INTRODUCTION
Platelet-rich concentrates (PRCs), including both platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), have been increasing in popularity, with uses extending to various fields including orthopedics, dentistry, aesthetics, and dermatology. These concentrates are an autologous serum and contain platelets, growth factors, and fibrin. PRP specifically has evolved as a treatment modality with numerous uses in the field of dermatology, including alopecia, skin rejuvenation, scarring, pigmentary disorders, and wound healing, among others. Combined use has been reported for synergistic benefits along with various techniques, including lasers, microneedling, dermal fillers, and autologous fat grafting.2
BACKGROUND
Given the autologous nature of PRCs, the safety profile of PRCs is excellent, which likely contributes to their increasing popularity, especially in dermatology. The majority of adverse events are localized, including injection-site pain, bruising, and edema, with other complications being uncommon or rare.3 However, a review of the PubMed database (including search terms "platelet-rich concentrates," "platelet-rich plasma," "platelet-rich fibrin," "HIV," "Hepatitis B" and "Hepatitis C") revealed no reported cases of HIV, hepatitis B or hepatitis C in association with PRCs at the time of query (August 31st, 2023). Nevertheless, news outlets have reported cases of these blood-borne viruses related to the administration of PRP in the United States,1 resulting potentially from medical errors or negligence/lack of safety protocols (or both).
Safety Approach for PRP
Patient safety and minimization of medical errors are at the center of clinical medicine. Medical errors tend to occur from the convergence of different contributory factors. Although human factors are often implicated, blaming individuals does not address nor prevent the errors from being repeated. Instead, there is a trend towards a systems-based approach, whereby care facilities recognize the potential for errors and focus on designing systems where errors are less likely to occur, along with a just culture, where workers are motivated to engage in the prevention of errors.4
Safety Approach for PRP
Below, we describe the various steps taken at our center to minimize errors during the administration of PRCs (PRP specifically), keeping a systems-based approach to patient safety in mind. Specifically, we review the protocol we use to minimize medical error-related adverse events. Two checklists, described below (Checklist Part I and Checklist Part II), are used as part of our protocol. Evidence supports the use of checklists for improving patient safety in healthcare settings, while reducing the incidence of adverse events, leading to improved communication between staff members and importantly, minimizing human error.5
Prior to administration of PRP, the following are reviewed with the patient by the treating physician: the clinical indication, the evidence for PRP treatment as well as reasonable alternatives. Contraindications are reviewed on intake form (Checklist Part I) and all questions are reviewed once again by the physician.
