BENEFITING A CLINICAL PRACTICE WITH PLATELET GEL

The Platelet

Almost all text books and references to platelets state that the function of the platelet is to form the platelet plug.

While this is certainly true, it is now known that platelets do much more.

Platelets are the key stone of hemostasis and also, major contributors to the healing process of both tissue and bone.

Platelets

Platelets arrive, almost instantaneously, at the scene of an injury and activate.

Platelets immediately release chemical vasoconstrictors which work in conjunction with vasospasm to limit the amount of blood loss.

Platelets release large quantities of growth factors into the site of injury.

Platelets degranulate, change shape, produce pseudopods, become sticky, and form a matrix along with RBC, WBC, and fibrinogen to mechanically seal the wound.

Platelets

 Platelet rich plasma appears to be effective in preventing growth of Pseudomonas and Staphylococcus Aureus. Bactericidal effects are also noted.

The infection fighting peptides of platelets are increased in direct proportion to the concentration of platelets in platelet gel.

Platelets

Platelets, several days after activation, release chemo attractants to bring Macrophages to the wound site.

Macrophages do much more than “clean up a wound”.

Macrophages carry and release huge quantities of growth factors, therefore further healing is enhanced.

The number of platelets at the wound site directly influences the number of Macrophages.

White Blood Cells

As the density of white blood cells (WBC) is very similar to platelets, the WBC contained in the processed whole blood are collected along with the platelets.

The layer of platelets and WBC is referred to as the Buffy Coat.

The combination of WBC and platelet peptides further enhances the infection fighting capabilities of platelet gel.

Definitions

Platelet Rich Plasma (PRP): all of the components of whole blood except the RBC

Buffy Coat: whitish colored layer which consists of concentrated WBC and platelets

Platelet Poor Plasma (PPP): The result of the removal of the Buffy Coat from PRP; Plasma water, proteins, and fibrinogen

Concentrated PRP: PRP with most of the plasma removed

Platelet Gel: activated concentrated PRP

Source of Platelet Gel

Platelet Gel is derived from a patient’s own autologous whole blood.

The process is performed at point-of-care. Whole anticoagulated blood is collected

in a syringe or blood collection bag. The anticoagulant is citrate (ACD, CPD) The process takes about 20 minutes.

Determining the Volume of Blood Draw

The ratio of whole blood to collected concentrated PRP is about 8:1 or 12% CPRP.

This ratio may be further reduced by producing a more concentrated CPRP.

The usual concentration is about 4X patient’s platelet count for soft tissue (6 ml per 55ml).

A concentration increase to 6X, or higher, is often utilized for bone applications (4ml per 55 ml).

Other Devices

There are several devices that are currently on the market that “produce a much higher ratio” of PRP to whole blood.

These devices only separate the RBC from whole blood, therefore producing PRP (true platelet rich plasma).

However, PRP is not Concentrated PRP (CPRP) and hence, the WBC and Platelets are at native levels.

Therefore, there is no concentrated increase in growth factors, infection fighting abilities, nor chemo attractants of Macrophages.

These devices are FDA cleared only as tissue sealants. Tissue sealant abilities are a side effect of Platelet Gel.

Where Can Platelet Gel Be used?

Platelet Gel may be used anywhere tissue or bone has been injured, cut or burned.

There are no documented limitations on the use of Platelet Gel, except when used in conjunction with certain types of mesh materials which are used in hernia repair.

These meshes rely on adhesion formation to give strength to the repair.

Platelet Gel, to a large degree, prevents the formation of adhesions.

Benefits of Platelet Gel to a Clinical Practice

(Facility Benefits) Less OR time (quicker closure with improved hemostasis)

Less post-op pain medications (narcotics)

less homologous blood usage (improved hemostasis)

less post-op nursing care (more comfortable patient) less hospital stay (earlier discharge - free-up beds)

less opportunities for medication and blood administration errors, along with a shorter hospitalization time, lowers the probability of a Never Event occurrence.

Benefits of Platelet Gel to a Clinical Practice

(Physician Benefits) less OR time (quicker closure with improved hemostasis)

less opportunities for medication and blood administration errors (diminished patient complications)

less post-op nursing care (less post-op physician demands)

Enhanced time efficiency (more personal time availability)

Enhanced patient outcomes (higher physician ratings)

Increased patient referrals (happier patients)

More satisfying clinical practice

COLLECTION / PROCESSING

Whole Blood Collection Blood is drawn, pre-operatively, in the

operating room (at bed-side), from the patient, into a standard blood collection bag or syringe containing anticoagulant.

Citrate anticoagulant is utilized.

Blood is Drawn from a Previously Unused Access Site (AABB Peri-Op Standard)

BLOOD MEASURED BY WEIGHT 1 GRAM = 1 ML BLOOD)

SYRINGE MEASURES BLOOD

Blood Draw Volume

The amount of blood draw depends on the amount of Platelet Gel required.

The blood draw amount ranges from 200 ml to 500 ml for autotransfusion type machines and 20 ml to 180 ml for table-top devices.

The ratio of Platelet Gel to whole blood is about 12 ml/100 ml, depending on the desired concentration.

Blood Processing The Blood is centrifuged at bedside.

The equipment utilized is either a FDA cleared computer programmed autotransfusion machine or a FDA cleared multi-speed centrifuge.

Equipment selection depends on the volume of blood draw/final product required.

Target Platelet Count

The target platelet count is to increase the count to about four times (4X – soft tissue) or six+ times (6X+ - bone) of the initial count.

This target can be achieved by concentration or dilution. It is done by utilizing less or more of the PPP.

PRP Collected from ATF Machine into Syringe by Autologous Blood Therapist

Applicator Set Loading

Endoscopic Brow Lift

PG Spray Under Flap During Surgical Face Lift

Surgical Facelift (Skin Closure)

Long Term Survival of Fat Grafts

FAT TRANSFER AS UPPER CHEEK IMPLANT GRAFT

PG ADDED TO ENHANCE SURVIVAL OF IMPLANT GRAFT

Abdominal Liposuction

Microcirculation + 3rd Space Sealant and Enhanced Healing

PPP SEALING (CAROTID) PRP FOR HEALING (CAROTID)

PG Hemostasis Achieved during Body Sculpturing Following Gastric Bypass (After

Weight Loss)

Platelet Gel to Breast Reduction

PG TO BREAST REDUCTION

CLOSURE WITHOUT DRAINS

PG to Breast Reconstruction with Implants

PG to Free Graft (Burn

Patient)

PG Applied to Diabetic Heel Wound

PG for Enhanced Healing and Prevention of Seroma Formation

LIPOMA EXTRACTION PG APPLIED FOR HEMOSTASIS, 3RD SPACE SEALING AND WOUND HEALING

Gall Bladder and Polyps Removal

PG APPLIED TO COVER ALL SITES

PG APPLIED TO ALL INCISION SITES

Endoscopic Knee Repair

PG to Underside of Total Joint Replacement (Total Knee)

PG to Ankle Reconstruction

Ankle Fusion

PG COATED BONE GRAFT PG TO TISSUE CLOSURE

Spine Reconstruction with PG Impregnated Bone Graft

Saphenous Vein Harvest Site Hemostasis (PPP)

Sternum Hemostasis CV Surgery

PG to 3rd Molar Extraction Site

PPP Top Coat Sealant to 3rd Molar Extraction Site

PG/Bone Reconstruction of Jaw

Closure with PG Compressed into Skin Incision

Expected Outcomes Closure Without Placement of Drains Virtually No Swelling or Bruising No Homologous Blood Products

Required (Passive Bleeding Eliminated)

Very Little or No Pain Medication No “Soreness” (ROM Better @ 24

Hours) Reduced Risks of Infection Earlier Discharge Enhanced Healing/Recovery