Case Report A rare but severe complication of filgrastim in a healthy donor: Splenic rupture Gulsah Akyol a,⇑ , Cigdem Pala a , Afra Yildirim b , Muzaffer Keklika a , Koray Demir a , Sumeyra Dortdudak c , Serdar Sivgin a , Leylagul Kaynar a , Bulent Esera a , Ali Unal a , Mustafa Cetin a a Erciyes Stem Cell Transplantation Center, Erciyes University, Kayseri, Turkey b Radiology, Erciyes University, Kayseri, Turkey c Internal Medicine, Erciyes University, Kayseri, Turkey article info Article history: Received 23 May 2013 Accepted 5 July 2013 Keywords: Splenic rupture Filgrastim Stem cell transplantation abstract Background: Granulocyte-colony stimulating factor (G-CSF) is widely administered to donors who provide peripheral blood stem cells (PBSCs) for individuals who undergo hematopoietic stem cell transplants. G-CSF administration is associated with a small but definite risks of serious adverse events like splenic rupture. Case Study: In this case, we report a 40 year old women, a healthy donor for her sister who has aplastic anemia, who had sharp left upper abdominal pain on the forth mobilization day. The diagnosis at CT scan was splenic rupture; irregular intrasplenic low-attenuation areas consistent with ruptured spleen and perisplenic high density fluid. Her bidimensional spleen size was 16 Â 6 cm. Results: She was followed conservatively. One month later the CT scan signs of rupture disappeared. Conclusion: We must pay attention to this rare but serious adverse event during filgrastim use. Ó 2013 Elsevier Ltd. All rights reserved. 1. Introduction Since recombinant G-CSF was produced in the late 1980s, it has been widely used for mobilization of peripheral blood progenitor cells from healthy donors. Other clinical use areas include; acceleration of neutrophil recovery after chemotherapy in acute myeloid leukemia, bone marrow/peripheral stem cell transplantation in pa- tients receiving myelo suppresive chemotherapy for solid as well as hematologic malignancies, and in the management of neutropenia due to other causes including AIDS and genetic disorders of granulocyte production [1]. The most common adverse events are bone pain (84%), headache (80%) and fatigue [2]. Life-threatening complica- tions such as stroke, myocardial infarction and splenic rup- ture, resulting from short-term or long-term use of these agents, however rare, can occur [3]. 2. Case report The donor, healthy individual with a body weight of 66 kg and height of 149 cm, had no remarkable previous history except a 10 year history of smoking (10 cigarettes/day) and any physical examination abnormality. Her complete blood count, biochemistry and chest X-ray were normal. Serologic tests for hepatitis B, C and HIV were all negative.We started G-CSF (filgrastim) therapy at a dose of 11 lg kg/day (twice daily administration) for 5 days. On the forth day of mobilization, 2 h after administration of G-CSF at 06 PM, she suffered from pain in her chest bones. 1473-0502/$ - see front matter Ó 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.transci.2013.07.036 ⇑ Corresponding author. Address: Erciyes Stem Cell Transplantation Center, Erciyes University, Kayseri 38039, Turkey. Tel.: +90 0(352) 2076666, mobile: +90 0(50) 56376776; fax: +90 0(352) 4379348. E-mail address: adigegul@yahoo.com (G. Akyol). Transfusion and Apheresis Science 50 (2014) 53–55 Contents lists available at ScienceDirect Transfusion and Apheresis Science journal homepage: www.elsevier.com/locate/transci