In Europe, and more recently in the United States, an increased trend has emerged in the use of autologous blood products in an effort to facilitate healing in a variety of applications. In recent years, scientific research and technology has provided a new perspective on understanding the wound healing process. Initially platelets were thought to act exclusively with clotting. However, we have learned that platelets also release many bioactive proteins responsible for attracting macrophages, mesenchymal stem cells, and osteoblasts which not only promotes removal of necrotic tissue, but also enhances tissue regeneration and healing.

According to the World Health Organization (WHO), musculoskeletal injuries are the most common cause of severe long-term pain and physical disability, and affect hundreds of millions of people around the world

Blood components

Blood contains plasma, red blood cells (RBC), white blood cells (WBC), and platelets. Plasma is the liquid component of blood, made mostly of water and acts as a transporter for cells. Plasma also contains fibrinogen, a protein that acts like a net and catches platelets at a wound site to form a clot. RBC helps pick up oxygen from the lungs and delivers
it to other body cells, while removing carbon dioxide. WBC fights infection, kills germs, and carries off dead blood cells. Platelets are responsible for hemostasis, construction of new connective tissue, and revascularization.

Platelets

Platelets are small discoid blood cells made in bone marrow with a lifespan of 7–10 days. Inside the platelets are many mes, and two types of granules. The alpha granules contain the clotting and growth factors that are eventually released in the healing process. Normally at the resting state, platelets require a trigger to activate and become a participant in wound healing and hemostasis. Upon activation by thrombin, the platelets morph into different shapes and develop branches, called pseudo-pods that spread over injured tissue. This
process is termed aggregation. Eventually the granules contained within platelets release the growth factors, which stimulate the inflammatory cascade and healing

PRP

The method, which is strikingly straightforward and easy to perform, centers on injecting portions of a patient’s blood directly into the injured area, which catalyzes the body’s instincts to repair muscle, bone and other tissue. Most enticing, many doctors said, is that the technique appears to help regenerate ligament and tendon fibers, which could shorten rehabilitation time and possibly obviate surgery.

Research into the effects of platelet-rich plasma therapy has accelerated in recent months, with most doctors cautioning that more rigorous studies are necessary before the therapy can emerge as scientifically proven. But many researchers suspect that the procedure could become an increasingly attractive course of treatment for reasons medical and financial.

Platelet-rich plasma is derived by placing a small amount of the patient’s blood in a filtration system or centrifuge that rotates at high speed, separating red blood cells from the platelets that release proteins and other particles involved in the body’s self-healing process, doctors said. A teaspoon or two of the remaining substance is then injected into the damaged area. The high concentration of platelets — from 3 to 10 times that of normal blood — often catalyzes the growth of new soft-tissue or bone cells. Because the substance is injected where blood would rarely go otherwise, it can deliver the healing instincts of platelets without triggering the clotting response for which platelets are typically known.

There is little chance for rejection or allergic reaction because the substance is autologous, meaning it comes from the patient’s own body; the injection carries far less chance for infection than an incision and leaves no scar, and it takes only about 20 minutes, with a considerably shorter recovery time than after surgery.

Because of those apparent benefits, the consensus among doctors is that the procedure is worth pursuing. However, several doctors emphasized that platelet-rich plasma therapy as it stands now appeared ineffective in about 20 to 40 percent of cases, depending on the injury. But they added that because the procedure costs a fraction of the costs incurred for surgery — they expected that with more refinement, insurance companies would eventually not only authorize the use of PRP therapy but even require it as a first course of treatment.

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