PRP SAFETY IN PATIENTS WITH INFECTIONS, CANCER OR BLOOD DISORDERS

Introduction: Understanding PRP and its Safety in Special Cases

Platelet-rich plasma (PRP) is a regenerative treatment increasingly used to aid in the healing of musculoskeletal injuries, such as joint or tendon problems. It involves using the patient's own platelets to stimulate tissue repair. Although it has been shown to be effective and well-tolerated in many cases, it's natural to question its safety if you have other medical conditions.

What if you have an infection, a history of cancer, or a blood disorder? Is PRP still a safe and appropriate option?

To answer these important questions, an international research group specializing in platelet injections (known as GRIIP) has brought together experts from diverse fields (musculoskeletal specialists, hematologists, oncologists, infectious disease specialists , and scientists) to develop clear guidelines.

Below is a summary of these recommendations, designed to guide both physicians and patients in making informed decisions about the use of PRP in these specific situations.
 

How were these Recommendations developed?

To develop these guidelines, a steering committee first reviewed all available scientific literature. They then developed initial recommendations, which were evaluated and discussed by an international panel of 31 experts. After a detailed analysis and a joint meeting, the general principles and specific recommendations you will read below were agreed upon. It is important to note that, although all the recommendations were deemed appropriate, most are based on the opinions and experience of these experts because the scientific evidence published to date is still limited in these specific situations.
 

General Principles for the Use of PRP (GRIIP Expert Consensus)

Before considering any PRP treatment, especially if other medical conditions exist, experts emphasize four key points:

• Indication by a Specialist : The need for a PRP injection to treat joint or tendon diseases should always be established by a physician specializing in musculoskeletal diseases.
•  Benefit-Risk Assessment : Before each PRP injection, a careful assessment of the balance between potential benefits and risks should be made, always considering other available therapeutic alternatives.
•  PRP as a Secondary Option for Comorbidities : If there are other diseases (comorbidities) that may affect platelet function or that could theoretically be transmitted or worsened by PRP, this treatment should only be considered if there are no other effective alternatives or if these have failed.
• Clear Information and Consent: Patients should receive complete, clear, and personalized information about the specific risks and benefits of PRP in their specific situation. Informed consent should always be obtained and recorded before the procedure.

Detailed Recommendations of the GRIIP Consensus

Specific recommendations for patients with infectious, oncological, or hematological diseases are detailed below.

A. PRP in Patients with Infectious Diseases:

• HIV : PRP injection can be performed in patients with HIV infection if the viral load is undetectable and the CD4 cell count is greater than 350/mm³.
• Hepatitis B (HBV) : PRP injection can be performed in patients with HBV infection if the viral load is undetectable.
• Hepatitis C (HCV) : PRP injection should only be performed after completing antiviral treatment for HCV.
• Acute Viral Syndrome : In the case of an acute viral syndrome (such as the flu), PRP injection may be performed if there are no severe general symptoms, no signs of secondary bacterial infection, and the patient is improving.
• Recent Bacterial Infection (treatment < 3 months) : If there was a bacterial infection that required antibiotics for less than 3 months, PRP injection should only be performed after the antibiotic treatment has been completely completed.
• Chronic Bacterial Infection (treatment > 3 months) : In the case of a controlled bacterial infection requiring antibiotics for more than 3 months, PRP injection should only be considered with the explicit agreement of the infectious disease physician .
• Chronic Kidney Failure with Dialysis : PRP injection may be considered, but the possible presence of bacteria in the blood (bacteremia) should be monitored and it should not be performed on the same day as dialysis.
• Prolonged Immunosuppressive Treatment : In patients on long-term and stable immunosuppressive treatment, PRP injection can be performed, paying special attention to the possible presence of simultaneous infections.
• Dental Infection or Invasive Oral Procedures : PRP injection should not be performed until any dental infection or wound from an invasive oral procedure has completed treatment and is completely healed.
• Asymptomatic Patients without Known Infection : In patients who do not present symptoms and do not have a known infectious pathology, additional tests are not considered necessary before PRP from an infectious point of view.

B. PRP in Patients with Oncological Diseases (Cancer):

• Proximity to Tumors : PRP should not be injected near known benign or malignant tumors, or near areas with metaplasia (abnormal cellular changes).
• Active or Diagnosed Solid Cancer : PRP injections should not be performed on patients with solid cancers that are in the process of being diagnosed or that are active, except for very specific exceptions that must be discussed and agreed upon with the oncologist.
• Non-Metastatic Solid Cancer in Remission : In patients with solid cancer that has not spread (non-metastatic) and is in complete remission after treatment, PRP injection may be performed.
• Metastatic Solid Cancer : If there is a metastatic solid cancer (spread to other organs), whether under treatment or in remission, PRP injection should only be considered with the explicit agreement of the oncologist.
• History of Cured Solid Cancer : If a patient had solid cancer in the past and is considered cured by their oncologist, PRP injection can be performed.

C. PRP in Patients with Hematological Diseases (Blood Disorders):

• Complete Blood Count Abnormalities : Any significant abnormality detected in a blood test (complete blood count) should be investigated before proceeding with a PRP injection.
• Thrombocytopenia (Low Platelets) : If the platelet count is above 50,000/mm³, the cause of this thrombocytopenia has been investigated and a hematological neoplasia (blood cancer) has been ruled out, having low platelets is not a contraindication for PRP.
• Active or Unstabilized Hematological Neoplasia : PRP injection should not be performed if there is a hematological neoplasia in the process of diagnosis or that is not stabilized, except for very specific exceptions that must be discussed and agreed upon with the hematologist.
• Hematologic Malignancy in Remission : In patients with a hematologic malignancy that is in remission after treatment (this includes immunosuppression after transplant), PRP injection may be performed if there are no significant platelet abnormalities.
• Stabilized Chronic Lymphoid Hemopathy : In cases of chronic lymphoid blood disease (such as chronic lymphocytic leukemia) that is stabilized, with or without treatment, PRP injection may be performed if there are no significant platelet abnormalities.
• Stabilized Chronic Myeloid Hemopathy : If a stabilized chronic myeloid blood disease exists, with or without treatment, PRP injection should only be considered with the explicit agreement of the hematologist.
• Gammopathy of Undetermined Significance (MGUS) : PRP injection can be performed in patients with MGUS.
• Cured Hematologic Neoplasia : If a patient had a hematologic neoplasia in the past and is considered cured by his or her hematologist, PRP injection can be performed.
   

Conclusion: Informed Decisions and Prioritizing Safety

This consensus from the International Research Group on Injections of Platelets (IGRP) offers the first specific and detailed recommendations for the use of PRP injections in patients with musculoskeletal disorders who also have infectious, oncological, or hematological comorbidities.

It is essential to remember that, given the limited scientific evidence currently available for these complex situations, these recommendations are based primarily on expert opinion and experience. They are intended to serve as a valuable guide for clinical practice. However, the experts themselves recognize the need for future studies to validate and strengthen these guidelines.

The most important thing is an individualized evaluation of each patient. When in doubt, prudence and caution should prevail, and PRP injections may be avoided if the potential risks outweigh the expected benefits in a particular case.

If you have any of these conditions and are considering PRP treatment, it's crucial that you discuss it in detail with your trauma specialist or our team. Only a professional can assess your case individually, explain the potential risks and benefits, and help you make the best decision for your health.

Make an appointment with Dr. Jordi Jiménez. He'll see you in the center of Palma and help you regain your quality of life.