Today we will be discussing platelet rich plasma or PRP. Autologous PRP injections are quite common and are used to aid in wound healing. Autologous PRP injections have become quite common in many clinical settings ranging from the orthopedic setting to dermatology, especially since major athletes such as Tiger Woods, Kobe Bryant and Hines Ward have received PRP injections.
Dr. Claudia Cohn explains the theory behind the utility of PRP:
“Platelets contain multiple cytokines and growth factors that may aid in the healing process. PRP is especially popular in the orthopedic setting, where it has been used to alleviate the pain and chronic wear and tear injuries, such as ‘tennis elbow’, or to hasten healing in acute muscle tears.”
Despite widespread use, no standards exist for autologous PRP. Various collection techniques can be used which yield wide variations in platelet count and concentration. Different cells preparations used also lead to variations in the presence of white blood cells and platelet-rich fibrin in the administered PRP.
A recent article in TRANSFUSION reviewed 12 randomized clinical trials of PRP use in orthopedic settings and found varying results. Only four of the 12 trials reported some benefit from PRP injections, which was usually a reduction in pain. The variation between trials is likely due to collection techniques and cell preparations. The presence or absence of white blood cells may be important since these cells help fight infections and serve as a source of growth factors causing angiogenesis.
Dr. Cohn comments:
“It will be difficult to properly access the therapeutic value of PRP until uniform standards are developed for PRP manufacturing and handling.”
Currently, PRP use has avoided regulatory scrutiny as a biologic because it is a low-risk, autologous product.
Dr. Mark Fung, who wrote an editorial on this issue, adds:
“The regulation around this is murky. It has been approved for the most part as a medical device. I think we need to step back and look at it as a blood-derived product and take into account the issues of the processing, not just strictly the device that has been approved.”
Dr. Fung also emphasized that the transfusion community would be ideal to help set-up regulations for PRP injections since they have broad experience in collecting and injecting blood components.
We’ll be back with another Transfusion News video on August 30, but will continue to have weekly news updates and the questions of the day throughout the summer.
References
1. Cohn CS, Lockhart E, McCullough JJ. The use of autologous platelet-rich plasma in the orthopedic setting. Transfusion 2015;55:1812-1820.
2. Fung M, Harm S. Platelet-rich plasma injections: out of control and on the loose? Transfusion 2015;55:1596-1598.
