CSF 10 µg/kg daily for peripheral blood stem cell mobilisation and collection. One month later, she received melphalan followed by autologous haematopoietic progenitor cells infusion. After 24 hours, she reported sudden diffuse abdominal pain, vomiting and nausea, rapidly evolving to hypovolaemic shock and pre-renal acute renal failure. Laparotomy revealed a haemoperitoneum of 1500mL and splenomegaly with subcapsular haematoma. The woman underwent splenectomy and pathological examination revealed extensive fibrillar deposit of an amorphous material, which was Congo-red positive. Immunohistochemistry staining was positive for amyloid P component and λ-light chain. Postoperatively, she developed fever and bilateral pulmonary infiltrates. Despite medical measures, her clinical outcome was unfavourable and she died of multiorgan failure on post-transplant day 3. Author comment: An "aspect that should be taken into account is that the use of G-CSF during stem cells mobilization can predispose to splenic rupture due to an increase in spleen size as a result of extramedullar hematopoiesis. However, the patient described here received high-dose G-CSF 1 month before while the cases previously reported developed the splenic rupture either in the mobilization period or shortly after receiving G-CSF". de Larrea CF, et al. Spontaneous rupture of the spleen as immediate complication in autologous transplantation for primary systemic amyloidosis. European Journal 801100876 of Haematology 80: 182-184, No. 2, Feb 2008 - Spain
0114-9954/10/1190-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 23 Feb 2008 No. 1190
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