【Objective】 To share the experience of autologous platelet-rich plasma(PRP) combined therapy in successful treatment of refractory osteomyelitis with fractures in children. 【Methods】 One case of refractory osteomyelitis with fracture in children failed to respond to traditional treatment for more than 14 months. A total of 20 mL of whole blood was collected from the child, and 6 mL of PRP with 4 to 5 times concentration was prepared by secondary centrifugation. To prepare 2 cm×2 cm platelet concentrate gel (PG), 3 mL of PRP was mixed with a 0.3 mL activator which was then covered with an absorbable dressing. A three-way tube sprayed the remaining 3 mL of PRP and 0.3 mL activator into the surrounding tissues. 【Results】 The X-ray film of the patient followed up for 1 week showed that the fracture line was blurred, and the fracture end had obvious callus formation. The X-ray film reexamination at 4 months showed that the fracture end healed well, the fracture surface healed, and the osteomyelitis healed. 【Conclusion】 Autologous PRP has a good effect in the treatment of refractory osteomyelitis combined with fracture in children, which can provide a new method for clinical treatment.

【Objective】 To study the changes in serum immunoglobulin levels in children with thalassemia who undergo repeated blood transfusions and explore their correlation with delayed hemolytic transfusion reactions(DHTR). 【Methods】 Serum samples from children with thalassemia who received blood transfusion treatment from June 2022 to April 2023 (observation group) and healthy children who underwent physical examination (control group) in our hospital were collected. The levels of serum immunoglobulins (IgG subtype, IgM, IgA, IgE and IgD) were detected using flow cytometry CBA multi-factor quantitative detection technology, and the differences between the two groups were compared. The children were divided into 4 groups according to different transfusion numbers: ≤10 numbers, 11-30 numbers, 31-50 numbers and >50 numbers, and the differences between different blood transfusion numbers and serum immunoglobulin levels in each group were compared using one-way analysis of variance (ANOVA). Children with thalassemia with DHTR were in the hemolysis group, and children with thalassemia who did not experience DHTR were in the non-hemolysis group. The changes in serum immunoglobulins (IgG subtypes, IgM, IgA, IgE and IgD) between the two groups were compared to explore the correlation between serum immunoglobulins in thalassemia children with repeated transfusion and DHTR. 【Results】 The levels of IgG1, IgG3, IgG4 and IgA in the observation group were significantly higher than those in the control group, with the increase of(2.07±2.12), (0.67±2.03), (0.30±0.37)and(6.04±11.40)mg/mL, respectively, while the level of IgD in observation group was significantly lower than that in the control group, with a decrease of(0.03±0.01)mg/mL, P<0.05. No significant difference was noticed in IgG2, IgM and IgE between the groups(P>0.05). IgG1 and IgG4 both significantly increased with the number of blood transfusions.The IgG1 in the 4 groups increased sequentially as(0.30±0.62), (0.41±0.51)and(3.60±3.48)mg/mL, and IgG4 increased sequentially as (0.12±0.13), (0.22±0.07) and (0.21±0.38)mg/mL. IgG2, IgM and IgD showed a significant decrease, with IgG 2, IgM, and IgD in four groups decreased as(0.91±1.50), (0.14±0.10)and(0.05±0.05)mg/mL, respectively, showing significant differences with the number of blood transfusions(P<0.05). No significant difference was found in IgG3, IgA and IgE with different number of transfusions(P>0.05). IgG1, IgG3 and IgG4 in the hemolysis group were significantly higher than those in the non-hemolysis group, with an increase of (4.44±3.41), (0.73±1.26)and(0.52±0.40), respectively(P<0.05).IgD in the hemolysis group was significantly lower than that in the non-hemolysis group, with a decrease of (0.00±0.06)mg/mL, P<0.05. No significance was noticed in IgG2, IgM, IgA and IgE between the hemolysis group and the non-hemolysis group(P>0.05). 【Conclusion】 The serum immunoglobulin levels of children with thalassemia who undergo repeated blood transfusions are abnormal. There are differences in correlation between the number of blood transfusions and serum immunoglobulin levels among children with thalassemia who undergo repeated blood transfusions. The relevant serum immunoglobulins for DHTR in children with thalassemia who undergo repeated blood transfusions are IgG1, IgG3 and IgG4.