Introduction to platelets
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Platelet Rich Plasma ( PRP ) is very popular in the treatment of musculo skeletal pathologies. This ppt gives a brief introduction to platelets and in sights into developing a PRP kit.
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Introduction to platelets
- 2. Definition & Indications • Biological substances musculoskeletal injuries fracture healing primary OA
- 3. • Bone grafts • Autologous blood • Autologous conditioned serum • Platelet rich plasma • Growth Factors • Stem cells ( BMAC )
- 4. 2008, Pittsburgh Steelers’ wide receiver, Hines Ward knee MCL sprain, credited PRP XLIII
- 5. The global market for PRP $45 million in 2009 projected worth > $120 million by 2016 Whyare platelets in the spot light ? Safe Nonsurgical Biological treatment musculo skeletal repair OA
- 6. Platelet Rich Plasma (PRP) • Store house of growth factors • used in concentrations many times the normal • speed up the healing cascade
- 7. Platelet : biology • Discoid, 2µ dia ( WBC about 20µ dia, RBC 7µ ) • 7-10 days life span • Anucleate • Granulated dense alpha granules & lysosomes 1000-3000 during life time
- 9. the regeneration cascade… • tissue reparative property of PRP 1,000,000 platelets/μl • GF’s stabilize damaged tissue during initial stages of tissue repair • mesenchymal and epithelial cells migrate collagen and matrix synthesis • VEGF and FGF-2, neovascularization
- 10. Ehrenfest et al. (2009), • Pure Platelet-Rich Plasma (P-PRP) or leucocyte-poor PRP • Leucocyte- and PRP (L-PRP most commercial systems • Pure platelet-rich fibrin (P-PRF) strongly activated gel form • Leucocyte- and platelet-rich fibrin (L-PRF) or second-generation PRP products
- 11. Activation of PRP • PRP activation prior to injection ? • activated exogenously by thrombin calcium chloride mechanical trauma • Collagen is a natural activator of PRP thus when PRP is used in soft tissue, it does not need to be exogenously activated Marlovits S, Mousavi M, Gabler C, Erdös J, Vécsei V, et al. A newsimplified technique for producing platelet-rich plasma: A short technical note. Eur Spine J. 13:102–06.
- 12. Why not in wide spread use ? Cost of kits Mostly imported Rs 4500-6000 Problem: Variable results Lack of standardisation …felt need large scale RCT’s to validate benefits streamline indications other components role
- 13. Literature review… • The International Cellular Medical Society (ICMS) asserts that a need exists to create standards for platelet rich plasma (PRP) protocols, preparations, techniques and tracking • Available data suggest that PRP may be helpful in enhancing soft-tissue repair, particularly for tendon and wound healing Dhillon et al. Arthritis Research & Therapy 2012, 14:219 • a substantial amount of research is needed to bring PRP technologies to the bedside, as clinical and laboratory findings that indicate its potential benefits must be followed by comprehensive clinical studies to demonstrate efficacy Mikel Sánchez, Isabel Andia, Eduardo Anitua and Pello Sánchez (2012). Platelet Rich Plasma (PRP) Biotechnology: Concepts and Therapeutic Applications in Orthopedics and Sports Medicine, Innovations in Biotechnology, Dr. Eddy C. Agbo (Ed.), ISBN: 978- 953-51-0096-6, InTech
- 14. Platelet Rich Plasma using readily available materials: a point-of-care procedure IOACON2014
- 15. Aim of study: design a PRP kit • Consistently concentrate platelets >1,000,000/µ ltr • Point-of-care • Assure sterility • Low cost This will facilitate well designed RCT’s and provide clear cut indications for PRP therapy
- 16. In a nut shell… • 2 spin technique • Soft spin, 1500rpm x 15 mins • Hard spin, 3500rpm x 7 mins platelet pellet Serum & Platelets
- 18. Safety profile • 50 consecutive samples were cultured No bacterial growth • This proves the safety of this method. • On-site preparation of PRP reduces risk of contamination during transport
- 19. PRP was extracted from 144 samples and the results are shown in Table Platelet counts in excess of 1million/µ ltr were obtained in 118 ( 81.9% ) which validates the methodology . PRP Count No Of Patients Remarks 8.0 L – 10.0 L 26 10.0 L – 12.0 L 21 12.0 L – 15.0 L 41 15.0 L & Above 56 Total 144
- 22. Indications & Usage Rotator cuff injuries & Tears osteoarthritis Knee ligamentous injuries Tennis Elbow Achilles Tendinopathy Plantar fascitis Retro Calcaneal bursitis
- 23. Summary: PRP • Point of care procedure • Low cost kit • Sterile • Optimal platelet concentration • Can be used as the core technique for designing RCT’s to evaluate the rationale for using platelets in musculo skeletal conditions.