PRP – Platelet Rich Plasma and its importance. – IASRM Global
The International Association of Stem Cell & Regenerative Medicine (IASRM )

Platelets have a significant role in the healing process, and we use…

Platelets have a significant role in the healing process, and we use them for regenerative medicine. Platelet-Rich Plasma (PRP) is not the same as stem cell therapy, even though people may think of it as a “stem cell attractant.” This mistaken belief stems from the use of PRP therapy in bone marrow stem cell therapy.

In cases of musculoskeletal injury, platelets rush to the site of injury and form a clot to control the bleeding, beginning the healing process. The activation and clot formation process is complicated, with numerous steps involved.
To begin, platelets attach to the injury site using surface receptors that bind to specific molecules exposed by the damaged blood vessels. Once attached, the platelets become active, releasing numerous substances from their internal granules.

The granules contain various molecules necessary for clotting and initiating the healing response. Alpha granules release growth factors, cytokines, and coagulation factors, while Dense granules release small molecules necessary for maintaining clot integrity and recruiting additional platelets. The Lysosomal granules release enzymes that help clear away damaged tissue and facilitate tissue repair.

Aside from the granules, platelets also release microparticles carrying different molecules. These particles play a significant role in inflammation, cell signaling, and the initiation of the immune response.
Overall, the molecules in the granules released by activated platelets promote cell division and multiplication, helping to create a loose plug that slows the bleeding, promotes the growth of new blood vessels, and aids in tissue repair. As the number of activated platelets increases and more platelets are attracted to the injury site, the plug begins to clump together, eventually forming a permanent clot.

In summary, the use of platelets in regenerative medicine is vital to the healing process, and PRP therapy is not the same as stem cell therapy, despite being associated with it. Platelets play an essential role in the healing process by forming a clot and releasing various molecules that promote the growth of new blood vessels, tissue repair, and the initiation of the immune response.

After the cessation of bleeding, the process of healing commences. The fibrin mesh and platelet plug collaborate as a scaffold for various cells drawn to the injury site. As we previously discussed, here are some of the principal cell types that platelet cytokines and chemokines attract to the injury site:

  1. Neutrophils are a type of white blood cell that are among the first to migrate to the site of an injury. They play a critical role in the body’s immune response by engulfing and breaking down bacteria and damaged tissue, thus helping to clear the area of debris and prevent infection.
  2. Monocytes and macrophages, two types of leukocytes, perform the vital task of eliminating bacterial intruders and degraded tissue from the bodily environment. These cells employ phagocytosis, a mechanism that involves ingestion and subsequent digestion of these harmful agents. Additionally, they can generate growth factors and cytokines, which stimulate reparative processes that aid in tissue reconstruction.
  1. Fibroblasts are cellular agents responsible for synthesizing the matrix, a crucial component that forms the foundational structure required for tissue healing and regeneration.
  2. Endothelial cells, which reside within the walls of blood vessels, play a crucial role in repairing damaged tissue. Platelet-derived growth factors stimulate these cells to divide and migrate towards the affected region, aiding in the creation of fresh blood vessels that aid in tissue regeneration and restoration.
  3. Platelet-derived growth factors not only attract endothelial cells but also prompt stem cells to migrate towards the affected area. Stem cells possess the unique ability to differentiate into a wide range of cell types, making them indispensable in tissue repair processes.

In conclusion, platelet-derived cytokines and chemokines perform dual roles of halting bleeding and attracting a diverse range of cells to the affected area, such as neutrophils, monocytes/macrophages, fibroblasts, endothelial cells, and stem cells. Through their collective efforts, these cells contribute to tissue repair and expedite the recovery process of the injury.

Evidently, platelets are an excellent trigger for an amplified healing reaction. Utilizing platelet-rich plasma can boost the platelet count by a significant factor compared to that found in your bloodstream.
The prerequisites for preparing platelet-rich plasma vary depending on the intended application, and it may or may not be feasible for the medical facility to tailor the platelet product to suit individual requirements. Nevertheless, below are some general guidelines for preparing PRP:

The primary prerequisite for creating a single batch of platelet-rich plasma is a blood sample of approximately 50-60ml, which is typically collected from a vein in the patient’s arm using a sterile syringe and needle.

An anticoagulant is used to prevent clotting during blood sample collection. Citrate, heparin, or ACD (acid citrate dextrose) are commonly used anticoagulants during the preparation of platelet-rich plasma.

To prepare PRP, the blood sample is put through a centrifuge and spun at high speeds. During the first spin, the blood is separated into its different components. The red blood cells settle at the bottom of the tube, the white blood cells form a thin layer in the middle, and the platelets and plasma remain in the top layer.

To prepare PRP, the platelets from the blood sample need to be concentrated. This is done by removing the top layer of platelet plasma (with or without the buffy coat) and further spinning it to increase the platelet concentration. The desired platelet concentration can vary depending on the specific medical need, but it is usually 3 to 10 times higher than the normal blood platelet count. The minimum concentration is typically 2 times higher than normal.

The last step of the PRP preparation process involves activating the platelets. This can be achieved by adding a calcium solution or thrombin to the PRP, which triggers the healing cascade by a factor of concentration (X) that was created. However, it’s important to note that activation may not always be necessary since platelets can slowly activate on their own through the calcium present in the tissues.

In summary, to prepare PRP, a sterile blood sample is required from the patient and treated with an anticoagulant to prevent clotting. The sample is then centrifuged to separate the blood components, and the platelets and plasma are concentrated. Platelet activation may also be necessary to initiate the healing cascade. However, it is crucial to achieve the appropriate platelet concentration and to inject the PRP accurately into the targeted area to achieve therapeutic results.

We utilize our flexible laboratory platform to process our PRP products and create a customized solution tailored to the specific needs of each patient. To ensure precise placement, we utilize image guidance techniques such as fluoroscopy and high-resolution ultrasound. For patients with insufficient blood flow, advanced age, or severe disease, we combine bone marrow stem cells with PRP and inject them directly into the affected area. This synergistic approach maximizes the potential for intense healing and regeneration.

Sure, I understand. We can continue to explore the bone marrow stem cell procedure in our next session. Let me know if you have any other questions or concerns in the meantime.

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