It is critical to ensure a standardised PRP preparation with the emphasis on overall preservation of platelets’ physiological properties until the time of injection into the target site.
Preparation of PRP
Before the PRP injection, the patient is informed of the procedure and potential risks and benefits - similar to other interventional procedures. Risks related to the interventional procedure include infection, haemorrhage, and soft-tissue injury. The use of sterile technique and a probe cover if using ultrasound guidance is recommended.
Contraindications
In general, PRP is avoided when there is local or systemic infection, prior history of malignancy at that site, bleeding and/or platelet disorders, current cancer elsewhere in the body, pregnancy, prior long acting steroid injection at the target site.
Patient consent
The patient is also educated with regard to short-term and long-term expectations. Because the injection of PRP induces local inflammation, pain should be expected after the procedure. This can be similar to the feeling of stiffness, warmth, pain that is experienced after an injury. These symptoms are part of the accelerated healing response and it usually can last up to 3 days post injection, with the most pain expected in the first 48 hours. Patients should be educated about suitable pain relief medications and ice therapy, rest, elevation etc that won’t interfere with the PRP's healing processes.
Pre and post procedure medications
Please find full details on recommended cessation periods for pre and post procedure within our patient and practitioner information packs. Restrictions are recommended for oral corticosteroids, injected long acting steroids, aspirin and non-steroidal ant-inflammatory medications. Additionally a diet free of alcohol, coffee, caffeine, fish oil supplements and minimal fatty foods for two days prior will improve platelets’ ability to release growth factors at the time of injection - to improve the healing response. Alcouro strongly advises that patients should not cease any medications without prior discussion with their GP or medical specialist.
Injection technique
Exposure to collagen within the target tissue activates platelets. Typically, the use of local anaesthetic in the region of the PRP injection is avoided because the effect on PRP success is not clear. If required, subdermal local anaesthetic can be used, but LA and or steroid should not be mixed with the PRP or deployed separately but at the same site, as both LA and steroid have been shown to have a deleterious effect of platelet aggregation and cellular growth.
Is pre-injection activation required?
No. Pre-activation of growth factors by either physical agitation or chemical reaction is not required, as the activation of the PRP occurs naturally at the time it comes into contact with collagen. Platelets release 95% of their growth factors within 10 minutes of activation, and studies have shown that activation with chemical agents or physical irritation to the platelets does not provide additional release of growth factors or benefit on tissue healing. In fact, pre-activation of platelets prior to injection may cause some growth factors to be wasted, or creates a less natural healing cascade reducing potential regenerative outcomes.
Activated vs. non activated PRP
Recent studies have shown that thrombin activated PRP releases all growth factors at the same time in a bolus, while non-activated PRP uses the platelets as a sustained drug delivery system. Spontaneous platelet activation occurs in situ after injection when the platelets come in to contact with collagen or another activated platelet, and are activated in “waves”, resulting in a more sustained-release growth factor profile.
Who can use alocuro Prp
Medical practitioners (GPs and medical specialists) and dental practitioners who have completed Alocuro PRP training and are familiar with correct aseptic technique can safely carry out the PRP injection following our protocols. Nursing staff can perform venepuncture, preparation of PRP and dermal injections under the supervision of a medical/dental practitioner
After the blood withdrawal, the PRP can be prepared in a laboratory, operating room or out-patient clinic requiring only a table-top centrifuge, Alocuro PRO-PRP device and an Alocuro stand for preparation and extraction of the PRP sample.
Health practitioners using therapeutic PRP techniques should be familiar with guidelines in the completion of minor interventional procedures, use of blood products and also have a clear understanding of possible complications and aseptic technique.