What is PRP? Your Guide to Platelet Rich Plasma Treatments

By Chris Centeno, MD /

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regenexx_prp

You’ve likely heard about PRP. It’s all the rage with professional athletes and weekend warriors alike. So what is PRP and is it one thing, or are there different kinds?

What is PRP, or Platelet Rich Plasma?

The term PRP applies to a wide variety of similar, but quite different preparations made from blood platelets. Platelets are the little packets of growth factors and other natural healing molecules that help clot your blood. So if you were to get a paper cut, they would both stop the blood flow and also release healing growth factors to help get the local cells on course to heal the skin. PRP is created by centrifuging the whole blood drawn from an arm vein (or anywhere else) and concentrating the platelets in the serum. The idea is that more of a good thing is better than less.

How is PRP made?

Automated PRP Machine

An Automated PRP Centrifuge

About 95% of medical practices that offer PRP make it in a push button, automatic centrifuge. The advantage of this type of processing is that it’s simple for the medical practice. Literally all the physician needs to know about how PRP is made is where to place the sample and where the “On” button is located.

The downside to this approach is that the PRP produced is “one size fits all”. For example, if a patient is more or less hydrated, this is not accounted for in these systems, so what’s produced on one day in terms of platelet concentration will be different than on another day, simply because of how much water the patient had to drink. This is because the area where the platelets are located in the centrifuged blood will fluctuate based on the water content of the sample.

Are there Different Kinds of PRP?

prp_info

Not all PRP is created equal + Click to view

Yes. There are stark differences between different PRP preparations. The first thing you’ll notice is that some samples are red, while others are more amber. The red PRP injections contain copious red blood cells and white blood cells. While no one is 100% sure if one type is clinically better than the other at this point, what is clear is that red PRP shots promote much more inflammation than amber PRP shots without red or white blood cells. In addition, our lab research clearly showed that stem cells exposed to both types of PRP did poorly with red PRP and much better with amber PRP.

Can a Better PRP be Created with a Lab?

Absolutely, but as noted above, most physicians who use PRP don’t bother with anything more than buying a simple automated machine. In our clinical experience, a lab in the medical practice can often accomplish a number of things that a bedside centrifuge cannot:

  1. The ability to adjust the processing to the unique properties of the patient sample
  2. Much higher concentrations of platelets than machines can muster
  3. The ability to customize various types of PRP and concentrations to address the specific needs of a patient.

The Benefits of PRP Injections at Regenexx

The other day I was injecting a low back patient who also needed a tendon and a knee injection. As I looked at the sterile tray of what was to be injected, I realized that I had three different platelet preparations on the sterile field. I also realized how unique Regenexx is in the world of PRP injections (or what we call SCP – super concentrated platelet) .

For example, for this patient I had:

  1. A 7X (7 times normal platelet concentration) amber PRP to inject into his tendons, as lower concentrations are used in this area. This means that the platelet concentration was 7 times over his normal baseline platelet count.
  2. A 20X amber PRP to inject into his knee joint. In our experience and based on our lab data, much higher concentrations of PRP are needed for successful joint treatments, especially in middle-aged and older patients who may have more significant arthritis. What’s interesting here is that no “one-size fits all” PRP machine on earth could have produced this sample, as most will only concentrate to about 7-10X max, and that’s with running the sample twice (i.e. not recommended by the manufacturer of the device).
  3. A 4th generation platelet lysate – This is PRP that has had all of it’s growth factors stripped from the platelets. This was being used to inject epidural to help reduce swelling and improve blood supply around irritated nerves in his low back. Watch the video to the right to understand the difference between PRP and Platelet Lysate.

Again, no clinic outside of the Regenexx Network could tailor what this patient really needed by producing three different types of platelet injectates. There are major differences between what we do with platelets at Regenexx and what’s being done by other doctors who are dabbling in regenerative medicine.

The upshot? A PRP shot is not the same worldwide or within the United States. There are many different types. At Regenexx, we sometimes take for granted that we have so many options available to us and that we have spent a decade perfecting every aspect of these procedures. It’s easy to forget that we’re operating on an entirely different level than others when it comes to regenerative medicine procedures.

So why take the risk of getting an injection with something that just isn’t as advanced, when you can stack the deck in your favor and increase the chances of a full recovery with a Regenexx PRP procedure?

Category: Regenexx-SCP

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17 thoughts on “What is PRP? Your Guide to Platelet Rich Plasma Treatments

  1. Bill

    Red blood cells plus placenta stem cells because they are younger and no known rejection from cartilage is this a good route to take ?

    1. Regenexx Team

      Bill,
      No. We have tested all of these products and they contain no stem cells, and while your red blood cells are good at what they are intended to do, they wouldn’t be helpful in this case. Your own bone marrow stem cells or platelets in the right type of PRP in the hands of a physician properly trained in what to do with them would be the route to take.

  2. Manny Katz

    You always fail to mention that none of your treatments has been proven to be safe and effective, nor are any FDA approved and should adverse events occur the hapless patient would have to foot the medical bills. Excuse me, but most of us aren’t rich and we don’t want to spend hard-earned savings on failures.

    1. Regenexx Team

      Manny,
      Neither are the surgeries they replace. Orthopedic surgery and stem cell procedures are the “Practice of Medicine” and are compliant with CFR 21 Part 1271 and fall under the same surgery exemption discussed in 1271.15 (b). Stem Cell Procedures are very significantly safer, however. This is one of our two “Safety and Complications” papers published http://www.ncbi.nlm.nih.gov/pubmed/22023622, which showed moderate swelling in some cases, as compared to the profound risks and complications of joint replacement. Regenexx Procedures are medical procedures and like all medical Procedures have a success and failure rate, but, have a significantly higher success rate than the surgeries they replace without the risks and complications. Read through the website, http://www.regenexx.com , and you will find infographics with all of the statistics, and countless blogs written on studies demonstrating the risks and complications of orthopedic surgery. This page will bring you to many of those risks: http://www.regenexx.com/?s=joint+replacement+risks

  3. Kevin kennedy

    I’m a 57 , do I need a person to drive me home after any of these procedures?

    1. Regenexx Team

      Kevin,
      We generally don’t recommend it, but it really depends on what you’re having done and how far you’re driving.

  4. Rosalie

    Dear Regenexx-Team,
    I have a little hole in the cartilage of my knee (about 0,5 mm diameter). Do you think a therapy with PRP could help me?
    And if yes, how many applications should I receive? And how often should I get PRP? Once a week? Or what would be the best?

    Thank you very much for your help.
    with kind regards
    Rosalie

    1. Regenexx Team

      Rosalie,
      Generally in cases like you describe we would use a stem cell procedure rather than a PRP type procedure, but we’d need to look at your MRI to say. A lot has to do with whether the hole was as a result of injury, or a degenerative process like arthritis. How did this hole in the articular cartilage occur? http://www.regenexx.com/the-regenexx-procedures/knee-surgery-alternative/

  5. Jackie Parker

    I have had one knee replacement and now it is time for the other knee to b replaced. I dont want to EVER go through another total knee replacement which left me in pain. I am so looking forward to my stem cell procedure and some day ride my horse once again off into the sun set.

    1. Regenexx Team

      Jackie,
      Unfortunately, chronic pain one of the most common complications of knee replacement, bizarre of course because pain is the most common reason they’re done. https://regenexx.com/blog/chronic-pain-after-knee-replacement-is-surprisingly-common-2/. Getting people back to doing what they love to do is really important to us as beyond joint function, it promotes overall good health. We’d love a pic of you riding your horse off into the sunset when it happens!

  6. Rosalie

    Dear Regenexx-Team
    Thank you for your answer, The physician says it is not a degenerative hole in the cartilage. He thinks it must be an old accident. I do not remember such an accident, maybe I have fallen in an unfortunate way on my knee? The hole was detected in the MRI because one morning I recognized a thick knee and the physician said,that there is water in my knee. What kind of stem cell therapy would you recommend me?
    Do you think PRP won`t for this condition?
    Thank you in advance.
    Rosalie

  7. Rosalie

    … one addendum sorry,
    my last sentence/question should mean:
    Do you think PRP won`t work for this condition?
    with kind regards
    Rosalie

    1. Regenexx Team

      Rosalie,
      We are not saying that PRP would not work, we are saying that you would need to be evaluated to see whether Regenexx SCP, which is our very much stronger than PRP platelet procedure, or Regenexx SD, our stem cell procedure, is what would be needed as many things go into determining a treatment plan. To be evaluated you would need to fill out the Candidate Form here: http://www.regenexx.com/the-regenexx-procedures/knee-surgery-alternative/

  8. Dave Black

    I am a runner age 55 who has run 10 consecutive Boston Marathons. I was diagnosed in August 2015 with a delaminated femoral articular cartilage that occurred while playing tennis in July. It is under the medial condyle and is about the size of a thumbnail. It was diagnosed with MRI. Other than this issue my knees are in excellent condition. I can only run about 10-15 miles per week now and get swelling and tightness in the affected knee. I can feel the cartilage click when I move it. I have been trying to manage the last 6 months but no improvement. The ortho doc who diagnosed my condition mentioned stem cell therapy as an option but told me it may or may not work. What are you thoughts on the likelihood of success?

    1. Regenexx Team

      Dave,
      Very encouraged to hear that your Ortho mentioned stem cells, as obviously any type of surgery would be a net negative. Your situation is something we deal with regularly. This was a case with some similarities: http://www.regenexx.com/helping-cross-fit-guru-knee-arthritis-get-squat-back/ . Obviously to discuss your case in particular we would need to speak with you directly and go over your MRI. To do that, please fill out the Candidate form on this page: http://www.regenexx.com/the-regenexx-procedures/knee-surgery-alternative/. On this page you will also find information about our knee treatments. Please let us know if we can be of further assistance.

  9. David

    Just in general, which of the various PRP types works best with achilles tendinosis? Thanks.

    1. Chris Centeno Post author

      In our experience leukocyte-poor injected under ultrasound guidance into areas of friability with fenestration, the dose depends on age.

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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