Platelet-Rich Plasma - An Overview

What is platelet-rich plasma?

Platelet gel is an autologous product derived from the patient's own blood.  It is produced by separating the platelet from the whole blood via centrifugation.  The resulting product is rich in hemostatic factors (platelets and plasma proteins) and healing factors (platelet-derived growth factors).

How is platelet-rich plasma made?

Platelet-rich plasma is produced using a small sample (40 to 180 ml's) of the patient's own blood.  This whole blood is anticoagulated with ACD-A and then processed by a specialized platelet separating device which specifically sequesters platelets via centrifugation.  The end product is plasma containing a very high concentration of platelets (platelet-rich plasma or PRP), and plasma containing a very low concentration of platelets (platelet-poor plasma or PPP).  The entire process takes about 20 minutes and can be done in the office, clinic, or operating room setting.

The PRP or PPP is applied using a specialized application device  Upon activation by contact with tissue factors or thrombin, the PRP or PPP becomes gelatinous.

How is platelet-rich plasma used?

Platelet-rich plasma is applied to a surgical wound to induce rapid hemostasis and accelerate the healing process. Because PRP is rich in platelets, there is a high concentration of hemostatic and growth factors delivered directly to the wound.  The activated platelets initiate the coagulation cascade to stop capillary bleeding and seal any disruptions in the lymphatic system. The activated platelets also release concentrated growth factors which immediately begin the healing and remodeling processes.  In addition, PRP contains an elevated number of leukocytes.  This increase in white cells delivered directly to the wound has been shown to have a significant antimicrobial effect, thus reducing the risk of infection.

How is platelet-rich plasma applied?

Spray or bead

Platelet-rich plasma is applied via a hand held applicator and is either delivered in the form of a spray or bead (like caulk).  There are many different applicators made to suit nearly every procedure including arthroscopic procedures.

Bone log

Platelet-rich plasma can also be mixed with bone chips to form a malleable bone log which can then be molded into any shape desired and placed where needed.

Membrane

A membrane can also be produced by dispensing platelet-rich plasma to a flat sterile surface.  This membrane can then be used to cover or seal a specific area.

What are the benefits of platelet-rish plasma?

Platelet-rich plasma offers a myriad of benefits to the patient as well as the practitioner. 

Patient Benefits:

Accelerated healing
Less bleeding, bruising, redness, and swelling
Reduced risk of infection
Reduced risk of seroma formation
Reduction in the use of or elimination of drains
Fewer blood transfusions
Significantly less pain and need for post-op analgesics
Shorter post-op hospital stay
Earlier ambulation

Physician Benefits:

Reduced costs associated with post-op visits
Improved outcomes with fewer complications
Greater patient satisfaction
Increased number of referrals
Distinct competitive advantage

How is platelet-poor plasma (PPP) used?

Platelet-poor plasma can be used as a hemostatic agent much like manufactured hemostats or fibrin glues (Co-Stasis™, TISSEEL™, Floseal™, etc.).  Because PPP is rich in plasma proteins and contains native levels of fibrinogen, it can be utilized as a sealant.

What are the benefits of PPP over manufactured hemostats/sealants?

Native levels of fibrinogen

PPP is a superior hemostatic agent and sealant since some manufactured hemostatic/sealant products contain very high concentrations of fibrinogen, which has been demonstrated to impede the healing process.

Less Expensive

In addition, PPP is an autologous product that is less expensive, readily available, and simple to procure. 

Autologous

Some manufactured hemostats are made from the plasma of multiple donors, thus increasing the risk of viral transmission to the patient.

Are there any contraindications for the use of platelet-rich plasma?

Yes.  The following are absolute contraindications for use of platelet-rich plasma:

  1. Presence of a tumor in the wound bed or metastatic disease.

  2. Active infections.

  3. Allergy to bovine products (If bovine source thrombin is used. Recombinant thrombin is a superior alternative and eliminates the risk of allergic reaction.)

The following are potential contraindications for the use of platelet gel:

  1. Platelet count less than 100,000/µL  (Note: Significant concentration of platelets is still possible if lesser amounts of platelet gel is required)

  2. Hemoglobin less than 10 g/dL.  (Note: Since the production of platelet gel requires only a small sample of whole blood, anemic patients may still be candidates for this therapy)