We have always done PRP injections very differently. Why? This difference is based on the lab data we’ve observed for many years. Let’s dig into those differences and that data and in the process learn about SCP.
What Is PRP?
PRP stands for platelet-rich plasma. This is concentrated blood platelets in the patient’s own plasma. To create this, the doctor takes blood and spins it in a centrifuge to concentrate the platelets.
The idea behind PRP injections is that platelets have growth factors that they release to aid healing. So if you cut yourself, the platelets clot the blood and also release growth factors to help the cut heal. Hence, PRP can help injured tissues heal.
PRP comes in many flavors, but the two main are with or without red/white blood cells. If the PRP has lots of WBCs and RBCs it’s red in color and called leukocyte rich or LR. If it’s amber in color it’s WBC/RBC poor and is called leukocyte poor or LP.
PRP Impacts Older Cells Differently
About 15 years ago we began using the patient’s own platelet growth factors to grow stem cells in culture. Back then this was a novel concept, as what was usually used to grow cells was fetal bovine serum. After we had experience with this technique, we began noticing a trend. That was that older cells (middle-aged and beyond) tended to grow better in higher doses of platelet growth factors. For younger cells it didn’t much matter, they did fine with lower doses.
Because we offered PRP injections, it wasn’t long before I had our lab team formally test this effect. What we observed was interesting. Older mesenchymal stem cells (generally older than mid-thirties to forties) had a direct dose-response relationship all the way up to 40X. That means that if you doubled the concentration of the platelets you would see more stem cell growth. In fact, you could keep doubling it until you got as high as 40 times over baseline and you would still see more growth.
On the other hand, with younger cells (patients in their 20’s or less), the concentration effect on cell growth maxed out at low concentrations. For those cells it really didn’t matter if we threw more platelets at them, they wouldn’t grow any more prolifically when you began doubling the number of platelets.
Another thing we observed was that having red blood cells in the mix stunted stem cell growth. Hence, in older patients, we began using LP-PRP (leukocyte poor) with a high concentration of platelets. This is amber-colored versus the red color product used in many PRP injections.
Poorly Done PRP Papers
We saw great clinical results with our high-dose PRP injections and because we weren’t injecting a bunch of red and white blood cells, we noted far fewer post-injection flare-ups. However, we then found a research paper that seemed to show that going higher on the platelet doses might hurt tendon cells. Given that this was one of the areas where we used high dose PRP injections, I was potentially concerned that we were doing it wrong. When I had our lab research team look at the research paper, they saw serious issues with the way the research was performed that I summarize in my video below:
Formalizing High-Dose PRP with a Research Paper of our Own
Given that the research that was published on PRP injections and how the dose impacted tendon cells was poorly done, we decided to do that experiment correctly in our state of the art lab located at Regenexx-HQ in Colorado. While we were sure that higher doses of PRP were better for stem cells, what we didn’t really know was whether tendon cells would be different.
What did we find? The graph here says it all. As the platelet doses got higher, in older cells, the response was the same that we had observed with stem cells. Meaning higher doses caused more tendon cell growth. We also were able to confirm this with a scratch test. Meaning higher doses also caused the tendon cells to close a gap more quickly, which is their job in the body.
Hence we published our own research on the topic showing that higher doses of platelets were needed for older cells and for younger cells the effect wasn’t there (1). Meaning, using higher dose PRP injections in older tendons made more sense than lower doses.
SCP and The Problems with Bedside Machine PRP
SCP is our version of ultra-high dose PRP. It has a special name because it really can’t be replicated outside of a flexible lab platform. Meaning what’s used in most doctor’s offices and hospitals and billed as PRP injections is created by a simple, automated bedside centrifuge. This creates some problems with dosing and customization. So let’s dig in on those issues.
One problem with simple bedside machines is that they can’t get to high concentrations of platelets. Meaning the usual concentrations that are obtained are 3-5X, or 3-5 times the normal concentration of platelets. While there are double spin hacks that practitioners try, these aren’t validated and they can only usually boost that to the 5-7X range. While a few machines can get higher, often that comes at the expense of needing to add in more red and white blood cells.
The other issue is that simple bedside machines can’t customize the sample processing to the patient’s blood. Meaning you may be better hydrated or dehydrated or have a more or less viscous blood sample. Your platelets also may be more or less sticky than the usual patient. All of that messes with the efficiency of bedside machines and their ability to concentrate platelets. To learn more, see my video below:
What Is SCP?
Super Concentrated Platelet PRP injections are at least 10-20X and have no or very few red and white blood cells. That’s rarefied air for most clinics as the simple bedside machines they use can’t touch that level of concentration or if they can get to 10X, that’s only by producing a dirty PRP contaminated with red and white blood cells.
How do we routinely do this at Regenexx? We use a flexible lab platform created at our Colorado HQ. That means that an actual lab tech is trained to process your blood using our validated protocols to get to those high concentrations without significant red or white blood cell contamination. These are proprietary processing protocols developed over a decade and a half of work back and forth from our research to our processing lab.
Since SCP type PRP injections require taking more blood, we have also developed an online tool that uses the AABB guidelines to calculate how much blood can safely be collected. In this situation, the doctor writes the orders of what he or she wants and the medical assistant performs a finger stick hematocrit measurement to find out how much blood is “in the tank”. He or she then enters the patient’s sex, age, and weight and this determines how much we’re permitted to draw. For example, if you’re small or anemic, we may need to reduce the volume of blood we take.
Where Is SCP Really Needed?
Again, if you’re older (middle-aged and beyond) we will shift from using lower concentrations of PRP to SCP. We also use this strategy based on how severe the issue is as well. For example, if you have a bigger tendon tear we will shift to higher dose SCP PRP injections. We may also do this if you have more significant knee arthritis.
The upshot? SCP is very different than what’s being done out there. It stems from our long-standing research programs showing that high-dose PRP is what’s needed in older patients. Hence, if you’re middle-aged or older, why settle for PRP injections that are at a dose that doesn’t maximize your healing?
(1) Berger DR, Centeno CJ, Steinmetz NJ. Platelet lysates from aged donors promote human tenocyte proliferation and migration in a concentration-dependent manner. Bone Joint Res. 2019;8(1):32–40. Published 2019 Feb 2. doi: 10.1302/2046-3758.81.BJR-2018-0164.R1