AAOS Now PRP Forum

AAOS Now reported on the recent platelet rich plasma forum in San Diego.


"The participants of the 2011 PRP Forum also endorsed the development of standards in the manufacture of PRP, noted that PRP may be contraindicated in some conditions, and called for the establishment of a study group to follow up on the other recommendations resulting from the session."
  
"At the end of the day, an informal survey of participants found most in agreement that PRP would be an option, particularly if conservative treatments have failed and the next step would be surgery."


The group agreed that PRP needs a classification system.  Dr. Allan Mishra proposed one that is under consideration.


AM

Mishra Platelet Rich Plasma Classification

Not all platelet rich plasma (PRP) is the same.  In order to be able to compare PRP, I am proposing a new classification system based on the presence or absence of white blood cells, activation status and platelet concentration.  Activation implies the use of thrombin and or calcium to cause the platelets to gel and release their bioactive molecules.  No activation implies in vivo activation by collagen. 

Platelet Concentration:   
A = 5 x baseline or higher
B =  Less than 5 x baseline

Type          White Blood Cells              Activation    

Type 1:       Increased WBCs                  Unactivated

Type 2:       Increased  WBCs                 Activated

Type 3:       Few/None WBCs                 Unactivated

Type 4:       Few/None WBCs                 Activated

Example:

Type 1A PRP:    Formulation with increased WBCs, 5.5x baseline platelets injected in an unactivated fashion.

The system is meant to be simple for now.  Clearly, there are other components to PRP including anticoagulation and buffering.  Importantly, new formulations may arise but for now we need a simple reproducible structure to discuss the different types of PRP.  I hope this represents a start.

AM
Total Tendon