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    Factors that modify PRP efficacy

    Platelet Rich Plasma (PRP) is recognised as a therapeutic field with scarce evidence of efficacy. This is difficult to get because the heterogeneity of the PRP used, and the lack of agreement to define its standard quality features.

    PRP efficacy could be modified by several factors along the preparation procedure. (Table 1), but growth factor or platelet content as its surrogated, are probably  the most relevant.

    The study  published recently by Reurink et al. (NEJM 370;26. June 26; 2014) on acute muscle injury,  is welcome as offer a well methodological design to improve knowledge on this controversial field,  but the study do not evaluated PRP quality parameters of the products injected,  being difficult to compare their results to other studies or generalise their conclusions to different scenarios where the PRP  product used were different, compromising the external validity of the study.

    PRP denomination includes a broad range of products with heterogenic quality parameters, and probably with different therapeutically effect. The consideration of those parameters in the PRP studies is desirable to get unbiased evidences.

    Table 1.  Factors  that could modify PRP efficacy. Most relevant in bold.

     
    Patient Age
    Sex
    Medicaments/drugs AnticoagulantsAspirin…others
    Cancer history
    Blood cell concentrations Specially platelets
    Blood collection Venopucture technic
    Blood container Tube (plastic or glass), Plastic bag
    Anticoagulant With  or without.
      EDTA , heparin, ACD-A;
    Time and Temperature from collection to processing
    Processing Centrifugation parameters
    PRP separation technic from the other blood components
    Processing temperature
    PRP quality parameters Growth factors content
      Platelet concentration
    Platelet total content
      Hemoglobin
    Leucocytes
    Leukocyte subsets
    Storage (if feasible) Temperature
    Container
    GF release from platelets (Activaton) Chemical or physical Thrombin, calcium, epinephrine; ADP…
    Clot or not.
    Therapheutical use Time from the activation
    Other products simultaneous used.
    System sterility Open or close system

     

     

    José Luis Bueno MD

    Hematologist

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