K. Dean Reeves, M.D.
Clinical Associate Professor Physical Medicine and Rehabilitation
Emphasis on Research in Use of Prolotherapy (Also called Regenerative Injection Therapy)
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K. Dean Reeves, M.D. Clinical Associate Professor Physical Medicine and Rehabilitation
Emphasis on Research in Use of Prolotherapy (Also called Regenerative Injection Therapy)
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| Use of Your Own Blood For Healing
TWO WAYS TO USE BLOOD: Unaltered and Centrifuged Unaltered Blood (Straight from your vein) This is called Autologous Blood. Autologous means from you. This involves taking blood from your own vein and injecting it into an area with a need for repair. Earlier, in the section called "What is RIT" we described how dextrose causes growth factors to be produced by nearby cells. Platelets already have growth factors that are produced and appear to have more potency that dextrose alone. Using blood instead of dextrose is more risky to health care workers because of a much greater potential for serious needle stick injuries (infections of the blood) but it is not more risky to you because you can't reject or react to your own blood. One limitation of unaltered blood is that it should not be used inside a large joint since red blood cells, when they break down, irritate the lining of a joint. Research articles on use of unaltered blood have primarily been on use in "tennis elbow" and "plantar fasciosis/arch sprain", but all ligaments and tendons have the potential of healing responses when exposed to unaltered blood. Home Centrifuged Blood (Platelet Rich Plasma, PRP) This can accurately be called a Platelet Rich Autologous Blood Allograft. Allograft means grafting from one part of you to another part. Note that blood is a tissue since it has both cells and supporting connective tissue (plasma) but it is unusual because it is liquid tissue. A skin graft, for example, needs to be "excised" or cut out to be grafted somewhere else. However, blood as a liquid tissue can be injected, as long as the injection is accurate in location. In an effort to substantially increase the practical function of blood as a graft and allow it to be injected in joints to help cartilage repair, a change in blood is necessary. This change is to decrease red blood cells (to protect big joints) and increase the concentration of platelets (for a stronger repair effect).
This platelet rich plasma naturally contains 7 growth factors, similar to what we have described with dextrose stimulation. It also naturally includes 3 molecules that make things stick together call adhesion molecules. These are called fibrin and fibronectin and vitronectin) When injected together with growth factors, the adhesion molecules help to keep the solution together to act as a graft. Thus platelet rich plasma it autologous and a variation of blood and is a graft onto yourself (allograft). Thus the term platelet rich autologous blood allograft. Home Things To Consider: Sounds exciting and promising, and indeed it is. However several things need to be kept in mind.
For More information, on PRP an article was published by Dr. Crane that is
much more informative. The reference is: Crane D, Everts PAM. Platelet Rich Plasma (PRP) Matrix Grafts. Pract Pain Mgmnt 08(1):12-26 A PDF of this article is not availble for posting on this site.
Best regards,
Dr. Reeves
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To contact us: General questions --> reevesoffice@kc.rr.com
Billing related questions --> reevesbilling@kc.rr.com
Research related questions --> dreeves1@kc.rr.com
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Why
Does Blood Heal? (Platelets hold the key)
Here is a picture of your blood. It
contains both cells and plasma (the liquid between the cells). This
is often present in an injury and bleeding into an injury is one way that
healing is stimulated. In an effort to understand why, examination
of what parts of the blood stimulate healing has led to an awareness of the
special importance of platelets. 
What
are platelets and where do they come from? Platelets are
fragments of cells that are produced in the bone marrow by a special cell
(see right picture) called a megakaryocyte. (This means "big
cell in the blood". ) This special cell breaks into pieces, each of
which is a platelet. Platelets contain many special proteins that are
called growth factors because they turn on growth and repair of cells, much as a
key turning in a lock starts a car. 
Most commonly this is done by taking 20 ml (1 ounce of
your blood and placing it in a centrifuge for 15 minutes in a special
container. The results are drawn up in such a way that this 20 ml makes
about 7 ml of a solution that has less cells and more platelets than unaltered
blood. The goal for platelet concentration is about 1 million platelets
for every ml of centrifuged blood. This platelet rich
blood is primarily plasma because red blood cells are reduced (red blood
cell poor) in the centrifuge step. Thus it is also called
platelet rich plasma. It is still blood "tissue", containing
both living cells (white and some red) and supportive connective tissue (plasma)
supporting structure. 
The
smaller specialized centrifuge container makes less than 1 teaspoonful
(4 ml) of
the platelet rich plasma and the larger container makes 2 teaspoonfuls.
(10 ml) This does not cover a large area, and is more suitable to treatment of
small areas. Information on the internet about treating
"backs" or " necks" with platelet rich plasma is potentially
misleading. 
Platelet rich autologous blood autograft will
likely achieve faster
and more substantial results than dextrose alone. However without more research, switching away
from dextrose as the primary solution for regeneration efforts is like putting
the "cart ahead of the horse." 
Making
platelet rich plasma is costly and statements about this being covered by
insurance are partly inaccurate. Medicare does not cover this treatment at
this time and with other insurers pre-authorization is required and that is not
a guarantee of payment. Nevertheless, the high level athlete in a
hurry to heal may want to utilize PRP. 