Allergic reaction to platelet-rich plasma (PRP)

Abstract

Rationale:In the recent years, growing interest is focused on the use of platelet-rich plasma (PRP) in wound healing and tissue regeneration. There are a number of papers regarding the usefulness of PRP in the healing of ulcerations, skin injures, bone loss or distraction osteogenesis. Most authors emphasize the safety of PRP usage due to its authogenic nature.Patient concerns:We present a case of a 14 -year-old boy admitted to our department due to simple bone cyst of the distal tibia, qualified for injection of PRP into the cyst. PRP was separated with the use of Magellan Autologous Platelet Separator System (Arteriocyte Medical Systems Hopkington, MA) according to the manufacturers’ manual. Immediately after separation during short-term IV anaesthesia, 3 mL of PRP was installed to the bone cyst under image intensifier control.Diagnoses:Within the first 24 hours after exposure to PRP, the skin rash appeared. Physical examination revealed the small red papular, regionally purpuric eruptions, mainly concentrated on the upper extremities and on more warmed regions of skin, in association with pharyngitis, tonsillar enlargement, mucopurulent discharge in the posterior pharynx and swelling of the eyelids.Interventions:As the patient received calcium citrate with the PRP injection additional calcium citrate test were performed. Skin prick testing (negative) was and an intradermal test was positive (10×13 mm). Treatment included Claritine (Loratidinum) and Clemastin (Clemastinum)—both antihistaminic drugs.Outcomes:All symptoms withdrew and the patient was released home after 4 days. The patient is in 6 years follow-up without any symptoms of allergic disease.Lessons:Our case shows that safety of use of PRP is not absolutely sure. The pure autologous tissue is safe, but preparation for its use can substantially decrease this safety. In our patient, only limited skin reaction to calcium citrate was observed, but general reaction leading to anaphylactic shock cannot be excluded. In order to reduce the risk of side effects skin test should be performed but as there were no records of allergic diseases on family and patients medical history this should apply to all patients.

Anticoagulants Interfere With the Angiogenic and Regenerative Responses Mediated by Platelets

“…Extrapolation of our findings to the clinic might explain the inflammatory reactions observed in patients after receiving regenerative and local treatments with PRP (Bowman et al, 2013;Kaux et al, 2014;Alam et al, 2018;Latalski et al, 2019). These complications were not associated with the presence of leukocytes in PRP since all the interventions were performed using free-leukocyte PRP.…”

“…The studies about the effect of anticoagulants in the context of regenerative treatments with platelets are only focused on optimizing platelets number, coagulation or platelet-derived growth factors levels (O'Neill et al, 2001;Giraldo et al, 2015;do Amaral et al, 2016;Gonzalez et al, 2016;Singh, 2018) but they do not analyze the functionality of platelets on target tissue neither the possible adverse consequences caused by anticoagulants additives in platelet solutions. Notably, adverse effects have been reported in patients in the context of tendinopathies treatments with PRP including swelling, erythema, edema, and pain (Bowman et al, 2013;Kaux et al, 2014); skin redness, swelling, bruising, pruritus, scaling, and dryness after intradermal injection of PRP in the context of skin rejuvenation (Alam et al, 2018); and the systemic allergic reaction postinjection of PRP into a bone cyst (Latalski et al, 2019). Although the potential mediators/mechanisms involved in these effects were not addressed, one of these studies revealed the intradermal allergic reaction against citrate during skin allergic test (Latalski et al, 2019) suggesting a possible toxic effect caused by the anticoagulant additive in PRP.…”

“…Notably, adverse effects have been reported in patients in the context of tendinopathies treatments with PRP including swelling, erythema, edema, and pain (Bowman et al, 2013;Kaux et al, 2014); skin redness, swelling, bruising, pruritus, scaling, and dryness after intradermal injection of PRP in the context of skin rejuvenation (Alam et al, 2018); and the systemic allergic reaction postinjection of PRP into a bone cyst (Latalski et al, 2019). Although the potential mediators/mechanisms involved in these effects were not addressed, one of these studies revealed the intradermal allergic reaction against citrate during skin allergic test (Latalski et al, 2019) suggesting a possible toxic effect caused by the anticoagulant additive in PRP. To further understand the local effect of citrate on tissue regeneration we evaluated the effect of ACD and SC analyzing their effect on the target phenomena of angiogenesis and regeneration mediated by platelets.…”

Platelet-derived bio-products: Classification update, applications, concerns and new perspectives

“…However, in this regard, there are not well-designed prospective studies that would address this aspect in a rigorous manner, including all clinical applications. The use of L-PRP (containing leukocytes) or fresh PRP may predispose to this type of reactions because living cells (not only white or red blood cells, but also platelets themselves) might exacerbate basal inflammation at the site of application, considering the novel functions of platelets beyond haemostasis (72)(73)(74)(75).…”

Tissue Modification in Nonsurgical Facelift Options

“…61 The current literature is very limited regarding treatment-related complications following PRP, so further studies are needed. 62 Interest in the use of PRP injections for use in the face has been growing due to the ability to provide volume fill and high concentrations of growth factors. Injection of PRP however has had mixed results within small-scale studies.…”