Circulatory arrest during PBPC apheresis in an unrelated donor

BACKGROUND: Nowadays, the collection of PBPCs by apheresis from healthy donors is a routine method. The mobilization with rHu G-CSF and the apheresis procedures are usually well tolerated without severe side effects. STUDY DESIGN AND METHODS: We report a severe complication in a 41-year-old unrelated female donor who was allowed to donate PBPCs and was mobilized with 10 microg of G-CSF per kg per day. During PBPC apheresis, she experienced a circulatory arrest after 132 minutes and processing of 7078 mL of blood (twice the donor's blood volume). RESULTS: Immediate cardiopulmonary resuscitation restored sinus rhythm and regulatory respiration without sequelae. Subsequent cardiologic examinations (heart catheterization, electrophysiologic testing, tilting table test) resulted in the diagnosis of a neurocardiogenic syncope. Other cardiac or circulatory disorders could be excluded. The implantation of a cardiac pacemaker was recommended to the donor. The 4-year-old recipient was successfully transplanted with the partial product collected until the arrest occurred. The patient received a total of 2.54 x 106 CD34+ cells per kg of body weight. CONCLUSION: After exclusion of other cardiac diseases, the diagnosed neurocardiogenic syncope probably induced the circulatory arrest during apheresis rather than the administration of G-CSF.