What exactly is platelet-rich plasma?
PRP injections offer ways to heal the body naturally - a feat made possible by platelet-rich plasma.
PRP has become very popular over the last decade.
But what exactly is platelet-rich plasma?
Platelet-rich plasma is a product made from a person's blood. A blood sample with PRP tubes is centrifuged in a PRP centrifuge to increase the concentration of platelets in the plasma. The result is a super-rich plasma with a platelet concentration of 94% compared to 6% normally found in human blood.
How platelets heal the body
Among other things, the plasma contains certain substances that are responsible for wound healing, the so-called growth factors. Together they form a complex system that is immediately activated in the event of injury and ensures the fastest possible regeneration. With this healing power, the body protects itself very effectively.
A typical blood sample consists of 93% red blood cells, 6% platelets and 1% white blood cells .
Platelets were first seen in blood in 1842 by the French doctor Alfred Donné. These are small disc-shaped cells with a lifespan of about 7 to 10 days.
After an injury that causes bleeding, platelets are activated and aggregate to release their granules, which contain growth factors that stimulate the inflammatory cascade and the healing process. Platelets are responsible for haemostasis, building new connective tissue and revascularisation, and most of the research in the last century has focused on this major function.
Only in the last two decades have we learned that platelet activation releases healing proteins in the body called growth factors.
There are numerous growth factors with different functions, but cumulatively they can accelerate the healing of tissues and wounds.
The ideology behind PRP treatment is to reverse the ratio of red blood cells to platelets by reducing red blood cells to 5% (which are less useful in the healing process) and, more importantly, concentrating platelets, which contain a potent mixture of growth factors, to 94%.
A normal platelet count in a healthy person is between 150,000 and 450,000 cells per microlitre of blood. Platelet concentrations of less than 1,000 × 10 6 / ml have not been reliable for improving wound healing, and most studies have shown that tissue reparative efficacy with PRP can be expected with a minimal increase of five times the normal platelet concentration (approximately) 1 million platelets / μl) [ 13], while much higher concentrations showed no further improvement in wound healing.
The ideal concentration has yet to be defined. The wide variability of platelet concentration devices and techniques used in different studies may alter the degranulation properties of platelets, which may affect clinical outcomes, making interpretation of results difficult.
Components of platelet-rich plasma
Platelet-rich plasma not only contains platelets, but is also rich in growth factors that are crucial for wound healing:
- Platelet-derived growth factor
- Keratinocyte growth factor
- Interleukin 8
- Vascular endothelial growth factor
- Insulin-like growth factor 1
- Insulin-like growth factor 2
- Connective tissue growth factor
- Fibroblast growth factor
- Transforming growth factor beta
- Epidermal growth factor
PRP also contains blood proteins such as vitronectin, fibronectin and fibrin.
Areas of application of platelet-rich plasma / PRP
There are numerous and ever-growing areas where PRP is being implemented, and its various factions.
- Rheumatology, traumatology or sports medicine
This is certainly the area of greatest projection in the use of PRP, far surpassing even the existing clinical evidence. In vitro PRP has been shown to regulate cytokine processes involved in neovascularisation, proliferation of tenocytes, fibroblasts, myocytes and chondrocytes, and recruitment of inflammatory cells with inhibitory effects of proinflammatory cytokines (IL-1) with anti-inflammatory and regenerative activity.
Epicondylitis is a tendinopathy-limiting condition with a marked tendency to a chronic and incidental partial response to conventional therapy with steroid injections and rehabilitation. Studies with PRP in these patients as a single infiltration resulted in significant functional analgesic improvement and 85% of them resulted in no adverse effect.
- Plantar fasciitis
As with the rest of tendinopathy with a tendency to become chronic, a study of a case series of patients with plantar fasciitis unresponsive to treatment with NSAIDs, immobilisation, physical therapy and corticosteroid infiltration was reviewed with significant functional improvement PRP infiltrated pain in 90% of them.
- Knee osteoarthritis
Case studies of patients compared to single infiltration of hyaluronic acid document up to 35% of respondents to the PRP infiltrate compared to 10% hyaluronic acid. While these studies only cover a small number of patients, it is important to note that for the first time the concentrations of growth factors infiltrated in PRP are specified, emphasising the importance of the leukocyte fraction not potentiating the proinflammatory effect of the final product obtained.
In recent years, the most extensive clinical cases have reported their success in implementing PRP injections. perhaps the largest series of the Spanish, who were part of a group that included the treatment of 261 patients with 3 separate PRP injections of 15 days.
PRP has also been found to be useful in chronic Achilles tendonitis, particularly in infiltrations of ozone, patellar tendinopathy previously used in repair of cuff rotators the anterior cruciate ligament or with plastic erector or tibial tendon graft bone, meniscus repair of the knee joint, in reconstruction of the glenoid labrum or hip and ultimately partial and complete muscle injury here open made later PRP repair and reinforce.
- Foot care
In most cases, the goal of medical research is not only to prolong the life of the patient, but also to improve the quality of the patient. Growth factor rich plasma is a novel and relatively new technique for tissue repair. It consists of a simple system for obtaining platelets and autologous plasma proteins from a patient's blood sample. In the field of podiatry, the use of PRGF enables the improvement of the evolution of patients with regenerative needs in the lower extremities such as: Acceleration of ossification postoperatively, Reduction of resolution time in diabetic ulcers or Improvement of scar formation among many others. Several studies on the use of growth factors have shown excellent results in various medical specialties, among which podiatry.
- Dentistry and maxillofacial surgery
Platelet-rich plasma (PRP) is a new approach to tissue regeneration and is becoming a valuable tool to promote healing in many dental and oral surgery procedures, especially in ageing patients.
- Aggressive periodontitis
Aggressive periodontitis is characterised by rapid loss of attachment, bone destruction and familial aggregation. Platelet-rich plasma (PRP) can help to promote regeneration of lost periodontal tissue.
Platelet-rich plasma has emerged as an alternative in periodontal therapy. PRP appears to increase the speed of the healing process as it is biologically possible that due to the higher concentration of platelets, it can aid wound healing and trigger a faster cellular response than the normal blood clot.
- Dental implants
PRP therapy can be very helpful for dental implants. This includes bone grafting to restore missing bone mass, ridge augmentation and sinus grafting, as well as the actual placement of your dental implants.
After bone grafting, PRP can help regenerate new bone while the surgical incisions heal. After implant placement, PRP helps your soft tissues to heal around your implants while supporting the process of osseointegration.
Periodontitis is defined as a complex, multifactorial disease characterised by loss of connective tissue attachment with destruction of periodontal tissue. The aim of periodontal therapy is to eliminate inflammatory processes, prevent the progression of periodontitis and also regenerate the lost periodontal tissue.
Platelets play a key role in wound healing and therefore wound healing after periodontal treatment can be accelerated by the use of platelet concentrates . The wound healing process triggered by the formation of blood clots and after tissue injury in periodontal surgery causes platelets to adhere and aggregate, which promotes the formation of thrombin and fibrin . In addition, certain substances are released from platelets that promote tissue repair, angiogenesis , inflammation and immune response .
Platelets also contain biologically active proteins and the binding of these secreted proteins within a developing fibrin network or to the extracellular matrixcan produce chemotactic gradients that favour stem cell recruitment, stimulate cell migration, differentiate and promote repair. Therefore, the use of autologous platelet concentrates is a promising application in the field of periodontal regeneration and can be used in clinical situations requiring rapid healing.
PRP is used in gynaecology under the following conditions:
The use of PRP has been shown to accelerate the healing of surgical wounds and reduce the length of hospital stay, even in high-risk patients such as those with diabetes mellitus. The need for painkillers is also reduced.
Vulval lesions / cervical ectopy:
PRP has been tried for many dermatological and autoimmune diseases of the vulva such as lichen sclerosis, which cause severe itching, dyspareunia and bleeding problems. Almost all patients treated with PRP show improvement. PRP has also been shown to be as effective as laser in treating patients with cervical ectopia with fewer complications such as infection or bleeding.
PRP for genital prolapse and genital fistula:
A study has shown that in patients with small genital fistula, conservative therapy with PRP injection was very successful. The ability of PRP to restore the anatomy and function of the pelvic ligaments is also helpful in women with genital prolapse, especially in the early stages.
PRP in reproductive medicine:
There are promising results in women with premature ovarian failure treated with PRP injection into the ovaries under ultrasound guidance. However, this modality is when the treatment is still in clinical trials and is not a routine treatment. The study was also very promising that injecting PRP into the endometrium can help improve embryo implantation rates in IVF cases.
PRP in gynaecology treatment:
PRP injection into the vagina rejuvenates and regenerates the mucosa, muscles and skin as well as vaginal vascularity. This will result in a greater increase in sensitivity and dramatically improve sexual life. The surrounding skin also becomes thicker and earlier, making the vagina and vulva pinker and more youthful. The ligaments and muscles become stronger, alleviating the problem of urinary incontinence.
- Cardiovascular surgery
PRP has been used in a number of surgical applications (plastic, maxillofacial and orthopaedic surgery) to promote wound and tissue healing. In addition, Staphylococcus aureus, the most common bacterium responsible for DSWI, may be inhibited by the use of PRP.
The use of PRP could also prevent the risk of the patient's body rejecting the foreign transfusion. In addition, surgeons could use PRP at the site where they took the vein for the bypass procedure.
- Plastic surgery
The use of platelet-rich plasma has emerged as one of the most desired non-surgical treatments for facial rejuvenation and hair restoration. It has evolved into a variety of applications in the field of plastic surgery, including its use in combination with microneedling, laser and fat grafting procedures.
Platelet-rich plasma has many properties that make it very attractive for use in plastic surgery: It is easily and inexpensively produced using the patient's own cells, with little or no risk of side effects. However, especially for cosmetic procedures, treatments can be time-consuming and require several sessions.
PRP was originally used to treat skin conditions and to promote bone grafting, and has found a growing number of applications in various surgical specialties - including plastic surgery. In the US alone, plastic surgeons performed more than 130,000 minimally invasive cosmetic procedures in 2019.
PRP has emerged as one of the most desired non-surgical treatments for a number of different cosmetic procedures - although in some cases the claims may outweigh the available evidence. Plastic surgeons are leading the way in identifying promising applications for PRP - including developing standardised procedures and building a body of evidence for good patient outcomes.
The autologous serum shows properties very similar to tears, such as pH, osmolarity, vitamin A and immunoglobulin A. It also shows that tears have several individually distinct components, such as albumin, lactoferrin, lysozymes, aldolase, amylase, fibronectin and substance.
Tears and serum contain abundant common growth factors and antibacterial components that enable the nutritional factors necessary to maintain cell viability in the epithelial repair process.
The use of autologous serum was first described in the search for a lubricious eye drop without harmful preservatives. Later, it became apparent that it could also have true epitheliotrophic potential due to the presence of growth factors and vitamins. Thus, the serum was used as a novel therapeutic approach for ocular surface disorders such as persistent epithelial defects or severe dry eye, which is not treatable with conventional therapy.
Autologous serum has been described not only as a lubricant of the ocular surface, but also as a supplier of various substances essential for the reconstruction of epithelial damage, including vitamin A, epithelial growth factor, fibronectin and various cytokines. With these epitheliotrophic factors, the serum promotes proliferation, migration and differentiation of the ocular surface epithelium. In addition, it is known for its anti-catabolic properties by inhibiting the inflammatory cascade triggered by interleukin-1 (IL-1 ) when it binds to its receptors, preventing tissue destruction.
Therefore, this product has been shown to be effective in the treatment of persistent epithelial defects, neurotrophic ulcers, superior limbal keratoconjunctivitis and dry eye diseases such as graft-versus-host disease or following refractive surgery such as LASIK (laser assisted in situ keratomilesius).
Autologous serum and platelet concentrate have a similar composition as they contain different growth and healing factors present in the blood. However, the autologous serum contains proinflammatory cytokines derived from leukocytes and monocytes, which can be harmful for patients with immunological disorders or diseases.
So, the platelet concentrate has the advantage of not containing these immunoglobulins of inflammation and also regulates the expression of various genes in cellular communication and differentiation, which improves the biological activity of corneal epithelial cells compared to autologous serum.
In addition, PC becomes more effective when it presents higher indices of growth factors, such as: EGF (epithelial growth factor), vitamin A, neuronal growth factor (NGF), insulin type I growth factor and platelet factor IV.
In 2016, Ribeiro et al. also demonstrated how the factors mimic the physicochemical properties of natural tears,(31) which was also demonstrated by Quinto et al. in terms of their importance for corneal and conjunctival epithelial stability and their mechanical and lubricating properties, as well as epitheliotropic and antimicrobial effects.
Growth factors are present in high concentrations in PRP as anabolic agents to support or enhance the healing of damaged tissue, as they are proteins that play an essential role in tissue repair and regeneration processes.
Platelet-rich plasma (PRP) is an autologous serum containing high concentrations of platelets and growth factors. PRP continues to develop as an important treatment modality with many applications in dermatology, particularly in the areas of hair restoration, skin rejuvenation, acne scars, skin augmentation and striae distensae. In addition, the combination of PRP with laser therapies, microneedling, dermal fillers and autologous fat grafting results in synergistic effects leading to improved aesthetic outcomes. Future studies should standardise PRP treatment protocols for specific indications. PRP shows promise in dermatology as therapeutic applications continue to increase.
- Neurology and neurosurgery
PRP therapy for neurological problems may not be one of the traditional and well-known treatment options, but can be used in patients suffering from some typically difficult-to-treat chronic neurological disorders , peripheral and central nervous system disorders, spinal disorders, etc. . PRP procedures have been shown to be particularly effective in treating the following symptoms and disorders:
- Intercostal neuralgia, lumbago & osteochondrosis
- Ankylosing spondylitis ( Bekhetever's disease)
- Spinal artery syndrome & cervicogenic headaches
- Spinal compression fractures
- Spinal injuries
- Headaches and neck pain
- Spondylarthrosis and spondylosis of the spine
- Herniated and slipped discs
- Kyphoscoliosis & scoliosis
The cause of many neurological diseases is often triggered by inflammation of the spine. Unlike most other parts of the body, the blood supply to the spine is quite poor. As a result, even minor and seemingly treatable neurological problems cannot really benefit from the healing properties of platelet-rich plasma (PRP) - a precious fragment of our blood can help the body heal itself.
Is PRP therapy safe?
Since PRP is only taken from the patient's own blood, complications after the procedure are rarely reported, making this new generation treatment incredibly risk-free. The solution injected into the patient usually contains only platelet-rich plasma. Sometimes medical experts use thixotropic gel and anticoagulants, such as those contained in the PRP tube, to give their patients a more successful PRP treatment.
PRP therapy is an ideal solution for patients who have a low tolerance to certain medications or are prone to allergic reactions.
The results after a PRP therapy session are permanent and can usually last up to 6 months after treatment. This is especially true for treatments with Plasma Fresh, as this product has established itself as the market leader in this niche. Neurological doctors may decide to schedule additional treatments depending on the condition they are treating and its severity.
Current clinical applications of platelet-rich plasma in various gynecological disorders: An appraisal of theory and practice