Regenerative Medicine and Platelets Rich Plasma

Platelets Rich plasma is only one type of regenerative medicine product that can come from your own body.  This is currently 1 of 3 techniques that can be used in our growing knowledge of how to use our bodies own natural healing capacities.  The other 2 current techniques have to do with Stem cells.  What is a Stem cell?  Stem cells are cells that are a “blank slate” for the body to use to replace more, specialized cells, if they are damaged or destroyed.  This is similar to car companies using one platform for a car, but between different chassis on top of it to get a different job done.

Stem cells can be collected either prenatally (before birth), or postnatally (after birth).  Major controversies are present about prenatal stem cells. This is not true of postnatal stem cells, if they came from the same individual, that is to have the procedure.  These postnatal cells are called Mesenchymal Stem Cells (MSC).  The kind of MSC used are committed to musculoskeletal tissue, but have not differentiated.  They’re located in bone marrow and adipose tissue (fat).  MSC can become new bone, fat, and cartilage cells.  This is part of the way the body can actually heal itself.  Techniques such as bone marrow aspiration involve pulling bone marrow out of the bone (usually pelvis bone), under local anesthesia.  This can be done in an office setting by a physician, centrifuging down the blood, then injecting into the same patient in one setting.  There is no usually no need for surgical centers or hospitals, unless indicated by special circumstances.

All 3 types of techniques are currently used.  Well, which one is best?  The answers are still out on that question.  This is a young clinical field, and many studies on people are ongoing even as I write this review.  It is important to realize that medicine is a constantly changing science.  We also realize that many of the non-regenerative medicine techniques have been out to her for decades, and are well studied.  This is the reason that it is prudent to try many of these “standard of care” techniques, before using regenerative medicine techniques at this point in time.  I have include

PRP.  What is it used for?

In today’s pain clinic we can find PRP being used in joints of the extremities (i.e., knees, shoulders), ligaments, muscle/tendons, and the nonunion of bone.  We have also seen uses in spinal discs, cervical and lumbar facet joints, sacroiliac joints, sacral–coccygeal joints, bursas, and pars fractures.  PRP promotes the natural healing process.  The goal is to return the target joint, tendon, or ligament to its original strength.  This is done by taking the patient’s own blood, spinning it down with the centrifuge, and pulling out the platelet rich plasma only.  This high concentration of platelets, which start the normal healing cycle after trauma, and then releases growth factors and nutrients.   They contain 30 bio- active proteins.  There are 7 growth factors–IGF-1,TGP-B,VEGF,PDGF,EGF,and CTGF.  This sounds very complicated, but is also a beautiful wonder of the human body.  The first 5 growth factors above are essential in healing musculoskeletal tissue.  These growth factors are in granules that fuse with cell walls, and enter the cell to promote a healing cascade, in the inflammatory process. They promote  new structures such as collagen, bring in other cells to help repair  the area, and much more.  All 3 phases of tissue healing, Inflammatory phase, Proliferative phase, and Maturation phase, are supported.

Why do we use PRP, how is a collected, and what does it do?

We use PRP because it is a natural, holistic if you will, way of actually starting or speeding up the healing process.  No drugs are used, and just the body’s own cells, to stimulate any normal healing process.  It is not a time-consuming process.  He can be done in a physician’s office, by using a single blood draw and centrifuge machine.  The end product, PRP, is injected into the previous mentioned places using standard techniques and a fluoroscopic x-ray machine.  Recovery time is no longer than normal for steroid injections with a few minor differences.  Usually, 27 cc of the patient’s own blood was collected by the physician.  This is sterilely placed in a centrifuge which spins at very high speeds, to separate out to different cells in your blood.  This is performed in the same room as the patient is, and they can watch.  Heavier cells go to the bottom of the container and lighter cells stay on top.  Blood is composed of red blood cells 45%, white blood cells/platelets, less than 1%, this is called the Buffy Coat, and plasma 55%.  The Buffy Coat is removed, which is mostly platelets.  This will usually contain about 3 cc of fluid.  This, 3 cc can be split up and injected into different spots of the body.

What do high concentrations of platelets actually do?

As mentioned previously, platelets are full of substances that promote healing.  Part of the healing process is activation of specialized cells to clean up cellular debris called Macrophages.  These substances promote wound healing, stabilizing the remaining structure (collagen proliferation).  These substances promote increased blood flow to the region, by dilating blood vessels, and growing new blood vessels.  Some Stem Cells are also present, which provided new specialized cells to replace damage ones.

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