Platelet-rich plasma

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Platelet-rich plasma
MeSH D053657

Platelet-rich plasma (PRP) is a concentrate of platelet-rich plasma protein derived from whole blood, centrifuged to remove red blood cells. It has a greater concentration of growth factors than whole blood, and has been used to encourage a brisk healing response across several specialties, in particular plastic surgery, dentistry, orthopedics and dermatology.

As a concentrated source of blood plasma and autologous conditioned plasma, PRP contains several different growth factors and other cytokines that can stimulate healing of soft tissue and joints. There are many indications as in sports medicine and orthopedics (acute muscle strains, tendinopathy and muscle-fascial injuries and osteoarthritis[1]), or dermatology (androgenic alopecia, wound healing, and skin rejuvenation) or even in proctology (fistula-in-ano[2]). For preparation of PRP, various protocols are used, with an underlying principle of concentrating platelets to 3–5 times physiological levels, then injecting this concentrate in the tissue where healing is desired.[3]

Medical use[edit]

In humans, PRP has been investigated and used as a clinical tool for several types of medical treatments, including chronic tendinitis,[4] osteoarthritis,[5] for bone repair and regeneration,[6] in oral surgery,[7] and in plastic surgery,[8] for example using a platelet-rich fibrin matrix method.

More recently, platelet rich plasma has found itself a new use in the field of infertility. Building on the research of Harvard scientists in 2006, it has been shown that female ovaries may continue to produce egg cells post-menopause, and may be activated for maturation via growth factors present in platelet rich plasma. While this is still largely offered as a clinical trial, a number of reports provide support for its success. Nevertheless, a large scale study is not yet to be available to determine how successful ovarian PRP treatment is in reality.[9]

Clinical validity[edit]

A 2015 meta-analysis reviewed 551 studies on PRP for osteoarthritic (OA) knee and found that only nine were worth considering and concluded that with respect to short term outcomes, PRP was not more efficacious than placebo in total WOMAC score but was more efficacious than hyaluronic acid (HA) on that measure; it was no different than placebo or HA with regard to adverse events.[10]

As of 2016 results of basic science and preclinical trials have not yet been confirmed in large-scale randomized controlled trials. A 2009 systematic review of the scientific literature found there were few randomized controlled trials that adequately evaluated the safety and efficacy of PRP treatments and concluded that PRP was "a promising, but not proven, treatment option for joint, tendon, ligament, and muscle injuries".[11]

A 2010 Cochrane analysis on PRP use in sinus lifts during dental implant placement found no evidence that PRP offered any benefit.[7]

Cerza 2012 Am Journal Sports Med, level 1, randomized control trial concluded that PRP was significantly better for OA knee than hyaluronic acid.[12]

A 2013 review stated more evidence was needed to determine PRP's effectiveness for hair regrowth.[13]

A 2014 Cochrane analysis for PRT use to treat musculoskeletal injuries found very weak (very low quality) evidence for a decrease in pain in the short term, up to three months and no difference in function in the short, medium or long term. There was weak evidence that suggested that harm occurred at comparable, low rates in treated and untreated people.[14] Similarly, another 2017 systematic review assessing PRT for treating pain on skin graft donor sites found that it was effective in reducing pain on a small, comorbid patient cohort. As such, the authors suggested that superior randomized control trials assessing PRT are required to determine efficacy.[15]

In 2014 the American Journal of Sports Medicine published a paper which concluded that "application of 3 consecutive PRP injections significantly improved symptoms and function in athletes with chronic patellar tendinopathy and allowed fast recovery and return to sport. There was return to normal architecture of the tendon as assessed by MRI.[16]

A 2016 systematic review and meta-analysis of randomized controlled clinical trials for PRP use to augment bone graft found only one study reporting a significant difference in bone augmentation, while four studies found no significant difference.[17]

Platelet-rich plasma injections into the hand for rejuvenation
Platelet-rich plasma injections into the hand for rejuvenation

Since 2004, proponents of PRP therapy have argued that negative clinical results are associated with poor-quality PRP produced by inadequate single spin devices. The fact that most gathering devices capture a percentage of a given thrombocyte count could bias results, because of inter-individual variability in the platelet concentration of human plasma and more would not necessarily be better.[18] The variability in platelet concentrating techniques may alter platelet degranulation characteristics that could affect clinical outcomes.[19]

In the field of aesthetics and plastic surgery, the clinical application is particularly wide and is under the name of Regenerative Plastic Surgery. PRP associated with adipose tissue,[20] is given for breast reconstruction,[21] facial soft tissues defects,[22] lower extremity ulcers and scars.[23] Promising results were obtained in the treatment of androgenetic alopecia,[24] as emerged from scientific studies published since 2013. Among these, the most significant by impact factor is the randomized scientific-clinical study of the clinical-instrumental evaluation of the effect of PRP in androgenetic alopecia published in 2015 by Pietro Gentile et al. and a multidisciplinary team at the University of Rome Tor Vergata The Effect of Platelet Rich Plasma in Hair Regrowth: A Randomized Placebo-Controlled Trial.[25]

Adverse effects[edit]

There are no studies to date that have reliably documented adverse effects associated with PRP treatment, possibly due to poor and inconsistent methodology.[26]


Whole blood placed in Centrifuge prior to two stage centrifugation

There are four general categories of preparation of PRP based on its leukocyte and fibrin content: leukocyte-rich PRP (L-PRP), leukocyte reduced PRP (P-PRP; leukocyte reduced or pure PRP), leukocyte platelet-rich fibrin and pure platelet-rich fibrin.[27][28]

The efficacy of certain growth factors in healing various injuries and the concentrations of these growth factors found within PRP are the theoretical basis for the use of PRP in tissue repair.[29] The platelets collected in PRP are activated by the addition of thrombin and calcium chloride, which induces the release of the mentioned factors from alpha granules. The growth factors and other cytokines present in PRP include:[29][19]


Blood drawn from patient
Removal of PRP after double centrifugation
PRP is Injected into area of injury via ultrasound guidance

As of 2009 there have been two PRP preparation methods approved by the U.S. Food and Drug Administration.[30] Both processes involve the collection of the patient's whole blood (that is anticoagulated with citrate dextrose) before undergoing two stages of centrifugation (TruPRP) (Harvest) (Pure PRP) designed to separate the PRP aliquot from platelet-poor plasma and red blood cells.[30] In humans, the typical baseline blood platelet count is approximately 200,000 per µL; therapeutic PRP concentrates the platelets by roughly five-fold.[18] There is broad variability in the production of PRP by various concentrating equipment and techniques.[31][32][33]


PRP was first developed in the 1970s and first used in Italy in 1987 in an open heart surgery procedure.[citation needed] PRP therapy began gaining popularity[where?] in the mid 1990s.[citation needed] It has since been applied to many different medical fields such as cosmetic surgery, dentistry, sports medicine and pain management.[citation needed]

The number of peer reviewed publications studying the PRP's efficacy has increased dramatically since 2007.[34]

Society and culture[edit]

The cost of a PRP treatment in the U.S. has been quoted as $1000 out-of-pocket expenses, as it is usually not covered by health insurance.[35]

PRP has received attention in the popular media as a result of its use in treating sports injuries in professional athletes.[36][37][38][35]

Risk of use in doping[edit]

Some concern exists as to whether PRP treatments violate anti-doping rules.[29] As of 2010 it was not clear if local injections of PRP could have a systemic impact on circulating cytokine levels, affecting doping tests and whether PRP treatments have systemic anabolic effects or affect performance.[29] In January 2011, the World Anti-Doping Agency removed intramuscular injections of PRP from its prohibitions after determining that there is a "lack of any current evidence concerning the use of these methods for purposes of performance enhancement".[39]

According to the Baltimore Sun, Zach Britton had PRP injections in his left shoulder in March 2012, Orioles first baseman Chris Davis underwent two PRP injections to speed the healing and recovery of an oblique injury in April 2014, and Dylan Bundy had the procedure in April before undergoing Tommy John surgery in June 2014.[40]

Veterinary use[edit]

Platelet-rich plasma is used in horses for treatment of equine lameness due to tendon and ligament injury, wounds, fractures, bone cysts, and osteoarthritis.[citation needed]

See also[edit]


  1. ^ Smith, Patrick A. (2016-04-01). "Intra-articular Autologous Conditioned Plasma Injections Provide Safe and Efficacious Treatment for Knee Osteoarthritis: An FDA-Sanctioned, Randomized, Double-blind, Placebo-controlled Clinical Trial". The American Journal of Sports Medicine. 44 (4): 884–891. doi:10.1177/0363546515624678. ISSN 1552-3365. PMID 26831629. 
  2. ^ de la Portilla, F.; Segura-Sampedro, J. J.; Reyes-Díaz, M. L.; Maestre, M. V.; Cabrera, A. M.; Jimenez-Rodríguez, R. M.; Vázquez-Monchul, J. M.; Diaz-Pavón, J. M.; Padillo-Ruiz, F. J. (2017-07-29). "Treatment of transsphincteric fistula-in-ano with growth factors from autologous platelets: results of a phase II clinical trial". International Journal of Colorectal Disease. doi:10.1007/s00384-017-2866-9. ISSN 1432-1262. PMID 28755243. 
  3. ^ "PRP Therapy | Hair Loss Treatment". OC Hair Restoration. Orange County, California. Retrieved 5 July 2016. 
  4. ^ Mishra A, Woodall J, Vieira A (2009). "Treatment of tendon and muscle using platelet-rich plasma". Clinics in Sports Medicine. 28 (1): 113–25. doi:10.1016/j.csm.2008.08.007. PMID 19064169. 
  5. ^ Andia I, Sanchez M, Maffulli N (2012). "joint pathology and platelet-rich plasma therapies". Expert Opinion in Biological Therapies. 12 (1): 7–22. doi:10.1517/14712598.2012.632765. PMID 22171664. 
  6. ^ Griffin XL, Smith CM, Costa ML (2009). "The clinical use of platelet-rich plasma in the promotion of bone healing: a systematic review". Injury. 40 (2): 158–62. doi:10.1016/j.injury.2008.06.025. PMID 19084836. 
  7. ^ a b Esposito M (Spring 2010). "Effectiveness of sinus lift procedures for dental implant rehabilitation: a Cochrane systematic review". Eur J Oral Implantol. 3 (1): 7–26. PMID 20467595. 
  8. ^ Por YC, Shi L, Samuel M, Song C, Yeow VK (2009). "Use of tissue sealants in face-lifts: a metaanalysis". Aesthetic Plastic Surgery. 33 (3): 336–9. doi:10.1007/s00266-008-9280-1. PMID 19089492. 
  9. ^ Ozyigit Ahmet, Ozyigit Savas (September 2018). The IVF Guide. United States: Universal Publishers. p. 122. ISBN 1627342451. 
  10. ^ Kanchanatawan, W; Arirachakaran, A; Chaijenkij, K; Prasathaporn, N; Boonard, M; Piyapittayanun, P; Kongtharvonskul, J (May 2016). "Short-term outcomes of platelet-rich plasma injection for treatment of osteoarthritis of the knee". Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. 24 (5): 1665–77. doi:10.1007/s00167-015-3784-4. PMID 26387122. 
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  12. ^ American Journal of Sports Med 2012
  13. ^ Valente Duarte de Sousa, Isabel Cristina; Tosti, Antonella (May 2013). "New investigational drugs for androgenetic alopecia". Expert Opinion on Investigational Drugs. 22 (5): 573–589. doi:10.1517/13543784.2013.784743. ISSN 1744-7658. PMID 23550739. 
  14. ^ Moraes VY (April 2014). "Platelet-rich therapies for musculoskeletal soft tissue injuries". Cochrane Database Syst Rev. 29 (4): CD010071. doi:10.1002/14651858.CD010071.pub3. 
  15. ^ Sinha S, Schreiner AJ, Biernaskie J, Nickerson D, Gabriel VA (June 2017). "Treating pain on skin graft donor sites: review and clinical recommendations". J Trauma Acute Care Surg. doi:10.1097/TA.0000000000001615. PMID 28598907. 
  16. ^ Charousset, Christophe; Zaoui, Amine; Bellaiche, Laurence; Bouyer, Benjamin (2014-04-01). "Are Multiple Platelet-Rich Plasma Injections Useful for Treatment of Chronic Patellar Tendinopathy in Athletes?: A Prospective Study". The American Journal of Sports Medicine. 42 (4): 906–911. doi:10.1177/0363546513519964. ISSN 0363-5465. 
  17. ^ Pocaterra A, Caruso S, Bernardi S; et al. (2016). "Effectiveness of platelet-rich plasma as an adjunctive material to bone graft: a systematic review and meta-analysis of randomized controlled clinical trials". Int J Oral Maxillofac Surg. 45: 1027–1034. doi:10.1016/j.ijom.2016.02.012. 
  18. ^ a b Marx RE (2004). "Platelet-rich plasma: evidence to support its use" (PDF). Journal of Oral and Maxillofacial Surgery. 62 (4): 489–96. doi:10.1016/j.joms.2003.12.003. PMID 15085519. 
  19. ^ a b Yu W, Wang J, Yin J (2011). "Platelet-Rich Plasma: A Promising Product for Treatment of Peripheral Nerve Regeneration After Nerve Injury". Int J Neurosci. 121 (4): 176–180. doi:10.3109/00207454.2010.544432. PMID 21244302. 
  20. ^ Stefano Fiorentino, Luigi F. Rodella, Veronica Bonazza, Valerio Cervelli, Pietro Gentile (2014). Il tessuto adiposo. Monduzzi. ISBN 9788865210758. 
  21. ^ Pietro Gentile, Camilla Di Pasquali, Ilaria Bocchini, Micol Floris, Tati Eleonora, Valeria Fiaschetti, Roberto Floris, Valerio Cervelli (10 September 2012). "Breast Reconstruction With Autologous Fat Graft Mixed With Platelet-Rich Plasma" (PDF). Surgical Innovation - SAGE. 
  22. ^ Valerio Cervelli, Ludovico Palla, Michele Pascali, Barbara De Angelis, Beniamino C. Curcio, Pietro Gentile (July 2009). "Autologous Platelet-Rich Plasma Mixed with Purified Fat Graft in Aesthetic Plastic Surgery" (PDF). Springer Science+Business Media, LLC and International Society of Aesthetic Plastic Surgery. 
  23. ^ Pietro Gentile, Barbara De Angelis, Methap Pasin, Giulio Cervelli, Cristiano B. Curcio, Micol Floris, Camilla Di Pasquali, Ilaria Bocchini, Alberto Balzani, Fabio Nicoli, Chiara Insalaco, Eleonora Tati, Lucilla Lucarini, Ludovico Palla, Michele Pascali, Pamela De Logu, Chiara Di Segni, Davide J. Bottini, Valerio Cervelli (2014). "Adipose-Derived Stromal Vascular Fraction Cells and Platelet-Rich Plasma: Basic and Clinical Evaluation for Cell-Based Therapies in Patients With Scars on the Face" (PDF). The Journal of Craniofacial Surgery. 25, n°1. 
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  34. ^ platelet-rich plasma evidence Results by year graph,, National Center for Biotechnology Information, U.S. National Library of Medicine, retrieved 23 March 2016
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  39. ^ "World Anti-Doping Agency announces changes to Prohibited List". Irish Medical Times. 2011-01-10. 
  40. ^ Dan Connolly Orioles first baseman Chris Davis receives two PRP injections Baltimore Sun, April 29, 2014