Latalski Michal, Walczyk Alicja, Fatyga Marek, Rutz Erich, Szponder Tomasz, Bielecki Tomasz, Danielewicz Anna
Department of Paediatric Orthopaedics, Medical University of Lublin.
Clinic of Paediatric Allergology, University Children Hospital, Lublin, Poland.
Medicine (Baltimore). 2019 Mar;98(10):e14702. doi: 10.1097/MD.0000000000014702.
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.
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.
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.
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.
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.
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.
近年来，人们越来越关注富血小板血浆（PRP）在伤口愈合和组织再生中的应用。有许多关于PRP在溃疡愈合、皮肤损伤、骨质流失或牵张成骨方面有用性的论文。大多数作者强调PRP使用的安全性，因为其自体性质。
我们报告一例14岁男孩，因胫骨远端单纯性骨囊肿入院，符合向囊肿内注射PRP的条件。使用麦哲伦自体血小板分离系统（美国马萨诸塞州霍普金顿的动脉细胞医疗系统公司）根据制造商手册分离PRP。在短期静脉麻醉下分离后立即在影像增强器控制下将3 mL PRP注入骨囊肿。
在接触PRP后的头24小时内出现皮疹。体格检查发现小红丘疹、局部紫癜性皮疹，主要集中在上肢和皮肤较温暖的部位，伴有咽炎、扁桃体肿大、咽后壁黏液脓性分泌物和眼睑肿胀。
由于患者在注射PRP时接受了柠檬酸钙，因此进行了额外的柠檬酸钙试验。皮肤点刺试验（阴性），皮内试验阳性（10×13 mm）。治疗包括氯雷他定（克敏能）和氯马斯汀（开瑞坦）——两种抗组胺药物。
所有症状消退，患者4天后出院。患者接受了6年随访，无任何过敏性疾病症状。
我们的病例表明，PRP使用的安全性并非绝对确定。纯自体组织是安全的，但其使用准备可能会大幅降低这种安全性。在我们的患者中，仅观察到对柠檬酸钙的有限皮肤反应，但不能排除导致过敏性休克的全身反应。为降低副作用风险，应进行皮肤试验，但由于患者家族和个人病史中无过敏疾病记录，这一措施应适用于所有患者。
