Platelet-rich plasma

Platelet-rich plasma
MeSH D053657

Platelet-rich plasma (PRP), also known as autologous conditioned plasma, is a concentrate of platelet-rich plasma protein derived from whole blood, centrifuged to remove red blood cells. Evidence for benefit is poor.

As a concentrated source of blood plasma and autologous conditioned plasma, PRP contains several different growth factors and other cytokines.

Medical use

Platelet-rich plasma injections into the hand
Platelet-rich plasma injection into the hand

PRP has been investigated and used for chronic tendinitis,[1] osteoarthritis,[2] in oral surgery,[3] and in plastic surgery.[4]

A 2015 meta-analysis on PRP for osteoarthritis (OA) of the knee and found that nine were worth considering and concluded that with respect to short term outcomes, PRP was no better than placebo.[5]

A 2009 review found few randomized controlled trials that adequately evaluated the safety and efficacy of PRP treatments and concluded that PRP was "a promising, but not proven, treatment option for joint, tendon, ligament, and muscle injuries".[6]

A 2010 Cochrane analysis on PRP use in sinus lifts during dental implant placement found no evidence that PRP offered any benefit.[3]

A 2013 review stated more evidence was needed to determine PRP's effectiveness for hair regrowth.[7]

A 2014 Cochrane review of PRP use in musculoskeletal injuries found very weak evidence for a decrease in pain in the short term, and no difference in function in the short, medium or long term. There was weak evidence that suggested that harm occurred at comparable, low rates in treated and untreated people.[8] Similarly, another 2017 review for treating pain on skin graft donor sites found the evidence for benefit was poor.[9]

It has not been shown to be useful for bone healing.[10] A 2016 review of PRP use to augment bone graft found only one study reporting a difference in bone augmentation, while four studies found no difference.[11]

Since 2004, proponents of PRP therapy have argued that negative clinical results are associated with poor-quality PRP produced by inadequate single spin devices. The fact that most gathering devices capture a percentage of a given thrombocyte count could bias results, because of inter-individual variability in the platelet concentration of human plasma and more would not necessarily be better.[12]

PRP is also being injected into the vagina, in a procedure called "O-shot" or "orgasm shot" with claims that this will improve orgasms.[13] There is no evidence, however, to support these claims.[13]

Adverse effects

There are no studies to date that have reliably documented adverse effects associated with PRP treatment, possibly due to poor and inconsistent methodology.[14]

Composition

Whole blood placed in Centrifuge prior to two stage centrifugation

There are four general categories of preparation of PRP based on its leukocyte and fibrin content: leukocyte-rich PRP (L-PRP), leukocyte reduced PRP (P-PRP; leukocyte reduced or pure PRP), leukocyte platelet-rich fibrin and pure platelet-rich fibrin.[15][16]

The efficacy of certain growth factors in healing various injuries and the concentrations of these growth factors found within PRP are the theoretical basis for the use of PRP in tissue repair.[17] The platelets collected in PRP are activated by the addition of thrombin and calcium chloride, which induces the release of the mentioned factors from alpha granules. The growth factors and other cytokines present in PRP include:[17][18]

Manufacturing

PRP is prepared by taking blood from the person, and then putting it through two stages of centrifugation designed to separate PRP from platelet-poor plasma and red blood cells. This is usually done by the clinic offering the treatment, using commercially available kits and equipment.[19] The resulting substance varies from person to person and from facility to facility, making it difficult to understand how safe and effective any specific use is.[19][20]

Society and culture

The cost of a PRP treatment in the U.S. has been quoted as $1000 out-of-pocket expenses, as it is usually not covered by health insurance.[21] PRP has received attention in the popular media as a result of its use in by atheletes.[22][23][24][21] Use in an office setting is not approved by the FDA.[25]

Doping

Some concern exists as to whether PRP treatments violate anti-doping rules.[17] As of 2010 it was not clear if local injections of PRP could have a systemic impact on circulating cytokine levels, affecting doping tests and whether PRP treatments have systemic anabolic effects or affect performance.[17] In January 2011, the World Anti-Doping Agency removed intramuscular injections of PRP from its prohibitions after determining that there is a "lack of any current evidence concerning the use of these methods for purposes of performance enhancement".[26]

Veterinary use

Platelet-rich plasma is used in horses for treatment of equine lameness due to tendon and ligament injury, wounds, fractures, bone cysts, and osteoarthritis.

See also

References

  1. ↑ Mishra A, Woodall J, Vieira A (2009). "Treatment of tendon and muscle using platelet-rich plasma". Clinics in Sports Medicine. 28 (1): 113–25. doi:10.1016/j.csm.2008.08.007. PMID 19064169.
  2. ↑ Andia I, Sanchez M, Maffulli N (2012). "joint pathology and platelet-rich plasma therapies". Expert Opinion in Biological Therapies. 12 (1): 7–22. doi:10.1517/14712598.2012.632765. PMID 22171664.
  3. 1 2 Esposito M (Spring 2010). "Effectiveness of sinus lift procedures for dental implant rehabilitation: a Cochrane systematic review". Eur J Oral Implantol. 3 (1): 7–26. PMID 20467595.
  4. ↑ Por YC, Shi L, Samuel M, Song C, Yeow VK (2009). "Use of tissue sealants in face-lifts: a metaanalysis". Aesthetic Plastic Surgery. 33 (3): 336–9. doi:10.1007/s00266-008-9280-1. PMID 19089492.
  5. ↑ Kanchanatawan, W; Arirachakaran, A; Chaijenkij, K; Prasathaporn, N; Boonard, M; Piyapittayanun, P; Kongtharvonskul, J (May 2016). "Short-term outcomes of platelet-rich plasma injection for treatment of osteoarthritis of the knee". Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. 24 (5): 1665–77. doi:10.1007/s00167-015-3784-4. PMID 26387122.
  6. ↑ Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA (2009). "Platelet-rich plasma: from basic science to clinical applications". Am J Sports Med. 37 (11): 2259–72. doi:10.1177/0363546509349921. PMID 19875361.
  7. ↑ Valente Duarte de Sousa, Isabel Cristina; Tosti, Antonella (May 2013). "New investigational drugs for androgenetic alopecia". Expert Opinion on Investigational Drugs. 22 (5): 573–589. doi:10.1517/13543784.2013.784743. ISSN 1744-7658. PMID 23550739.
  8. ↑ Moraes VY (April 2014). "Platelet-rich therapies for musculoskeletal soft tissue injuries". Cochrane Database Syst Rev. 29 (4): CD010071. doi:10.1002/14651858.CD010071.pub3.
  9. ↑ Sinha S, Schreiner AJ, Biernaskie J, Nickerson D, Gabriel VA (June 2017). "Treating pain on skin graft donor sites: review and clinical recommendations". J Trauma Acute Care Surg. doi:10.1097/TA.0000000000001615. PMID 28598907.
  10. ↑ Griffin XL, Smith CM, Costa ML (2009). "The clinical use of platelet-rich plasma in the promotion of bone healing: a systematic review". Injury. 40 (2): 158–62. doi:10.1016/j.injury.2008.06.025. PMID 19084836.
  11. ↑ Pocaterra A, Caruso S, Bernardi S; et al. (2016). "Effectiveness of platelet-rich plasma as an adjunctive material to bone graft: a systematic review and meta-analysis of randomized controlled clinical trials". Int J Oral Maxillofac Surg. 45: 1027–1034. doi:10.1016/j.ijom.2016.02.012.
  12. ↑ Marx RE (2004). "Platelet-rich plasma: evidence to support its use" (PDF). Journal of Oral and Maxillofacial Surgery. 62 (4): 489–96. doi:10.1016/j.joms.2003.12.003. PMID 15085519.
  13. 1 2 Osborne, Hannah (8 July 2016). "Injecting blood plasma into your clitoris for $2,500 won't give you with better orgasms". International Business Times UK. Retrieved 1 October 2018.
  14. ↑ Frautschi, RS; Hashem, AM; Halasa, B; Cakmakoglu, C; Zins, JE (1 March 2017). "Current Evidence for Clinical Efficacy of Platelet Rich Plasma in Aesthetic Surgery: A Systematic Review". Aesthetic surgery journal. 37 (3): 353–362. doi:10.1093/asj/sjw178. PMID 28207031.
  15. ↑ Pavlovic, V; Ciric, M; Jovanovic, V; Stojanovic, P (2016). "Platelet Rich Plasma: a short overview of certain bioactive components". Open Medicine. 11 (1): 242–247. doi:10.1515/med-2016-0048. PMC 5329835. PMID 28352802.
  16. ↑ Bielecki, T; Dohan Ehrenfest, DM; Everts, PA; Wiczkowski, A (June 2012). "The role of leukocytes from L-PRP/L-PRF in wound healing and immune defense: new perspectives". Current Pharmaceutical Biotechnology. 13 (7): 1153–62. doi:10.2174/138920112800624373. PMID 21740376.
  17. 1 2 3 4 Borrione P, Gianfrancesco AD, Pereira MT, Pigozzi F (2010). "Platelet-rich plasma in muscle healing". Am J Phys Med Rehabil. 89 (10): 854–61. doi:10.1097/PHM.0b013e3181f1c1c7. PMID 20855985.
  18. ↑ Yu W, Wang J, Yin J (2011). "Platelet-Rich Plasma: A Promising Product for Treatment of Peripheral Nerve Regeneration After Nerve Injury". Int J Neurosci. 121 (4): 176–180. doi:10.3109/00207454.2010.544432. PMID 21244302.
  19. 1 2 Dhurat, R; Sukesh, M (2014). "Principles and Methods of Preparation of Platelet-Rich Plasma: A Review and Author's Perspective". Journal of cutaneous and aesthetic surgery. 7 (4): 189–97. doi:10.4103/0974-2077.150734. PMC 4338460. PMID 25722595.
  20. ↑ Kanchanatawan, W; Arirachakaran, A; Chaijenkij, K; Prasathaporn, N; Boonard, M; Piyapittayanun, P; Kongtharvonskul, J (May 2016). "Short-term outcomes of platelet-rich plasma injection for treatment of osteoarthritis of the knee". Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. 24 (5): 1665–77. doi:10.1007/s00167-015-3784-4. PMID 26387122.
  21. 1 2 Gina Kolata (2010-01-12). "Popular Blood Therapy May Not Work". New York Times.
  22. ↑ Alan Schwarz (2009-02-16). "A Promising Treatment for Athletes, in Blood". New York Times. New York.
  23. ↑ Gretchen Reynolds (2011-01-26). "Phys Ed: Does Platelet-Rich Plasma Therapy Really Work?". New York Times.
  24. ↑ Carina Storrs (2009-12-18). "Is Platelet-Rich Plasma an Effective Healing Therapy?". Scientific American.
  25. ↑ Beitzel, K; Allen, D; Apostolakos, J; Russell, RP; McCarthy, MB; Gallo, GJ; Cote, MP; Mazzocca, AD (February 2015). "US definitions, current use, and FDA stance on use of platelet-rich plasma in sports medicine". The journal of knee surgery. 28 (1): 29–34. doi:10.1055/s-0034-1390030. PMID 25268794.
  26. ↑ "World Anti-Doping Agency announces changes to Prohibited List". Irish Medical Times. 2011-01-10.
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