Platelet-Rich Plasma Centrifugation Changes Leukocyte RatiosTheodore E. Harrison, Jannice Bowler, Todd N. Levins, K. Dean Reeves, An-Lin Cheng
Published: April 13, 2021 (see history)
In this study, we looked at what happens to the white blood cells during centrifugation. In our first study we observed that there seemed to be a swing from the "heavier" denser white blood cells to the "lighter" white blood cells. While we don't know what effect this has for your PRP results, we do know that some of these "lighter" cells act as scavengers cleaning up debris and removing the more inflammatory white cells, as well as stimulating the "rest and repair" aspect of the immune system. This may explain some of the healing mechanisms that happen after your initial PRP inflammation has settled down.
Please see our updated handout answering many of your commonly asked questions, under the FAQ page, and then the PRP page. Note that this can also be used following prolotherapy for optimal recovery. There are detailed instructions on what exercises should be done when, along with other tips and instructions. Thanks to Dr Annette Zaharoff for a lot of the information included in the handout. She is a colleague in Texas, who also used to be a professional tennis player, so she knows a thing or two! She has an avid interest in "prehab", ie. getting you prepared for PRP, as well as optimal "rehab" afterwards, and is very knowledgeable in these areas. Please spend time reading this handout before your PRP appointment for best results! A copy is attached here.
A study has been published, showing a significant rise in your platelet count (and thus also the number of platelets you will have when we draw your blood) in response to exercise. Specifically this was after 4 minutes of high intensity training (HIT), tested on a stationary bike. We can probably assume if you do this within 30 mins or less of your blood draw, ie. stop for a quick sprint/jog/aerobic activity (raising your heart rate) to the best of your ability, we will get better platelet counts. If you don't have a heart condition, consider doing this at the Interurban Rail Trail (on the Prospect Lake Rd side of the West Saanich/Prospect Lake intersection) or at the Whitehead park which is minutes from our clinic. Make sure you tell the receptionist as soon as you arrive, so that we can take your blood sample as quickly as possible, for the best result!
Hot off the press is the article I co-wrote with colleagues Drs. Harrison and Levins, on comparing platelet yields using 6 different preparation methods. While this is more of a basic science and technical paper, the bottom line is there is a lot one can do to produce high quality, effective platelet-rich plasma (PRP) to facilitate healing from many chronic musculoskeletal pain conditions. This paper can be found on our research page, under the PRP section. We have already started work on a second paper!
PRP and the knee
We now have a meta-analyis of 10 level 1 studies (level 1 being the highest calibre of studies) showing that platelet-rich plasma (PRP) should be offered for knee osteoarthritis as it is more effective than hyaluronic acid injections (a frequently used treatment) at the 1 year mark. You can find the article about this under our research tab. This is encouraging news for those of us offering and receiving PRP.
The CAOM holds annual conferences in Regenerative Medicine and this year we met in Vancouver. It is always stimulating to listen to excellent speakers in the field, meet old colleagues and new, and exchange information that makes all of us better practitioners. This year we heard an excellent talk on nutrition and its importance by Dr Aileen Burford-Mason - this will have its own blog entry. In addition we had workshops on prolotherapy, platelet-rich plasma and ultrasound-guided techniques. Erik Ouellette, well-respected prolotherapist from Ontario gave a great lecture on injecting the shoulder, and followed up by doing just that. Physicians presented new research studies, some so new they haven't been published quite yet, and our North Vancouver colleague Dr Helene Bertrand discussed her positive shoulder prolotherapy study which has been accepted for publication. Kelowna physician Dr Francois Louw piqued our interest with favourable early trends in his TMJ (jaw) pain study. We came away tired but grateful to belong to such a good organization.
Platelet-rich plasma (PRP)
More people are becoming familiar with platelet-rich plasma, or PRP. This is an effective treatment for musculoskeletal pain which involves having your blood drawn, much like a lab test, centrifuging it into red cells, white cells and platelets, and removing the concentrated platelet section containing liquid gold growth factors (and there are many of these!). This PRP is injected into the area of concern (for example the knee joint) to begin the regeneration of healthy tissue needed for recovery. PRP is similar to prolotherapy in that it stimulates tissue repair, but it can speed up the healing process enormously. Our new system provides a whopping 8x concentration of the platelets and we think this leads to its effectiveness. While not guaranteed to work for everyone, it is gratifying for most. For more information see our updated FAQ page; and also our Links page for some studies on platelet-rich plasma.
An interesting study was published recently. Having a knee arthroscopy (a surgical procedure with a "telescope" looking into the knee, and cleaning out any part that is rough or loose) does not improve pain. Many, many people suffer from knee arthritis and so this is helpful in deciding on a course of action. Having a knee replacement may be the eventual answer, but in the mean time regenerative injections (perineural injecting of dextrose, or prolotherapy, or PRP) can be a big help in reducing symptoms, and may even prevent the "kneed" to do surgery at all.
This changed my practice
The University of BC regularly sends out articles by physicians who have found some aspect of medicine has changed the way they practice. I have been meaning to send them my views on the subject and here they are! Thank you to the many patients over the years who have taught me so much about the treatment of pain.
Platelet Rich Plasma
We now offer this cutting-edge therapy to our patients. More about platelet-rich plasma, or PRP, can be found under our FAQs tab. This is what the process look like: 15 ml of your blood is withdrawn, then centrifuged to separate it into red cells, platelets, and platelet-rich yellow plasma at the top. The plasma is then re-injected into a painful joint, ligament or tendon junction. This sets off the inflammatory cascade of healing, and once the initial discomfort has settled, growth factors in the plasma stimulate the production of healthy new tissue to facilitate healing. It is a quicker way to stimulate healing than prolotherapy, but it is also a more expensive procedure, although typically fewer PRP treatments are needed than prolotherapy treatments to achieve the same degree of healing. Sometimes PRP is combined with prolotherapy for the best effect. PRP is usually given into the affected joint, with prolotherapy given to the surrounding ligaments for stronger support.
Jannice is a family physician with an interest in the treatment of pain. Anything to help the process is added to this blog.