Human blood consists of many different elements, including red blood cells to carry oxygen, white blood cells to fight infection and help repair wounds and injuries, platelets to help the blood clot, and plasma. It has long been known how important each of these elements are, and scientists and medical professionals are always looking for new ways to use them to benefit patients. In recent years, a treatment called ‘platelet rich plasma therapy’ has been used for a wide range of conditions.
Here is what you need to know about the science behind the therapy.
What does Plasma do?
The plasma in our blood carries hormones, growth factors, and protein, including many very specialized proteins released by blood and other immune cells called chemokines and cytokines. Chemokines act as homing (migration) proteins, attracting cells to areas of damage or inflammation to enable healing, while cytokines are signaling molecules that mediate and regulate immunity, cellular proliferation, inflammation, and healing.
How is Platelet Rich Plasma produced?
Platelet rich plasma (PRP) is obtained by centrifuging whole blood taken from a patient or donor. As red cells are heavier than all other blood cells, they drop to the bottom of centrifuged blood leaving the platelets, white cells and plasma above to be easily collected. Strict sterility precautions are required if the PRP is intended to be given back to an individual.
PRP is usually collected from a patient immediately prior to being used for the treatment of the underlying condition but it can be frozen and used at a later date. The use of your own PRP is very safe and although you can use PRP donated from another person, this has more potential complications such as the transmission of infection and immune reactions which very rarely can be clinically serious.
What is Platelet Rich Plasma Used to Treat?
Although originally used in facial surgery and cardiology, given its wide applicability to both traumatic and degenerative conditions, PRP is emerging as an important therapy in many orthopedic disorders in every state across the country, particularly in states like Georgia. There is now a PRP treatment in Atlanta that can help with conditions including tendon and ligament rupture, cartilage damage including arthritis, vertebral disc degeneration, sports including rotator cuff (shoulder) injuries, and plantar fasciitis. The ability to inject PRP directly to the site of damage or inflammation means healing may occur without the need to resort to surgery.
PRP has been shown to heal tissues quicker and more effectively making them thicker and stronger. It is particularly useful for cartilage damage, as occurs in the knee or hip osteoarthritis, as it stimulates new cartilage growth despite the lack of blood vessels leading to less pain and increased mobility.
Although bone typically has a good blood supply and ability to regenerate, PRP has been shown to increase healing in the uncommon case of fractured bones not re-forming.
Further studies are required to see if all PRPs have the same ability to heal and whether certain properties of a PRP e.g. red or white cell content makes the product more or less beneficial in a given indication e.g. tendon repair.
Why is Platelet Rich Plasma Thought to be Beneficial?
The healing cascade encompasses three major phases: 1) inflammation, 2) proliferation, and 3) maturation and remodeling. However, many structural tissues including tendons, ligaments, and cartilage have a relatively poor blood supply and hence limited ability to attract important healing cells and the chemokines and cytokines they secrete. They, therefore, have relatively restricted self-replication and repair capacity and typically heal by scarring (fibrosis) leading to a loss of function.
Platelets have an abundance of the most important healing chemokines and cytokines in their alpha granules. PRP increases cellular proliferation, migration, differentiation, and maturation, and so can aid the healing cascade when injected into damaged tissue as it leads to a higher concentration of platelets, growth factors, chemokines, and cytokines than would be present if normal physiological healing was taking place.
Are there any Problems with PRP?
Despite the existence of many commercial equipment providers, there is no agreed and standardised way of collecting PRP. The different centrifugal forces, centrifugal times, length of rotating centrifuge arms, and types of collection tubes which are recommended by the various manufacturers, alters the amount of red cell contamination, the number of white blood cells and platelets, the degree of platelet activation (alpha granule release) and the volume of plasma collected, meaning the PRP produced can be very different. There are international attempts being made to standardize the collection and definitions of the various types of PRP produced as it is highly likely that the presence of red cells or white cells, as well as the number and activated state of the platelets themselves, will markedly alter the healing properties of the PRP.
PRP is an emerging and very promising therapy for a range of orthopedic conditions. If you have one of these conditions, you should speak to your local PRP therapists and orthopedic services and see what they can do for you.