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Rate ePoster

Musculoskeletal and Sports Medicine

Allergic Reaction to Anticoagulant after Platelet-Rich Plasma Injection

Saturday, October 25, 2025
8:00 AM - 9:15 AM MT
Location: Kiosk 3

    Poster Presenter(s)

  • Ian Cummins, MD

    Resident Physician
    University of Alabama Medical Center PM&R Program
    Birmingham, Alabama

    • Co-Author(s)

  • IM

    Ian D. McKeag, MD, Other

    Associate Professor, UAB Department of Family & Community Medicine, Sports & Exercise Medicine
    University of Alabama At Birmingham
    Birmingham, Alabama

  • Berdale Colorado, DO, MPH

    Associate Professor, Assistant Dean, Vice Chair, Program Director
    University of Alabama At Birmingham
    Hoover, Alabama

Disclosure(s):
Berdale Colorado, DO, MPH: No financial relationships to disclose
Case Diagnosis: Allergic reaction to Anticoagulant Citrate Dextrose Solution A (ACD-A) is a potential risk of PRP injections.

Case Description or Program Description: 18 year old female collegiate athlete presented with chronic pain in the right medial tibia. MRI of the right lower leg showed no bone marrow edema or other abnormality. Compartment testing and electrodiagnostic testing of the right lower extremity were within normal limits. An ultrasound-guided diagnostic injection targeting the flexor digitorum longus and soleus at the level of the medial tibial attachment produced 75% relief of her pain. She subsequently underwent a platelet-rich plasma (PRP) injection targeting these same structures. 80 mL of whole blood was mixed with ACD-A and placed in the centrifuge (Arthrex Angel® PRP System). 5 mL of PRP was obtained and subsequently injected under ultrasound guidance. Within 48 hours of the PRP injection, the patient developed a mildly pruritic rash over the right anterior medial lower leg. The rash was not present over the lateral or posterior lower leg. There were no systemic signs or symptoms.

Setting: Tertiary Care Academic Medical Center

Assessment/Results: An allergic reaction to the ACD-A was suspected. Her rash resolved within 10 days of the PRP injection. At 2 months post PRP injection, the patient reported over 90% pain relief and gradual return to sport was initiated.

Discussion (relevance): The ACD-A was the suspected cause of the allergic reaction since the other products utilized (chlorhexidine antiseptic solution and ethyl chloride topical anesthetic spray) were used previously during the diagnostic injection with no adverse effects. The allergic reaction did not impact the patient’s overall positive response to the PRP injection.

Conclusions: Allergic reaction to ACD-A is rare, however can occur following PRP injections.