BACKGROUND: Collection of hematopoietic progenitor cells by apheresis (HPC-A) 
requires separation of cells by density. Previous studies highlighted the 
challenges of HPC-A collection from patients with abnormal red blood cells 
(RBCs). TEMPI syndrome is a recently described condition defined by 
teleangiectasias, elevated erythropoietin and erythrocytosis, monoclonal 
gammopathy, perinephric fluid collections, and intrapulmonary shunting. Patients 
with TEMPI syndrome have responded to therapies used to treat plasma cell 
dyscrasias and may benefit from autologous HPC transplantation. We report HPC-A 
collection from a patient with TEMPI syndrome that was complicated by severe 
iron deficiency.
STUDY DESIGN AND METHODS: The patient received granulocyte-colony-stimulating 
factor (G-CSF) and plerixafor for HPC mobilization and underwent 3 days of HPC-A 
collection.
RESULTS: The patient presented for collection with a microcytic erythrocytosis. 
Over 3 days, approximately 50 L of whole blood was processed, and 2 × 10(8) 
CD34+ cells were collected (2.8 × 10(6) CD34+ cells/kg). The mean collection 
efficiency (CE), percentage of mononuclear cells, hematocrit (Hct), and RBC 
count were 18%, 90%, 14%, and 9 × 10(11) , respectively. Altering collection 
variables to avoid RBC contamination reduced CE. Ficoll preparations of the 
products after freeze-thaw showed RBC contamination and hemolysis. Postthaw 
viability exceeded 95%. The products were not RBC reduced or washed. There were 
no adverse reactions during or after infusion.
CONCLUSIONS: HPC-A collection from a patient with TEMPI syndrome was complicated 
by microcytic erythrocytosis, leading to RBC contamination and hemolysis in the 
product. Adequate HPCs were collected and the patient tolerated infusion without 
RBC depletion or washing. Our report highlights difficulties of HPC-A collection 
from iron-deficient patients.