Platelet Rich Plasma

Platelet Rich Plasma  (PRP)

In our clinic we use PRP several times a week. A variety of research studies on this site use PRP (click here to display the search results for "PRP" on this site, which includes a list of studies). Not all pain is from connective tissue or cartilage 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 optimistic 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 a New York Times article (2009) that you may read here.

 

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 (which literally 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 factor"s because they turn on growth and repair of cells, much as a key turning in a lock starts a car.

 

Making Platelet Rich Plasma

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 blood 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, called "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" or "blood autograft."  Some have also proposed the term "autologous platelet leukocyte concentrate."

 

Things To Consider:

PHP 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 suitable for the treatment of local regions rather than large regions or 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.

 

For More information

An article was published by Dr. Crane that is much more informative: Crane D, Everts PAM. Platelet Rich Plasma (PRP) Matrix Grafts. Pract Pain Mgmnt 08(1):12-26 

K. Dean Reeves, M.D. is a physician and medical researcher in the area of pain caused by arthritis, chronic sprains and chronic strains. His private practice is located in the greater Kansas City area of Roeland Park, Kansas.  He collaborates in research with other locations across the country and internationally, and is licensed in the states of Kansas and Missouri.

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Copyright 2011-2014
Dr. K. Dean Reeves

No part of this site should be understood to be personal medical advice or instruction in how to perform injection therapy. A decision on treatment requires a good history and full examination and a knowledge of your treatment goals. Treatment decisions should be made in consultation with your personal healthcare professional and/or prolotherapist.