Introduction

The use of platelet-rich plasma (PRP) has been steadily gaining ground in the field of orthobiologic and musculoskeletal medicine. However, its application in patients with severe comorbidities—infectious, oncological, or hematological—has been limited by the lack of clear guidelines.

To address this gap, the expert group of the International Research Group on Platelet Injections (GRIIP) developed a formal consensus defining the indications and contraindications for PRP in these clinical scenarios.
The document, published in Knee Surgery, Sports Traumatology, Arthroscopy (KSSA, 2025), constitutes an international reference for evidence-based clinical practice.

Clinical context and need for the consensus

PRP is used in various musculoskeletal conditions to enhance tissue repair, modulate local inflammation, and improve function.
However, when patients present systemic comorbidities—such as chronic viral infections, active tumors, or hematological disorders—legitimate concerns arise regarding safety, efficacy, and potential adverse effects, including infection spread, tumor proliferation, or hematological alterations during PRP preparation.

The GRIIP consensus provides a clinical and scientific decision-making framework for these complex cases, where practices previously varied considerably between centers.

Titled “Indications and contraindications to platelet-rich plasma injections in musculoskeletal diseases in case of infectious, oncological and haematological comorbidities”, the consensus was developed through a formal Delphi process, based on a literature review and structured discussions among international experts in regenerative medicine, hematology, oncology, and infectious diseases.
The outcome was the formulation of 4 general principles and 23 clinical recommendations, reflecting the current level of evidence and expert opinion regarding PRP use in patients with complex comorbidities.

Key findings and clinical recommendations

• Controlled viral infections (e.g., HIV or hepatitis with undetectable viral load) are not automatically a contraindication for PRP use.
• Active bacterial infections and active oncological processes are considered absolute contraindications.
• In hematological conditions, PRP can be considered in patients in remission or with stable disease, always under specialized evaluation.
• Decisions should be made on an individualized basis, taking into account the type and status of the comorbidity, the patient’s immune status, and the clinical context of PRP.
• Close monitoring and coordination with infectious disease, oncology, or hematology teams are recommended as appropriate.

Implications for clinical practice and future directions

This consensus represents a significant step toward standardizing PRP use in complex clinical contexts, contributing to greater safety and consistency in decision-making.
The document also highlights the need for prospective and comparative studies to evaluate PRP safety and efficacy in patients with comorbidities, as well as the standardization of preparation, application, and follow-up protocols.

Although it does not replace high-level evidence, the GRIIP consensus provides a pragmatic, consensus-based roadmap while the scientific literature continues to evolve.

More info HERE