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Platelet rich concentrate (PRP)

Platelet rich concentrate (PRP). Brigadier( Dr ) Paramjit Dhot MD. DNB. PhD. VSM. Dean Santosh Medical College Ghaziabad. UP. Dr Naveen Agnihotri MD. Senior Consultant & HOD Blood Transfusion Medicine, Nayati Medicity , Mathura Uttar Pradesh.

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Platelet rich concentrate (PRP)

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  1. Platelet rich concentrate (PRP)

  2. Brigadier(Dr) ParamjitDhot MD. DNB. PhD. VSM Dean Santosh Medical College Ghaziabad. UP

  3. Dr Naveen Agnihotri MD Senior Consultant & HOD Blood Transfusion Medicine, NayatiMedicity, Mathura Uttar Pradesh

  4. DrVineeth MS(orthopedics) Consultant Orthopedic Surgery Regenerative Medicine Magj Hospital. Angamally Kerala

  5. Dr. Aboobacker Mohamed Rafi. MD Assistant Professor Blood Transfusion Medicine Jubilee Mission Medical College (JMMCRI) Thrissur. Kerala

  6. PRP is a biological product defined as a portion of the plasma fraction of autologous blood with a platelet concentration above the baseline. • Blood Derived Biomaterials, unique group of blood products • Common Features – Physiologically compatible (Autologous Origin) – Devoid of risk of adverse reactions – Biodegradable by body enzymes Burnouf T et al. Blood Reviews 27 (2013) 77–89.

  7. Biomaterials should follow principles that • They should enhance tissue repair to a clinically significant degree, • Not lead to scar formation (keloids), • Provide a minimal risk, act only at the site of the wound (not systemically), • Be cost-effective, and • Be easily applied to the wound area The role of growth factors in wound healing Greenhalgh DG et al J Trauma, 1996

  8. PRP accelerates endothelial, epithelial, and epidermal regeneration, stimulates angiogenesis, enhances collagen synthesis, promotes soft tissue healing, decreases dermal scarring, enhances the hemostatic response to injury, and reverses the inhibition of wound healing caused by glucocorticoids. The high leukocyte concentration of PRP has an added antimicrobial effect. Platelet-rich Plasma: Properties and Clinical Applications RICK G. SMITH et al The Journal of Lancaster General Hospital • Summer 2007 • Vol. 2 – No. 2 7

  9. What is Platelet rich plasma (PRP)? Dr. Aboobacker Mohamed Rafi.

  10. PLATELET RICH PLASMA • PRP is defined as a portion of the plasma fraction of autologous blood having a platelet concentration 3-4 times more than baseline . • Usage of PRP started early at around in the 1970 s • It started with Fibrin glue for arresting bleeding – The hemostatic property of Platelets • Later only its other properties were used • Growth factors • Cytokines • They have been extensively used in • Dermatology & Cosmetology • Plastic surgery • Dental & OMFS • Orthopedics • OA • EPICONDYLITIS • MUSCLE & Tendon injury • Osteonecrosis

  11. Arora S, Agnihotri N. Platelet derived Biomaterials for Therapeutic Use: Review of technical Aspects. IJHBT2016

  12. Anticoagulation WholeBlood Non-Anticoagulated PlasmaProducts PlateletProducts Multiple Donor Pool Single Donor Apheresis Platelet RichFibrin (PRF) Viral Inactivation Thrombin Activated Plasma Platelet Concentrate Cryo-ppt Fibrinogen Platelet Biomaterials & Growth Factors(PRP) PlateletFibrin Glue FibrinSealant PlateletGel Arora S, Agnihotri N. Platelet derived Biomaterials for Therapeutic Use: Review of technical Aspects. IJHBT2016

  13. various properties of platelets that are used are Anabolic Effect Growth Factors PlateletRich Plasma Inflammatory Mediators AntiInflammatory Effect Fibrinogen ScaffoldingEffect Arora S, Agnihotri N. Platelet derived Biomaterials for Therapeutic Use: Review of technical Aspects. IJHBT2016

  14. What are the factors needs to be considered while preparing PRP? Dr. ParamjitDhot

  15. Manual methods of preparation ? DrVineeth

  16. Available devices for PRP preparation and approximate cost of treatment? Dr Naveen Agnihotri

  17. Quality indicators of PRP Dr Naveen Agnihotri

  18. 1) PRP in skin lesions and wound healing 2) PRP in cervical ectopy 3) PRP in vulvar dystrophy 4) PRP in reconstructive surgery for vulvar cancer 5) PRP in urogenital disorders (1) PRP in genital fistulae (2) PRP in genital prolapse and urinary incontinence

  19. PRP in reproductive medicine 1) PRP in premature ovarian failure 2) PRP in ovarian torsion 3) PRP in refractory endometrium 4) PRP in refractory endometrium 5) PRP in breast reconstruction PRP is an innovative therapeutic modality, as it is affordable, simple, easily performed, and effective

  20. Ortho and musculoskeletal indications DrVineeth

  21. Non-orthopedic indications Dr. ParamjitDhot

  22. Background • Androgenetic alopecia (AGA) is a hereditary, androgen-dependent dermatological disorder • More common in men. Occasionally seen in women. • Begins by 20 years of age and affects nearly 50% of men by the age of 50 years. • There is progressive thinning of the scalp hair in a defined pattern causing significant lowering of the self-esteem and psychological well-being of the patient.

  23. MATERIAL AND METHOD • In our study, 12 young male and 4 female patients suffering with alopecia in the age group of 25-35 years were selected. • Consent was taken • Autologous PRP injections were given subcutaneously on the affected area of alopecia with insulin syringes in a therapeutic dose of 1.5 million platelets per ml.

  24. The injections were given over a period of 3 months at the interval of 2-3 weeks and results were assessed. • PRP is generated by taking 30 ml of blood; • Blood is centrifuged at 1000 rpm for 10 minutes (low spin). The plasma is removed and centrifuged at 2000 rpm for 15 minutes (hard spin). • The buffy coat is removed and this is PRP.

  25. Results • Hair growth was seen in three patients after 7 days and in four patients after 15 days. • 3 months after the treatment patient presented with growth in the number of hair, thickness, hair strength and overall alopecia. • None of the patients had any inflammation or infection.

  26. Before 12 weeks After 12 weeks

  27. Discussion • Androgen-dependent processes are predominantly due to the binding of Dihydrotestosterone (DHT) to the Androgen Receptor (AR). • DHT-dependent cell functions depend on • the availability of weak androgens, • their conversion to more potent androgens via the action of five alpha-reductase, • low enzymatic activity of androgen inactivating enzymes, and • functionally active AR present in high numbers.

  28. The predisposed scalp exhibits high levels of DHT and increased expression of the AR. • Conversion of testosterone to DHT within the dermal papilla plays a central role, while androgen-regulated factors deriving from dermal papilla cells are believed to influence the growth of other components of the hair follicle. • The main growth factors involved in the establishment of hair follicle are • VEGF, • epidermal growth factor (EGF), • insulin 1-like growth factor, and • fibroblast growth factor.

  29. Patient Safety & Adverse effects Dr. Aboobacker Mohamed Rafi.

  30. Safety Concerns • Its usually a safe outpatient procedure • It is a convenient and inexpensive procedure • It has no issues regarding transmission of infections as it is autologous • Risk of adverse events are very Less if done using GMP • Some reports of Inflammation and pain have been reported • Long term complications not yet reported /known

  31. Regulatory issues Dr Naveen Agnihotri

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