false negativity of tc99m labeled sodium phytate bone marrow imaging under the effect of gcsf prescription in aplastic anemia: a case report

Granulocyte colonystimulating factor (g-csf) is a hematopoietic cytokine which controls the differentiation and growth of hematopoietic cells in the bone marrow. we report a severe aplastic anemia (saa) patient with falsenegative 99mtc sodium phytate bone marrow imaging findings under concurrent g-csf therapy. the first bone marrow imaging showed a normal bone marrow activity. however, the bone marrow biopsy pathology report revealed a lack of hematopoietic cells. furthermore, the complete blood count indicated severe pancytopenia resulting in the diagnosis of aplastic anemia (aa). a second marrow scan implemented after the stoppage of g-csf showed an abnormal bone marrow activity, which matched the pathology reports. accordingly, the concurrent administration of g-csf was considered as the cause of falsenegative bone marrow imaging findings obtained in the first scan. consequently, it should be kept in mind that a 99mtc sodium phytate bone marrow scintigraphy during the concurrent administration of g-csf may lead to the achievement of false negative results because it induces changes in bone marrow mimicking a normal marrow scan in patients with aa.