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Perf tech 3 > PRP > Flashcards

PRP Flashcards

1
Q

Young, fecund, robust, inactivated platelets are HOW BIG

A

1-3 μm discoids

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2
Q

Humans: Normally HAVE HOW many platelets

A

150,000-300,000/ml of blood

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3
Q

life span of a platelet

A

one week

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4
Q

dog platelets amount

A

145,000-440,000/ml but similar size

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5
Q

cat platelet amount

A 
190,000-800,000/ml
Very large platelets
Easily activated
Much higher tendency
to aggregate
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6
Q

horse platelets

A

100,000-600,000/ml
Small platelets
Uniform size and shape

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7
Q

cow platelets

A 
100,000-800,000/ml
Small platelets of variable
size
Lack the microtubular
system and open canalicular system of non-ruminants
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8
Q

mouse platelets

A

LOTS (>1,000,000/ml)
Also small platelets
that are very readily
activated. Why?

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9
Q

α-granules contain

A

clotting factors, growth factors, and various other proteins

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10
Q

dense granules contain

A

ADP, ATP, Serotonin, and Calcium

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11
Q

young platelet size

A

large and heavy

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12
Q

old platelet size

A

small and light

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13
Q

young platelets aggregation compared to old platelets

A

much faster (3-5 x) than older platelets

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14
Q

Young platelets ATP and ADP release compared to old platelets

A

release dramatically more ATP (4-8 x) and ADP (4-6 x) than do older platelets

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15
Q

Old platelets require substantially greater amounts

A

ADP to be activated than do young platelets

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16
Q

Interestingly, old and young platelets don’t necessarily

A

live in the same neighborhood

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17
Q

Interestingly, old and young platelets don’t necessarily

A

live in the same neighborhood

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18
Q

PRIMARY HEMOSTASIS OF PLATELETS

A

vasoconstriction, platelet adhesion, platelet aggregation

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19
Q

secondary hemostasis

A

activation of coagulation factors. fibrin formation

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20
Q

fibrinolysis

A

activation of fibrinolytic system, clot lysis

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21
Q

platelet process up to aggregation

A

Wound
Exposes subendothelial collagen
Binds von Willebrand Factor
Platelet adhesion to blood vessel wall via glycoprotein
IIb/IIIa receptors
Platelet activation
Platelet cytoskeleton (via actin and myosin) expands
from a disc to a multi-pseudopodal sticky blob
Platelet aggregation

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22
Q

platelet aggregation process

A

Serotonin Vasoconstriction
ADP Recruits other platelets to aggregate and degranulate
Thromboxane Platelet aggregation and PGF release
…and more cytokines, chemotactic and growth factors, etc., etc. than you can imagine (more are discovered on a monthly basis)

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23
Q

PDGF: Platelet-Derived Growth Factor

A

STRONGLY mitogenic and chemotactic for leukocytes
 By itself PDGF application doubles the rate of collagen
deposition in a wound
 (plus a bunch of other stuff that aggressively accelerates
healing…)

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24
Q

TGF-β: Transforming Growth Factor-Beta

A

Also strongly mitogenic
 Allows damaged (irradiated, corticosteroid-treated)
tissues to revert to normalized collagen deposition

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25
Q

Attracted neutrophils and macrophages release

A

a host

of other healing factors

26
Q

Granulocytes (neutrophils) may be

A

good bad or indifferent

27
Q

neutrophils Cells expressing the CD34

protein are

A

concentrated in
the mononuclear layer of
platelet concentrate
-These cells are stem cell “markers” and are
important for other cells’ adhesion/chemotaxis

28
Q

TGF beta source and function

A

platelets,matrix of bone, cartilage, TH1 cells, natural killer cells, macrophages, and monocytes. mesenchymal cell proliferation, regulates endothelial fibroblasts, osteoblastic mitogenesis, inhibits macrophage and monocyte proliferation.

29
Q

TGF beta source and function

A

platelets,matrix of bone, cartilage, TH1 cells, natural killer cells, macrophages, and monocytes. mesenchymal cell proliferation, regulates endothelial fibroblasts, osteoblastic mitogenesis, inhibits macrophage and monocyte proliferation.

30
Q

PRP

A

“The components of whole blood remaining after the removal of (most of) the red cells”
The buffy coat (white cells and platelets) extending ??? into the top of the red cell column
PLUS all of the plasma

31
Q

PPP

A

“Plasma layer without the buffy coat”

So…you get lots of fibrinogen & coagulation factors but no cells

32
Q

PLATELET CONCENTRATE

A

Essentially the buffy coat +/- a small (variable) amount of plasma
Buffy coat = leukocytes + platelets
Leukocytes = neutrophils, eosinophils, basophils, macrophages, B- and T-lymphocytes

33
Q

Platelet gel

A

Platelet Concentrate with enough fibrinogen (2-4mg/ml) to “set up” when combined with an activator

34
Q

activator =

A

= Thrombin (bovine or human), Calcium (usually CaCl₂) or Collagen

35
Q

platelet concentration in platelet gel

A

Platelets 2-6x over baseline

36
Q

how many platelets do you need

A
  1. )Increase in multiples above baseline
    - Typically 2-6 times above baseline
    - Evidence suggests >6x actually delays healing…why? Theory suggests possible up-regulation of other tissues to “factors” in the presence of thrombocytopenia.
    2) Absolute numeric concentration
    - Typically > 1,000,000/μL
37
Q

nervous tissue and platelet gel

A

doesn’t do crap on nervous tissue

38
Q

platelet gel contraindications

A 
Severe hypovolemia
Unstable angina/LM disease
Heparin therapy
Post-incisional harvest
Thrombocytopenia (~
39
Q

Never, ever, EVER apply platelet concentrates to

A

coronary grafts (and don’t let surgeons do it, either!)

40
Q

Cell-saver based systems are (IMHO) “maximally suboptimal because of

A

Dramatic differences in cost, % platelet recovery, volume accommodated, increases in platelet count above baseline, “hands on” requirements, consistency, time required for processing, technical support, portability, customization potential, RBC recovery, PPP availability, and perfusion support

41
Q

platelet gel makers

A

arteriocyte magellan, cytomedix angel

42
Q

To get more volume…

A

…you either need more blood initally
…or lower “Increases Above Baseline” or you add more RBCs to the mix. There IS no “free lunch” (although sales reps may try to convince you & your surgeons otherwise!)

43
Q

You don’t get “something for nothing”…

If you start with less volume, the only way to get more PRP

A

is to have less enrichment and/or add more RBC’s (a bad thing)

44
Q

How many platelets in a “unit” of whole blood

A

(Platelets/μL) X 1000 X (ml of whole blood

45
Q

How many platelets in a “unit” of PRP?

A

(Platelets/μL) X 1000 X (ml of PRP

46
Q

What is the percent yield of platelets in PRP?

A

(# platelets in PRP X 100)/(# platelets in whole blood)

47
Q

Essentially two “fields” of stem cell therapy

A 
Bone Marrow (“Mesenchymal”) Derived
2) Adipose Derived
48
Q

mesenchymal stem cells

A

Generally found in the bone marrow but can be isolated from circulating blood, cord blood, fallopian tubes, and fetal tissue.
High capacity for pluropotentiality (what’s this?)
High capacity for self renewal

49
Q

mesenchymal stem cells

A

Generally found in the bone marrow but can be isolated from circulating blood, cord blood, fallopian tubes, and fetal tissue.
High capacity for pluropotentiality (what’s this?)
High capacity for self renewal

50
Q

bone marrow derived stem cells Problems:

A

Critters are “funny” about having a massive pointy needle rammed into their pelvis and having those contents removed with vigorous suction!
People are less sensitive about having fat sucked out of “fat-rich” parts of their anatomy (“Take more! TAKE MORE!!!)
Stem cells are “few and far between” in the bone marrow

51
Q

adipose stem cells

A

Also a source of multipotent (less pluropotent?) stem cells
> 500 X more stem cells in 1 gram of fat as compared to 1 gram of aspirated bone marrow
Have similar (+/-) ability to differentiate as does B.M.-derived.
Can be extracted without anesthesia/sedative/tranquilizer
Avoids “fetal stem cell” discussion
*Technology for utilizing adipose-derived stem cells is much simpler (and more commercially available)
(Moving away from B.M. towards A.D.)

52
Q

Stem cells have the

ability to

A

to morph

53
Q

stem cells are synergistically attracted/stimulated by

A

activated platelets and the “factors” those platelets produce

54
Q

adipose stem cells extraction systems

A

1) Remove the “lipids”
2) Remove the supernatant (saline, phenylephrine, lidocaine)
3) Concentrate the adipose stem cells (hopefully)
4) Maintain the Stromal Vascular Fraction (SVF) which creates a warm, fuzzy microenvironment for the stem cells and helps promote graft retention
5) +/or allow for the stem cell extract to be mixed at some ratio with platelet concentrate in an aerobic environment

55
Q

platelet to adipose ratio

A

Still being elucidated

1:2-1:10…too early for anything resembling “evidence

56
Q

procedure for horse with scrap metal

A

Step 1: 4X4 soaked in sterile saline, wrung out to “Just Damp” is applied
Step 2: Cotton wrap bandage is applied
Step 3: Water proof tape or Op- Site
Step 4: Coban Dressing is Top Coat

57
Q

outcomes from scrap metal horse

A

The wound was 80% closed at 5 Day inspection
Complete healing at 15 days
Hair re-generated at 20 days

58
Q

horse with right front hoof 6 day old the dressing

A 
Step 1: 4X4 soaked in sterile saline, wrung out to “Just Damp” is applied
Step 2: Cotton wrap bandage is applied
Step 3: Water proof tape or Op- Site
Step 4: Compression Bandage
Step 5: Coban Dressing is Top Coat
59
Q

outcomes for hoof injury horse

A 
Single Treatment of PG Required
No Oozing or Drainage on Day 5
No Infection During Recovery
Uneventful Complete Recovery
Resumed Normal Activities at 80 Days
Barrel Racing at 90 Days
60
Q

knee wound horse outcomes

A

At 5 day inspection the wound appeared to have healed to a 14 day level
The wound continued to heal over the next 3 ½ weeks until all that remained was a scabbed wound about 1” high x 2” long.
The horse then became tangled in a slot in a gate and recreated the wound to almost the original size
The horse was then sent to a special wound therapy clinic and treated with allograft growth factors. The wound healed in about 3 months

61
Q

knee wound horse outcomes

A

At 5 day inspection the wound appeared to have healed to a 14 day level
The wound continued to heal over the next 3 ½ weeks until all that remained was a scabbed wound about 1” high x 2” long.
The horse then became tangled in a slot in a gate and recreated the wound to almost the original size
The horse was then sent to a special wound therapy clinic and treated with allograft growth factors. The wound healed in about 3 months

62
Q

device considerations for animal pg

A

The size of the client must be taken into consideration as it relates directly to the availability of a sufficient blood draw.
The wound size is not always in proportion
Small volume device availability is a must for the treatment of dogs and cats
ATF type devices are required for some wounds in horses and cattle
The device should provide enough PG (3x-4x) to completely cover the wound. PPP may be used as a top coat.

Perf tech 3 (14 decks)

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