PLATELET
RICH PLASMA (PRP):
In our clinic we use PRP several times a day. We are preparing
several research projects using PRP in the relatively near future. A summary of PRP
is found at Whole Blood and PRP
Studies on PRP are included in our summary of research at Research.
Just search for PRP once you are on that page. Not
all pain is from connective tissue or cartlage sources and good examination and
history are still critical. PRP is safe,
but post injection discomfort is typically more and injection discomfort is
usually more as well. We are currently working on ways to make it
less expensive to make research more feasible and we are very optomistic about
that. Our goal in the near future is to make it easily available for
the everyday patient as well as the elite athlete.
It should be noted that PRP is the form of prolotherapy that will likely cause a tremendous increase in publicity due to being more palatable to those who do not understand the simple methods by which dextrose works and the great cost effectiveness of dextrose alone. This will be apparent by the New York Times article of 2009 which the reader may want to read. http://www.nytimes.com/2009/02/17/sports/17blood.html?_r=1&hp
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.
Making PRP (Platelet Rich Plasma, PRP)
When
blood is placed in a centrifuge and spun at several thousand revolutions per
minute, the blood separates into several layers depending on the weight of each
part. Red blood cells are at the bottom because they are small cells with
a nucleus, the white blood cells and platelets are next. White cells are
lighter than red cells because their heavy part (nucleus) is smaller in
proportion since they are a larger cell. Platelets are lighter
because they are cell fragments without a nucleus. Together the white
blood cells and platelets make up what is called the buffy coat.
Lighter than the buffy coat, and on top of it, is the plasma layer which is
light because it has no cells. The goal of making PRP is to
separate the buffy coat from the red cells and plasma as efficiently as
possible. There are automatic and manual ways to do
that. The separated and concentrated platelet solution is called platelet
rich plasma. In reality it is simply platelet rich blood because it still
contains some red plood cells as well as plasma. Generally the goal is to
concentrate the platelets 4 times or more. Although higher and higher
platelet concentrations might logically be better, there is a level above which
the PRP is not as well tolerated with injection.
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 (autograft). Thus the term platelet rich autologous blood autograft. Some have also proposed the term autologous platelet leukocyte concentrate. Home
Things To Consider:
Sounds exciting and promising, and indeed it is. However several things need to be kept in mind.
30 ml (1 ounce) of blood generally makes 3 ml of PRP. Because of how much blood it takes and the cost of its preparation PRP is more suitalbe for the treatment of local regions rather than large regions. complex areas.
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. Less expensive ways of making PRP are making it more feasible
to use however, and particularly the athlete with a time limit on healing may
want to utilize PRP. Home
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 available for posting on this site.