Not All PRP is Actually Rich in Platelets…Do The Math!
There is an increasing recognition of the power of PRP (Platelet Rich Plasma). Platelets contain a high concentration of growth factors and immune modulators which have been shown to improve wound healing, improve hair growth, and possibly rejuvenate skin and other areas of the body. The “Vampire Facial and Facelift” have become popular procedures in medspas and refers to applying PRP into the skin surface with microneedling devices (facial) or more deeply with injections (facelift). Wound care centers have great success at expediting healing in chronic would which have failed conventional therapy. Many orthopedic joint problems have been improved or resolved with PRP injections into the joint area. Cardiac surgeons have noted a significant drop in wound problems by using preventative treatments with PRP. Hair growth has been documented with PRP scalp injections and improvement in hair transplant results are found by bathing the follicles in PRP prior to implantation has been noted. Laser resurfacing has been shown to heal faster when PRP is applied immediately to the skin. It is clear, PRP has significant benefits for multiple medical ailments.
What’s even better news is that using PRP is extremely safe! Essentially what PRP consists of is using your own blood and isolating a concentrated portion of it, the platelets. This is where the lack of regulation can be abused. Since the FDA has considered PRP to be “minimal manipulation” of taking something out of the body and then placing it back, there is no FDA approval needed and oversight is minimal. The problem then becomes that there is tremendous variation is what one office considers PRP versus another office and concentrations of platelets can be all over the map.
Blood is essentially 2 components – Red blood cells (RBC) and plasma. In normal individuals, RBC’s make up about 40% of the blood (hemoglobin of 40). Plasma is serum and platelets, the other 60%. So in a 10 cc blood sample, about 5cc can be considered useful for making PRP. Through a process of centrifugation, the RBC’s can be removed, and the concentration of platelets can be increased. It has been shown by studies, that the “sweet spot” for PRP is a platelet concentration of 6X (1.5 milllion/ml) the normal value found in blood. Higher concentrations have been shown in some studies to actually be counter productive and lead to more inflammation, and lower concentrations have less improvements.
So, doing the math, if only a 10cc tube of blood is drawn, only about 1cc of useful PRP is obtainable if shooting for the 6X goal. A cc of PRP is 1/5 of a teaspoon…not much. Much higher volumes are needed to get an adequate amount of PRP to be useful (the author uses 60-120cc blood volumes). There was one study presented at the IMCAS conference in Paris over 2 years ago (which the author attended) which looked at the concentration of platelets using 14 different devices. In about half the devices, the platelets weren’t even concentrated more than what is found in normal blood. Only half the remaining were in the therapeutic “sweet spot” of 6X concentration.
Bottom Line: If only 10-20cc of blood are being drawn, then the final product is either not the ideal concentration of PRP (6X) or the volume of PRP is too small to be useful!
There is no doubt that there are clear benefits to PRP in the areas of wound healing, orthopedics, and hair restoration. However, with the lack of FDA oversight, many patients who think they are receiving therapeutic doses of PRP, are actually getting suboptimal doses or just plain plasma, which has little to no benefits. When seeking out PRP treatments, make sure that provider knows the concentration of platelets that his/her device is producing, and the math makes sense.