Understanding and managing PRP side effects: A guide for patients and physicians

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  • Regenerative Medicine, PRP side effects, Patient education, Off-label therapy
Understanding and managing PRP side effects: A guide for patients and physicians

PRP side effects in clinical practice

Classification, risks and management from the perspective of regenerative medicine

Target group: Doctors, alternative practitioners with an injection license, healthcare professionals

Note: Off-label applications depending on the indication. No therapy recommendation, but professional classification.

Why the issue of side effects with PRP is often underestimated

Autologous material quickly leads to the assumption that PRP is "inherently safe". In practice, however, the risk rarely comes from the plasma itself, but from the overall process:

  • Blood collection and preparation (pre-analysis, contamination, adherence to protocol)
  • Injection technique and knowledge of anatomy
  • Patient selection (comorbidities, medication, skin/mucous membrane status)
  • Education, aftercare, accessibility

PRP is therefore less "risky" than some pharmacological interventions, but it is not harmless either. Anyone offering PRP needs a clean workflow, realistic communication and a plan for complications.

Definition: PRP is not the same as PRP

PRP is not a standardized finished medicinal product, but a biological, patient-specific product. Relevant variables that can also influence the side effect profile:

Leukocyte content

  • LP-PRP (leukocyte-poor) vs. LR-PRP (leukocyte-rich)
    LR-PRP is described as more reactogenic in some settings; the clinical significance depends on the indication.

Activation / additives

  • frequently calcium chloride (depending on protocol), less frequently other activators
    Reactions then mostly affect the additive, not the autologous plasma.

Preparation / handling

  • closed vs. open handling
  • Time to application
  • Choice of material, sterility, cross-contamination risks

If you want to seriously manage side effects, you must standardize PRP in your own setting (protocol, material, training) and only then evaluate it properly.

PRP tubes

What is clinically understood by PRP

PRP refers to plasma obtained from autologous whole blood with an increased platelet concentration. It is produced by centrifugation; composition and biological activity vary depending on the centrifugation protocol (RCF, time, stages):

  • Centrifuge protocol (RCF, time, stages)
  • Leukocyte content (LP-PRP / leukocyte-rich PRP vs. LR-PRP / leukocyte-poor PRP)
  • Activation (e.g. calcium chloride, mechanical)
  • Form and site of application

This variability is clinically relevant as it influences both the biological response and the side effect profile.

General side effects of PRP injections

1) Local reactions (frequent, mostly self-limiting)

Typical:

  • Pain, pressure sensation
  • Redness, swelling, local heat
  • Hematoma

Classification:

These are primarily the consequences of needle trauma, volume, tissue pressure and a local inflammatory reaction. As a rule, these reactions subside within a few days, but can vary in severity depending on the region (face, scalp, joint).

Practical point:

A "reactive" phase after PRP is not automatically a warning sign. Warning signs are the course and intensity dynamics (increasing instead of subsiding).

2) Infections (rare, but high-stakes)

Clinical picture:

  • progressive pain
  • increasing redness/overheating
  • Secretion, pus, fever, reduced general condition
  • in joints: significant deterioration in function, effusion, severe pain on exertion

Classification:

Infections are rarely reported overall, but are clinically relevant because the consequences (especially intra-articular) can be considerable. The risk increases with process errors (skin antisepsis, handling, material reuse, open refilling), but cannot be reduced to zero even with correct technique.

Management (practical, without "cookbook medicine"):

  • clear triage rules
  • low threshold for clinical control
  • if joint is suspected: actively rule out septic arthritis (clinical, laboratory, imaging, puncture/diagnostics according to standard if necessary)

3) Reactions to additives / concomitant medication (occasionally)

Dizziness, nausea, syncope and cold sweat may occur, especially during blood sampling and injections:

  • Dizziness, nausea, syncope, cold sweat.

Practice:

Patient positioning, monitoring of high-risk patients, clear follow-up routine. This is banal, but prevents many "side effect panic" situations.

4) Vasovagal reaction (not uncommon in practice)

Possible with activated protocols or concomitant measures:

  • localized urticaria/itching
  • irritative reactions
  • very rarely systemic reactions

Important:

If you use additives (activators, local anesthetics), this should be included in the clarification and documentation, including allergy history.

5) Special immunological reactions (very rare, but cannot be explained away)

There are individual case reports of granulomatous reactions after injections, especially in aesthetic settings and with a corresponding history. This is not a "typical PRP risk", but it is a reason to avoid sloppy indication and to take documentation seriously in the case of immunological history.

Regional particularities: Side effects according to area of application

A) Face / Aesthetics

Frequent:

  • Erythema, edema, hematomas (periorbital/perioral)

Rare, but critical:

  • vascular complications are generally possible with facial injections (due to technique and anatomy). This is not specific to PRP, but is relevant as soon as you work with needles/cannulas in risk zones.

Standard practice:

  • slow application, anatomy-related safety principles
  • only by sufficiently trained users
  • Emergency procedure (even if it is rarely used)

B) Scalp / Trichology

Typical:

  • localized pain, feeling of pressure
  • small crusts/hematomas

Possible:

  • Folliculitis (mostly process/hygiene factor)
  • Triggering of existing dermatoses in predisposed patients

Note:

If you use LR-PRP (leukocyte-rich PRP), you should rather expect reactogenicity. This is not "bad", but requires communication and aftercare.

PRP in trichology

C) Orthopaedics (joint, tendon)

Frequently:

  • reactive pain intensification and swelling in the first few days

Rare, but relevant:

  • Infection (especially intra-articular)
  • Misplacement / iatrogenic irritation with inadequate technique

Ultrasound:

Imaging can reduce misplacement. Whether and to what extent this is "significant" depends heavily on the setting and user experience; however, as a general principle it is useful where it is standard or risks are high.

PRP in orthopaedics

D) Urology / intimate medicine

Typical:

  • short-term burning sensation, hematoma, feeling of pressure

Crucial in terms of communication:

  • Manage expectations clearly (time course, number of sessions, uncertainty of evidence)
  • do not use negative statements such as "does not occur" or "is not documented". This is scientifically unwise and legally unnecessary.
PRP in urology

E) Gynecology

Possible:

  • Spotting, pressure sensation, local swelling, small hematomas

Important:

  • strict hygiene standards
  • clear behavioral recommendations and follow-up according to standard
  • consider patient-specific risk factors (tendency to infection, mucosal status, medication)
PRP in gynecology

Material and consumables: Why PRP tubes are clinically relevant

Many complaints and "unexpected" procedures have less to do with PRP as a concept than with preanalytics and process variability. PRP tubes are a central component of this because they directly influence the workflow:

  • Blood collection (vacuum/handling)
  • Contamination risk (closed system vs. open transfer)
  • Reproducibility (same tube + same insert + same protocol)
  • mechanical safety (fit in rotor/insert, balance, risk of breakage)

Important: It is not about "better" in the sense of effect, but about process stability and safety standardization.

What to look out for in everyday life

  • Tube type according to SOP: with/without anticoagulant; with/without separating gel; glass/plastic depending on protocol and equipment
  • sterile single use, no re-use
  • compatible adapters/inserts (no "somehow fits")
  • documented filling volumes and balance
  • Standardization of centrifugation via RCF (g) instead of RPM (device-dependent deviations)

Practice note: Typical PRP tube-related sources of error

If results or reactions fluctuate between appointments, it is often worth looking at the basics first:

Has the tube type been changed (anticoagulant/separating gel/additive-free)? Does the insert really fit (fit, play, imbalance)? Was RPM instead of RCF used by mistake? Such process deviations are more common than rare biological special cases and can usually be rectified quickly with a clear SOP.

How common are side effects really?

Many studies report predominantly mild, short-term side effects. The problem is not so much "PRP is dangerous", but rather:

The data situation is heterogeneous (indications, protocols, outcome definitions, follow-up) and side effects are not always recorded cleanly or uniformly.

A technically accurate statement is therefore:

  • Mild local reactions are common.
  • Severe complications are rarely reported, but are possible.
  • A reliable, indication-spanning risk profile can only be generalized from the literature to a limited extent.

If you really want to know how "safe" you are in your own setting: internal AE tracking with standard definitions, at least quarterly review.

Risk management: four building blocks that really work in practice

Now it's getting really practical. Here are the four golden pillars with which you can make PRP applications safer:

1) Clarification and consent (professional and legal)

  • Clearly state off-label status (where applicable)
  • realistic objective, no promise of success
  • typical side effects and warning signs in writing
  • Documentation of the discussion (not just a signature)

2) Hygiene and process standardization

  • Disposable material consistently, no "exception"
  • prefer closed handling
  • clear SOP: skin antisepsis, set-up, sequence, disposal
  • Team training (also for "rare" events)

3) Patient selection and contraindications

  • active infections (local/systemic)
  • relevant coagulation disorders / anticoagulation
  • pronounced immune dysregulation (weigh up individually)
  • Allergies to additives / local anesthetics used
  • Expectations and compliance

4) Aftercare and accessibility

  • clear rules: Sport/heat/manipulation depending on the region
  • when to report, when to come immediately
  • defined triage (telephone vs. presentation vs. emergency)

Quick practical checklist: Warning signs you should take seriously

Always actively clarify if:

  • increasing pain after initial improvement
  • progressive redness/overheating
  • Fever, chills, clear pathological value
  • Secretion/pus
  • for joints: severe deterioration in function, effusion, inability to bear weight

These are not "PRP-specific" signs, but classic red flags after injections. This is precisely why they should be included in every PRP clarification sheet.

PRP is not a "problem procedure", but it is also not a self-runner

PRP can be a manageable procedure in suitable indications and with a clean process. The side effects are manageable in many settings, but not trivial because they depend heavily on technique, workflow and patient selection.

Anyone who offers PRP seriously does three things consistently:

  • standardizes the process,
  • documents it properly,
  • and take side effects as seriously as with any other injection therapy.

PRP in science

Department-specific sources

  • General safety and side effects of PRP

Johns Hopkins Medicine (2022): PRP treatments can support wound healing in trauma and joint injuries. Results are visible after several weeks.

https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/plateletrich-plasma-prp-treatment

Izhakoff et al (2020): Report of cutaneous sarcoidosis after PRP injections in the face, possibly triggered by the Koebner phenomenon.

https://pmc.ncbi.nlm.nih.gov/articles/PMC7422914/

  • Trichology (hair)

Evans et al (2020): PRP may be effective for androgenetic alopecia, particularly in men, with efficacy in women still under debate.

https://pubmed.ncbi.nlm.nih.gov/32761771/

PubMed

  • Orthopaedics

Kim et al (2021): PRP injections provide better outcomes than other injection options for knee osteoarthritis, with benefits increasing over time.

https://pubmed.ncbi.nlm.nih.gov/32551947/

Comparison of LP-PRP and LR-PRP: Study shows that leukocyte-poor PRP (LP-PRP) provides better results in the repair of disc degeneration than leukocyte-rich PRP (LR-PRP).

https://josr-online.biomedcentral.com/articles/10.1186/s13018-024-05196-8

  • Urology

Anastasiadis et al (2022): Review of the efficacy of PRP injections for erectile dysfunction, with reference to the potential of regenerative medicine.

https://www.frontiersin.org/journals/reproductive-health/articles/10.3389/frph.2022.944765/full

  • Gynecology

Waghe et al (2024): Study on the safety of PRP in vulvovaginal atrophy and menopausal genitourinary syndrome.

https://pubmed.ncbi.nlm.nih.gov/39100535/

Legal notice (specialist group)

This article is intended solely for the information of medical professionals. It does not replace an individual indication, patient clarification or therapy decision. Depending on the indication, PRP applications can be used outside of approved areas of application and require a patient-specific risk-benefit assessment and documented clarification.

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