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Platelet rich plasma and Bone marrow Aspirant progenitor cells

Platelet rich plasma and Bone marrow Aspirant progenitor cells. Where are we ? David Wood, ABT Regional Manager, autologous blood therapies Houston Extracorporeal Therapies.

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Platelet rich plasma and Bone marrow Aspirant progenitor cells

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  1. Platelet rich plasma and Bone marrow Aspirant progenitor cells Where are we ? David Wood, ABT Regional Manager, autologous blood therapies Houston Extracorporeal Therapies

  2. “All life is either growing or dying” -Lou Holtz

  3. Overview • What are these therapies? • What are the current indications? • Todays bottom line • the future

  4. Platelet rich plasma • Platelet rich plasma (PRP) is a concentrated source of autologous PLTs and platelet derived growth factors. • is obtained by sequestering and concentrating platelets by gradient density centrifugation.

  5. HUH ???

  6. Platelet rich plasma • Use of specialized disposables and centrifuges • 20-60 ml blood in ACD-A anticoagulant placed in centrifuge at 3200 rpm to get buffy coat of platelets plus leukocytes. • Yields 3-10 ml of platelet rich plasma and 10-30ml of Platelet poor plasma. • Takes 15 minutes and should be used within 6 hours

  7. Platelet rich plasma

  8. Platelet rich plasma

  9. Platelet rich plasma • Platelet rich and platelet poor is applied with or without thrombin and calcium chloride. Increase platelet concentration in wound by more than 300 percent.

  10. Platelet rich plasma

  11. Topical application of autologous blood products during surgical closure following a coronary artery bypass graft Reza S. Khalafi, Darien W. Bradford and Michael G. Wilson Eur J CardiothoracSurg 2008;34:360-364 DOI: 10.1016/j.ejcts.2008.04.026

  12. Platelet rich plasma • 1128 patients 571 with PRP and 577 without (control) • Using propensity scoring, sternal infection odds reduced 93% • Chest drainage odds reduced 96% • Leg drainage odds reduced 88%

  13. Bone Marrow Aspirate concentrate • BMA is an autologous concentrated source of autologous PLTs as well as sequestered progenitor cells. • is obtained by sequestering and concentrating harvested bone marrow by gradient density centrifugation.

  14. Bone Marrow Aspirate concentrate • Use of specialized disposables and centrifuges • 60 ml bone marrow aspirate in ACD-A anticoagulant placed in centrifuge at 3200 rpm to get buffy coat of platelets plus sequestered progenitor cells. • Yields 7-10 ml of platelet rich plasma and 30ml of Platelet poor plasma. • Takes 15 minutes and should be used within 6 hours.

  15. Bone Marrow Aspirate concentrate

  16. Bone Marrow Aspirate concentrate

  17. Bone Marrow Aspirate concentrate • BMAC is applied by mixing the concentrate from bone marrow with or without thrombin and calcium chloride delivering concentrated levels of pdgf and progenitor cells to the application site.

  18. Bone Marrow Aspirate concentrate

  19. Bone Marrow Aspirate concentrate • Endothelial Progenitor Cells Stimulate angiogenesis, release BMP-2 and BMP-6, and up-regulate the production of BMP-21 • Hematopoietic Stem Cells Orchestrate bone formation and directly convert to stromal MSC’s • MesenchymalStem Cells Convert to osteoblasts in support of new bone formation

  20. Bone Marrow Aspirate concentrate • Ongoing studies for critical limb ischemia • Ongoing studies in TREATMENT OF ACUTE MYOCARDIAL INFARCTION

  21. Bone marrow aspirate concentrate Encouraging Experience with Intracardiac Transplantation of Unselected Autologous Bone Marrow Cells Concomitant with Coronary Artery Bypass Surgery after Myocardial Infarction Sebastian Holinski, MD,1BirteSchmeck, MD,1 Benjamin Claus, MD,1HartmutRadtke, MD, PhD,2 Thomas Elgeti, MD,3 Martin Holzhausen, PhD,4 and Wolfgang Konertz, MD, PhD1

  22. Bone Marrow Aspirate concentrate • Experimental transplantation of bone marrow cells (BMC) into infarcted myocardium resulted in regeneration and functional improvement.

  23. Current indications PRP bmaC • Sternotomy • Graft Conduit Sites • Esophagogastrectomy • Soft tissue closure • Orthopedic applications for soft tissue and bone • Orthopedic non-unions and grafts • Ongoing studies for critical limb ischemia • Ongoing studies in TREATMENT OF ACUTE MYOCARDIAL INFARCTION

  24. Bottom line • Improved patient outcomes • Faster healing with reduction of pain • Reduced infection rates • Fewer returns to the Operating room

  25. Bottom line • Reimbursement current reimbursement is all over the map • Insurance Approved indications not many • Self pay many patients currently paying for in office procedures • Lack of randomized studies MAINLY ANECDOTAL evidence based

  26. Bottom line • Lack of regulation anyone can spin , no certification need • Greed of service providers/reps over-selling the product • Hospital costs are all over the map charging arbitrary amounts • Hospitals taking off of formulary

  27. Future of autologous therapies • promising • Recent rise in numbers of ongoing randomized studies • Patient awareness • Outcome based decisions • Insurance companies are slowly realizing the importance

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