One to two weeks before the intended popular PRP therapy procedure, our nurse and doctors will ask the patient to stop all pain killer, non-steroidal anti-inflammatory drug, steroidal drug, wherever possible. His because we want to induce inflammatory response during the PRP therapy for knee pain, ankle and foot pain, lower back pain, shoulder pain, tennis or golfer elbow pain, muscle and tendon/ligament injury. Furthermore, stop all herbal supplement and all other vitamin, mineral pill or any supplement for the time being for the similar reasons. Normal activity can be allowed.
On the day itself, a sample blood is withdrawn from the patient’s forearm. Depending on the system used, a total of 10 to 30 ml whole blood is taken in one or a number of tubes. Within this tube is added earlier on with the anti-coagulant, citrate dextrose.
This blood is then subject to be centrifuged at certain time period and certain revolution per minute speed depending on the machine used, meaning the tube inclination or the distance from the center where the tube is placed. A typical example is to spin at 3200 rpm for a 5 minutes period.
The centrifuged sample show approximately the two halves. The lower half is the dark red portion of compacted Red Blood Cell, the RBC.
The upper half is the clear transparent yellowish fluid, thick in consistency, which is the plasma. This plasma, the top portion contain the platelet poor plasma, the PPP.
The interface between the RBC and the plasma is where the PRP lies. Here the colour is extra yellowish and whitish in colour. A small volume from here is taken which is PRP, withn which lies the platelet and all the various bioactive protein such as the growth factors and the cytokines. The amount extracted is 0.5 to 1.0 ml or more depending the system of tubing used.
A carefully extracted PRP is usually very pure. Keeping in mind not to take in the RBC portion which can contaminate the PRP. Some system has separator which completely separate the RBC from the plasma. Still other has mechanism that can move a sty let upward or downward to lock away the RBC from the plasma. The plasma may be centrifuged the second time in some system to separate the PPP from the PRP with a locking system.
Depending on the system used, the concentration of PRP that can be achieved can range from five to ten times. Of course, the higher the better. All said, it is the quality that counts more, not just the quantity. But both are important.
PRP is Injected into area of injury via ultrasound guidance