Platelet-Rich Plasma Injections: Protocol Guide
Almost all sports medicine doctors agree that there’s no harm in trying Platelet Rich Plasma Injections (PRP Injections) for their patients. After all, there are hundreds of thousands of cases with positive results. All it needs is research to prove its worth. Currently, many independent researches are ongoing, funded privately, like the one conducted by Dr. Kimberly G. Harmon M.D., director of the Primary Care Sports Medicine fellowship at the University of Washington. She recently received a gift to support her research from UW alumni who firmly believe in Platelet-Rich Plasma (PRP).
While the process of extracting PRP is fairly simple—there are many variants as long as platelets are above baseline levels with at least seven growth factors—many physicians are still unsure about what they can and can’t do when it comes to this marvelous procedure. Today, let’s shed light on the fine print.
Platelet-Rich Plasma Injections Protocol
Protocol/Technique
Usually, the procedure requires the physician/surgeon and an assistant or two to help with the preparation of the graft, maintenance of sterile technique, and saving the ultrasound images (if relevant).
Pre-Procedure Considerations
- There should always be a specific indication associated with a physical exam with confirmed imaging studies such as an ultrasound, CT scan, or MRI before treatment.
- Proper patient education and a discussion must be had with the patient, as well as a signed informed consent prior to the procedure.
- Contraindications must be reviewed prior to the procedure.
Graft Preparation
- The patient should be positioned in a comfortable seated or reclining position.
- Sterile single needles and syringes must be used with proper handling and disposal.
- Using an aseptic procedure, the proper amount of blood is then drawn from the vein for the PRP procedure.
- If the blood cannot be obtained from the site the first time, a new site must be used to prevent early activation.
- Using a sterile technique, transfer the tube of venous blood to the centrifuge. Platelet-Rich Plasma should be acquired using a separating device created for autologous blood. Preference is always given to a closed system that will prevent exposure of the blood and its cellular components to the open air, and permits minimal use of the tissue.
Image Guidance PRP Therapy
- Real-time imaging guidance using ultrasound, CT, or fluoroscopy should always be used when performing a PRP injection.
- If ultrasound is going to be used, the following considerations need to be decided in advance: For lengthy procedures, PRP injections near the spine, and intra-articular injections, sterile gel is recommended.
- Always use sterile probe covers. Cleansing the probe before and after the PRP procedures and observing sterile technique is sufficient.
- Guided images and indelible markings of the site of the probe position and the needle entry always need to be made before cleaning the skin where the probe and needle will be inserted.
- Always apply a bandage or a dressing after the procedure to protect the entry site from germs.
Post-Injection Care
- The patient should be monitored for any post-PRP procedure complications such as vaso-vagal reactions.
- Patients should be given post-procedure directions and precautions, and any questions should be answered before they leave. They should also have emergency contact information.
- Patients should be instructed about immobilization and any post-procedure activities that are allowed and/or not allowed.
- Post-PRP procedure pain prescriptions need to be given to the patient before discharge, and any questions about the medication(s) should be answered at this time. Patients also need to be instructed to avoid NSAIDs until they have healed, are pain-free, and have full function returned to the treated area.
- Per OSHA guidelines, contaminated areas must be disinfected before the next patient uses the room.
- The PRP procedure must be documented in detail, including a procedure note with the following information: date, pre- and post-procedure diagnosis, name of the procedure, physician/surgeon(s), any assistants, whether or not anesthesia was used and what type, short-term indication of the procedure, a description of the graft preparation, and a description of the procedure, including any/all guidance and instruments used.
Follow-up Care
- Patients are normally re-examined 2-6 weeks after the PRP procedure to follow up on pain, use, the injection site, and to discuss any concerns and future course of action.
- The patient response to the treatment should be recorded using authenticated outcome measures.
- Any complications, responses, and all other relevant information should be logged into the ICMS tracking system.
- Consideration for another PRP injection should be the center of the discussion, and the patient will be able to make a decision based on the outcome.
Safety Considerations
- Universal precautions must be used before, during, and after the procedure.
- Risk of infection: PRP is antimicrobial and provides effective protection against most bacterial infections except for Klebsiella, Pseudomonas, and Enterococcus.
- With the graft being made entirely out of autologous blood, it virtually eliminates the risk of disease transmission unless the graft becomes contaminated.
Risks to Patients from the Procedure
- Infection
- Bleeding
- Nerve damage
- Pain
- Lack of result
- Loss of limb and death (very rare)
Platelet-Rich Plasma: Indications
Musculoskeletal complaints require a complete history and exam to find a diagnosis. Often, diagnostic studies may be needed and reviewed to understand why prior treatments failed. PRP is usually considered an optional treatment for chronic and subacute conditions. Commonly, healing slows down or stops altogether at the 6-12 week period following an acute or traumatic injury. If the patient has not had any improvement for over the first six weeks, it’s probable the healing period has stopped.
Platelet-Rich Plasma: Contraindications
- Septicemia
- Platelet dysfunction syndrome
- Localized infection at the procedure site
- Hemodynamic instability
- Critical thrombocytopenia
- Patient not willing to take the risks involved with the procedure
Relative Contraindications:
- Regular use of NSAIDs within 48 hours of the PRP procedure
- HGB of < 10 g/dl
- Platelet count of < 105/ul
- Systemic use of corticosteroids within 2 weeks
- Recent illness or fever
- Cancer, particularly hematopoietic or bone
- HGB < 10 g/dl
- Platelet count < 105/ul
- Corticosteroid injection at the treatment site within 1 month
- Tobacco use
- Published in Corporate News / Blog
Platelet-Rich Plasma For Melasma — Will It Fade Forever?
For most women, a tiny pimple on the face is enough to ruin their day. Or week. Even the slightest imperfection that may have a 1% chance of getting noticed by others will freak them out. For these women, Melasma is their darkest nightmare. It’s a pretty common issue, a result of exposure to the sun, that causes brown patches on the face. Permanent patches, I should add.
If you’re suffering from Melasma, the road to “recovery” usually looks like this:
- You hope that it’ll fade away.
- Your friend suggests you try apple cider vinegar and lemon juice treatment.
- Slightly disappointed.
- You visit a dermatologist who’ll prescribe a bleaching cream (hydroquinone or similar).
- Full-on disappointment.
- You Google the hell out of the topic.
- Overwhelm.
- Concealers and makeup become your best friend.
At this point, no one can convince you there is a treatment for getting rid of melasma. Trying more and more treatments only runs the risk of making the condition worse. So what would you do?
What About Platelet-Rich Plasma For Melasma?
According to recent Turkish and Malaysian studies, Platelet-Rich Plasma is showing great promise for melasma. The one good thing about PRP for Melasma is the fact that PRP won’t make the condition worse unlike IPL, Fraxel, or other treatments. So that’s one of the treatments you can confidently try without worry. It’s like getting a natural facial treatment that has a whole lot of potential benefits even if it didn’t help cure melasma.
PRP injections work by supplying growth factors to reduce the pigmentation. And being an independent treatment with no downtime, it can be done in conjunction with conventional treatments for melasma to add and enhance the effects. There are more than 30 bioactive substances in Platelet-Rich Plasma that have separate roles like increasing skin volume and adding new blood vessels to name a few.
Platelet-Rich Plasma with Microneedling
This is the most common combination for Platelet-Rich Plasma therapy. Here’s a video of Dr. Michael Somenek performing a PRP injection on a patient of his immediately after microneedling. The combination is known to have produced results for a lot of varieties of skin pigmentation issues that it’d not be wise for anyone to ignore it for melasma, especially when creams and peels didn’t help. More important is PRP’s ability to stimulate collagen production in the area so it tightens the pores and makes your skin glowing.
Why Platelet-Rich Plasma?
PRP is primarily a healing vehicle. It needs to be injected into the membrane below the skin. The way it works is by supplying the underlying skin membrane with collagen and tenascin stimulated by the transforming growth factors in PRP. These growth factors also promote the formation of new blood vessels that in some cases results in the disappearance of spider veins.
The released growth factors (mainly platelet-derived growth factor (PDGF), epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), and transforming growth factor-beta (TGF-ß)) can stimulate the proliferation of fibroblasts and epidermal cells, and collagen synthesis. In addition, the transforming growth factor-beta (TGF-ß) has been proven to inhibit melanogenesis — or reverse skin pigmentation — the exact opposite effect of exposure to UV-B radiation.
Typically, patients see excellent results with 2-3 PRP injections in the first 3 months. And clinical studies have shown that it will maintain after 6 months. However, Melasma is known to recur even after successful treatments. So you must take precautions against it by using sunscreen with broad-spectrum protection and an SPF of 30 or higher. And avoid skincare products that are harsh as they can exacerbate melasma.
- Published in Corporate News / Blog
tem Cell Platelet-Rich Plasma: The Best Regenerative Therapy?
To understand why stem cell platelet-rich plasma or co-transplantation of adipose-derived mesenchymal stem cells (ADSC) and PRP is such a remarkable idea in regenerative medicine, let’s spend a little time looking at the mechanics of PRP.
Platelet-Rich Plasma’s Role as Repairmen
The one thing that makes Platelet-Rich Plasma a hero in several fields (if not all) of medicine is the fact that the diverse growth factors in it are able to stimulate stem cell proliferation and cell differentiation (the factors that determine effective tissue regeneration and healing) on any part of the body. These growth factors are abundant in the blood and act as the natural repairmen of tissues. In the perfect scenario, there’s plenty of blood flow to every part of the body, and these “repairmen” are always on-call to address any healing needs that may arise. However, if the injured area has a poor blood supply — especially areas that constantly move like tendons, ligaments, and joints — demand for these repairmen can outgrow supply. Meaning, healing (or regeneration of tissues) is put on hold till further repairmen are available.
The train of Platelet-Rich Plasma then arrives with enough of these repairmen to warrant the resumption of healing. There’s another part of this picture we haven’t talked about so far: stem cells.
Stem Cells as the Raw Materials for PRP
As far as Platelet-Rich Plasma and its growth factors are concerned, they are mere repairmen. They can’t do the work by themselves. They need the basic raw materials to work with. And that raw material here is stem cells. Stem cells are the ones actually being regenerated to form new tissues for healing.
Supplying Both PRP and Stem Cells for Regeneration
Stem cells are the only raw materials that PRP works with for regeneration. These are like the fundamental building blocks of all other cells. These cells can be guided into becoming specialized cells under the right conditions. In addition, they can also divide themselves to form new stem cells or new specialized cells. So for Platelet-Rich Plasma to work well, it needs to be applied to an area with lots of stem cells like the heart, liver, blood vessels, etc. Incidentally, Platelet-Rich Plasma’s healing properties were first discovered by cardiac surgeons who played with concentrated blood for faster healing of the heart after surgery, and it showed tremendous promise because stem cells are abundant in heart tissues. But what if healing is needed in an area where there are not many stem cells?
With the new developments in stem cell technology, that can be solved too. Because now we can supply the stem cells to areas where there are less like the joints, ligaments, and tendons. For this, scientists usually use “mesenchymal stem cell” or MSCs. These are cells isolated from stroma and can differentiate to form adipocytes, cartilage, bone, tendons, muscle, and skin. The easiest way is to harvest it from adipose tissue or fat that we call Adipose-derived mesenchymal stem cells or ADSC.
The Future of Stem Cell Platelet-Rich Plasma
In regions with hypoxia (poor blood supply) like joints, meniscus tissue, rotator cuff, spinal discs, etc., the supply of platelets (and therefore growth factors) as well as the stem cells are limited. So what if we supplied both the stem cells and Platelet-Rich Plasma for triggering the regeneration process? That’s the question these Japanese scientists answered in their research. Here’s another group of scientists who took on the same challenge.
They used Adipose-derived mesenchymal stem cells (ADSC), which are known for their ease of isolation and extensive differentiation potential. These researchers noted that these stem cells often can’t survive in areas of local hypoxia, oxidative stress, and inflammation – thereby making them ineffective. However, when Platelet-Rich Plasma (or thrombin-activated PRP) is added to ADSC, it kept them alive for prolonged periods and the growth factors in the Platelet-Rich Plasma triggered cell differentiation and proliferation more easily.
Why This Exact Combination Is the Future
Done this way, both Adipose-derived mesenchymal stem cells (ADSC) and Platelet-Rich Plasma are raw materials for healing that’s already available in plenty in almost everyone (there are exceptions of course). That means, for complete healing to take place, this combination treatment, still in its very primitive stage of development, may have the potential to replace expensive synthetic drugs that carry complex unexplained side effects. The procedure takes our body’s natural healing agents — stem cells from body fat and PRP from blood — and then injects them inside the knee or other joints (or other areas where they are insufficient) for regeneration. Isn’t that like the most wonderful thing ever?
Whether it’s a cartilage cell, a bone cell, or a collagen cell for ligaments and tendons that need to be healed, all you need is a same-day procedure by a local, but specialized doctor, using the natural ingredients of the body. I believe this special combo is a huge win for Platelet-Rich Plasma.
The Challenges for Growing Adoption of This Treatment
We know Platelet-Rich Plasma has safe, yet high-speed recovery potential with its multiple growth factors. And it is effective in regenerative healing of cartilage injuries – the toughest injuries to heal – as well as Osteoarthritis. However, the challenges are Platelet Quality. We need to somehow ensure the Platelet-Rich Plasma quality is uniform. Currently, it varies from two to several fold above baseline concentration based on the donor’s physical condition.
Next, we need to identify the exact PRP growth factors that promote ADSC proliferation. Scientists believe growth factors such as basic fibroblast growth factor (bFGF), epidermal growth factor, and platelet-derived growth factor stimulate stem cell proliferation while some growth factors under certain conditions are known to inhibit the process. The percentage of PRP matters too. Scientists have tested 5 percent, 10 percent, 15 percent, and 20 percent Platelet-Rich Plasma in ADSC.
The Only Treatment in Modern Medicine for Cartilage Regeneration
The bottom line is that Stem Cell Platelet-Rich Plasma or ADSC + PRP procedure is the only treatment in modern medicine that has shown cartilage regeneration. So it’s too important to ignore. And it could be one of the greatest advances that science has brought to the millions of people suffering from serious pain in their joints, knee, and spine as well as people suffering from all kinds of tendon diseases and injuries.
To understand why stem cell platelet-rich plasma or co-transplantation of Adipose-derived mesenchymal stem cells and PRP, is such a remarkable idea in regenerative medicine, let’s spend a little time looking at the mechanics of PRP.
- Published in Corporate News / Blog
