Peer Reviewed Articles to support the benefits of autologous platelet-leukocyte enriched plasma.  If you would like a full text version and are not able to find the specific article on line email rikihelms@bytheblood.com and we will be happy to assist you with your research or email you the full text article for your review.

                                                                                                         Sincerely , BTB

Dynamic Multiple Benefits

General Purpose

Crane, David, M.D., & Everts, Peter A. M. PhD. (2008). Platelet Rich Plasma (PRP) Matrix Grafts.

     Practical PAIN MANAGEMENT, January/February, 12-26.

Conclusion:  PRP matrix grafts along with other biologic grafting techniques are becoming more prevalent in the treatment paradigms of musculoskeletal medicine.  These PRP matrix grafts provide effective, safe, relatively low-cost treatment options to patients who have the time and wherewithal to allow collagen synthesis and maturation at the graft site.  PRP matrix grafts appear to restore tissue homeostasis and biotensegrity of collagen.  Other pain inhibiting effects are also present in PRP matrix grafts which allow earlier resumption of pain free activity.  It is the authors' experiences that these grafts, along with other regenerative grafting options, are at times the only viable treatment option for a select group of patients with degenerative myofascial tissue injuries.  The authors recommends appropriate first line therapies such as relative rest, appropriate bracing and kinesiotaping, evaluation of kinetic chain mechanics, and physical therapy - with or without eccentric loading protocols - prior to the utilization of these PRP matrix grafting protocols.

Reduction in pain after PRP applications has been observed by several authors.  However, an explanation of this phenomena has not always been given.  The authors believe that serotonin released from activated platelets might be responsible for decreased pain, as described by Everts and Fanning.  Except for the growth factors in the Alpha-granules, large amounts of serotonin are contained within the dense platelet granules.  Since platelet counts of the PRP are generally almost six-fold higher when compared to whole blood levels, it stands to reason that serotonin levels are therefore also significantly increased at the wound site.  This phenomena has been explained in detail by Sprott et al who reported on pain reduction following acupuncture and measured a decrease in serotonin concentration in platelets from these patients and an increase in serotonin levels in plasma - suggesting normalization of plasma serotonin levels due to the mobilization of platelet serotonin.

Marx, Robert E. (2001). Platelet-Rich Plasma (PRP):  What Is PRP and What Is Not PRP?.

     Implant Dentisty, Vol. 10, Number 4, 225-228.

Definition of Paper:  Platelet-rish plasma (PRP) has been a breakthrough in the stimulation and acceleration of bone and soft tissue healing.  It represents a relatively new biotechnology that si part of the growing interest in tissue engineering and cellular therapy today.  Because of its newness, there is a potential for misunderstanding, misuse, and application of what the practitioner may incorrectly think is PRP.  The purpose of this paper is to discuss the definition of PRP, its safety, its proper development, and its most efficacious means of application.

Marx, Robert E. (2004). Platelet Rich Plasma: Evidence To Support Its Use. Journal of Oral and

     Maxillofacial Surgery, October 09, 2004, 489-496

Summary:  This article answers some tough questions regarding standard for the industry and the use of FDA approved devices verse non-approved off label uses of cell saver devices and centrifuges.  It discusses how PRP works, how many platelets are enough for therapuetic effect, safety, dispels the reader of the myth that PRP is just a blood clot that could promote infection.  "PRP has a pH of 6.5 to 6.7 compared with a mature blood clot of 7.0 to 7.2.  It has thus been countersuggested that PRP actually inhibits bacterial growth." 

Antimicrobial/Bactericidal Benefits

Antimicrobial Activity of Platelet Gel against Staphylococcus Aureus 

Eddy Overdevest, Perfusionist Catharina Hospital,

Eindhoven, The Netherlands

"Concepts in Perfusion"

7th European Conference on Perfusion Education and Training

Discussion:  This experiment showed that platelet gel has a significant antimicrobial activity against S. aureus.  Although it did not result in a total kill using the current set-up, it did reduce the absolute number of bacteria to less than 1% of the control up to 8 hours.  Strikingly, also non-activated PRP and even PPP decreased bacterial growth.  This may be explained by the presence of lower amounts of antimicrobial agents in these groups as well.  As platelet gel is a safe to use autologous blood product, which can be easily prepared during surgery, it appears to be a potentially useful prophylactic strategy against prostoperative infections, for example as a coating on uncemented implants.  However, further research should prove its efficacy in combination with implants and in the in vivo situation.

"Overdevest, E P; *Everts, P A M; **Moojen; D J F **Schure, R M; ***J T A Knape, **R M Castelein, **Creemers, L B; **Dhert, W J A, * Department of Blood Management, Catharina Hospital, Eindhoven, The Netherlands

**Department of Orthopaedics, University Medical Center Utrecht, ***Department of Anesthesiology, University Medical Center Utrecht, The Netherlands

Isaly, Jessica N. & Beckley, Philip PhD., (n.d.). An In-Vitro Determination of Platelet Gel Efficacy as

     Prevention of Post-Operative Bacterial Infections. The Ohio State University, School of Allied

     Medicine, Circulation Technology Division

Discussion:  Platelet rich plasma appears to be effective in preventing growth of Pseudomonas and Staphylococcus Aureus.  Bactericidal effects are also noted.  Contamination and/or human error explains the lack of inhibition of Enterococci growth.  Further studies need to be conducted to confirm this hypothesis.

This study can be considered pioneer in that very little research has been done on the antibacterial properties of platelets gels.  Platelet gel as an "unconventional antibiotic" provides exciting and promising effects for all surgical and burn victims.   This is especially important in cardiac surgery, where the occurrence of infection is significant.  One study results that 21.7% of cardiac patients developed some type of nosocomial infection which required an increased length of stay in the hospital.

The applications of platelet gel usage will continue to increase over the coming years.  This will necessitate cost-effective and practical protocols to be implemented in healthcare centers all over the world.

Orthopedic Benefits

Mooar, Pekka A. M.D., Gardner, Michael J. B.A., Klepchick, Paul R. B.A., & Sherk, Henry H., (n.d.). C

     The Efficacy of Autologous Platelet Gel in Pain Control and Blood Loss in Total Knee Arthroplasty.

     Department of Orthopaedic Surgery, Medical College of Pennsylvania and Hahnemann University

     School of Medicine.

Conclusion:  Autologous platelet gel is clinically beneficial following total knee arthroplasty.  The results of this study indicate that application of autologous platelet gel leads to improved hemostasis, better pain control, and a decreased hospital stay.

Treatment Of Wounds

Barrett, Stephen L. DPM, CWS. (2003), A New Approach To Using Growth Factors In Wound Healing.

     Podiatry Today, October 2003, Vol. 16, 44-50.

Conclusion:  Clinically, when it comes to using APC+, (Autologous Platelet Concentrate aka PRP, Platelet Rich Plasma), the results have been impressive.  We achieved a 94 percent success rate in this series of chronic wounds, with the criteria for success being complete epithelialization.

Not only has this technology repeatedly proved itself with closure and epithelialization in different types of wounds, there are certain economic benefits as well in the most difficult refractory cases.  While this technology is simple to use and is effective in an office-based setting, one may anticipate huge savings of the healthcare dollar once this technology becomes more available.

In addition to further implementation of this technology into the wound care arena, it is my opinion that widespread use of this technology will become commonplace in other aspects of podiatric surgery.  APC+ will enhance and accelerate bone healing in osteotomies (i.e., common procedures like bunionectomies) and augment bone grafting techniques.  It is also very likely to prove useful in a myrid of other podiatric situations.  Investigation has begun on the use of growth factors in tendinopathies and degenerative processes in joints.

Indeed, this technology may greatly change the way podiatric surgeons view and manage many different clinical pathologies. 

Adam J. Singer, M.D. and Richard A.F. Clark, M.D., (1999). Mechanisms Of Disease: Cutaneous Wound Healing, The New England Journal of Medicine, Vol. 341, No. 10, September 2, 1999.

Clinical Implications:  In general, conservative and time-honored methods of wound care should be attempted first.  These methods are successful in the majority of patients with skin wounds and include the use of standard wound dressings, remediation of underlying problems such as hyperglycemia, debridement of nonviable tissue, restoration of adequate tissue perfusion, limitation of pressure at the wound site, and control of infection.  Particularly large and life-threatening skin wounds (such as extensive burns) may require the use of cultured autologous epidermal-cell grafts or biologic skin substitutes.  There are not yet enough clinical data to support the routine use of growth factors or other wound mediators.  However, further refinement and developement of substances that stimulate wound healing are likely.  

Harrington, Catherine, PHARMD, PhD, Zagari, Martin J. M.D., Corea, John B.A., & Klitenic, Jenny B.A.,

     (2000). A Cost Analysis of Diabetic Lower-Extremity Ulcers. Diabetes Care, Vol. 23, Num. 9,

     September, p. 1333.

Conclusion:  Lower-extremity ulcers cost the Medicare system $1.5 bilion in 1995.  Any wound care intervention that could prevent even a small percentage of wounds from progressing to the stage at which inpatient care is required may have a favorable cost effect on the Medicare system.

Maxillofacial Surgery

Textbooks

Everts, Peter A. M., (2007). Autologous Platelet-Leukocyte Enriched Gel * Basics and Efficacy *     

     The Netherlands: D&L Graphics, Kerkrade. ISBN 10: 90-8590-016-0  ISBN 13:978-90-8590-016-0