4. Platelet-Rich Plasma and Autologous Conditioned Sera Flashcards
What part of the platelet contains all the growth factors?
What part of the platelet contains all the growth factors?
Alpha granules
What are the 8 most common/major factors in the alpha granules that are essential for healing?
What are the 8 most common/major factors in the alpha granules that are essential for healing?
Platelet derived growth factor (PDGF), vascular endothelial growth factor (VEGF), Transforming growth factor B (TGH-B), basic fibroblast growth factor (bFGF), insulin like growth factor (IGF), hepatocyte growth factor (HGF), endothelial growth factor (EGF), and connective tissue growth factor (CTGF)
How concentrated should the platelets be to be considered PRP?
How concentrated should the platelets be to be considered PRP?
3-5x that of peripheral blood
What is false about PRP?
A. Shown to increase the proliferation of mesenchymal stem cells and fibroblasts in a dose dependent manner.
B. TGF-B has been shown to increase collagen type 1 production in tendon fibroblasts and increases the strength of the tendons
C. Platelets stimulate the formation of osteoclast-like cells critical for long bone growth and remodeling
D. There are several studies that show solid evidence showing that PRP when used alone can accelerate cortical bone healing.
What is false about PRP?
D. There are several studies that show solid evidence showing that PRP when used alone can accelerate cortical bone healing.
**There is no evidence that PRP accelerates cortical bone healing when used alone…thus should use it with grafts or recombinant growth factors
TRUE:
A. Shown to increase the proliferation of mesenchymal stem cells and fibroblasts in a dose dependent manner.
B. TGF-B has been shown to increase collagen type 1 production in tendon fibroblasts and increases the strength of the tendons
C. Platelets stimulate the formation of osteoclast-like cells critical for long bone growth and remodeling
What are the two methods of preparing PRP?
What are the two methods of preparing PRP?
Filtration & Centrifugation
Filtration:
Gravity is used to pass the blood through a filter, on which platelets, erythrocytes, and some leukocytes are captured. Sterile saline is then flushed back through the filter in the opposite direction to displace the cells from the filter. This results in a leukocyte- and platelet-rich preparation in saline solution.
Centrifugation (most common):
10-110 mL of whole blood is collected with anticoagulant. Low force brief centrifuge “soft spin” gives three layers: red blood cells, a buffy coat containing leukocytes and platelets, and a plasma layer. For leukocyte-free platelet-rich plasma, the plasma and ONLY uppermost layer of the buffy coat are transferred to a new separation device (if you want the leukocytes, take the whole buffy coat). 2nd longer centrifugation is performed at a higher force, “hard spin”. Results in a second buffy coat containing a large number of platelets beneath a platelet-poor component of plasma. The majority of the platelet-poor plasma is discarded, and the pellet is resuspended in the desired volume of platelet-poor plasma, resulting in a small volume of platelet-rich plasma containing platelets and fibrin-rich plasma.
What are the advantages and disadvantages of filtration PRP preparation system over centrifugation?
What are the advantages and disadvantages of filtration PRP preparation system over centrifugation?
Advantages = Ease of use, reduced overhead costs in that a system-specific centrifuge is not required, and speed of platelet-rich plasma preparation (approximately 6 to 10 minutes)
Disadvantages = Recovered cells are suspended in saline rather than plasma, thus eliminating any benefits that plasma and associated proteins may provide, and 2 studies have shown canine platelet-rich plasma produced via filtration contained lower concentrations of platelets and increased concentrations of leukocytes and erythrocytes than centrifuged PRP.
What are the limitations of PRP?
What are the limitations of PRP?
Deficits in basic science research, inherent variability in the platelet-rich plasma “product” due to discrepancies between donors and preparation systems, the inability to completely assess individual platelet-rich plasma samples prior to clinical application.
Unknown what the ideal platelet number, growth factor concentration, and proper delivery timeline necessary to successfully treat specific diseases are - consistent platelet-rich plasma dosing protocols have yet to be established for small-animal applications.
Limited risk of contamination, also contraindicated in patients with thrombocytopenia or coagulation defects.
Lack of strong supportive published evidence.
Based on currently available literature, what level of confidence would you have in recommending PRP injections for the treatment of OA, what frequency?
Based on currently available literature, what level of confidence would you have in recommending PRP injections for the treatment of OA, what frequency?
No one knows, every 3 months?
Based on currently available literature, what level of confidence would you have in recommending PRP injections for tendinopathy?
Based on currently available literature, what level of confidence would you have in recommending PRP injections for tendinopathy?
Data is sparse and not convincing.
How many studies on PRP are available for treating client-owned cats?
How many studies on PRP are available for treating client-owned cats?
NONE.
Which cytokine blunts the effect of Il-1B?
Which cytokine blunts the effect of Il-1B?
IL-1ra
What is the primarily studied use for autologous conditioned sera and how is it administered?
What is the primarily studied use for autologous conditioned sera and how is it administered?
Management of osteoarthritis & intra articular injection
