Platelet Rich Plasma Injection

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Indications

Tendinopathy, mild osteoarthritis, cartilage tears etc

Risks

infection, bleed, nerve damage all rare

Pre-procedure Instructions

Stop NSAIDs and potentially anti-platelet prior to and just after (as long as not contraindicated to stop).

Equipment

Procedure described for doing one leukocyte rich and one leukocyte poor injection.

• Syringes
  • 60mL syringe for the blood
  • 10mL syringe for the local anaesthetic
  • 10mL syringe for the leukocyte poor PRP
  • 10mL syringe for the leukocyte rich PRP
• Needles
  • butterfly set for taking blood
  • drawing up needle
  • 25g needle for the local anaesthetic
  • Needle for the PRP injection e.g. 22g 70mm spinal needle for the hip joint.
• 3 x ACDA tubes for the anticoagulant
• PRP kit
  • One cartridge for the blood (e.g. omni PRP which is ~6x concentration, or regen which is ~2x concentration)
  • Another cartridge as a counterbalance, measured to weigh the same, filled with water.
• Centrifuge
• Sterile ultrasound jelly
• Ultrasound machine
• PRP benchtop processing station.

Preparation

• 

  PRP processing station

• Leukocyte rich PRP extraction.jpg

  Extraction of leukocyte rich PRP

• 

  Buffy coat

• Extract ~2.5mL of ACDA into the 60mL syringe
• Draw up 55mL of blood into the 60mL syringe
• Place the drawing up syringe onto the syringe, open the top of the cartridge, and then transfer the mixed blood/ACDA solution. Close the top
• Place the cartridge into the centrifuge, along with an equal counterweight cartridge.
• Spin at 3350rpm for 7 minutes
• Remove the cartridge, it should be separated into red cells at the bottom, leukocytes in the middle, and plasma at the top
• Place the cartridge into the PRP benchtop processing station, facing up
• Use the dial on the station to control the plunger
• Remove and discard the top half of the plasma which is called platelet poor plasma.
• The remaining plasma is leukocyte poor at the top, and leukocyte rich at the bottom. The very bottom of the plasma has the leukocytes which is called the buffy coat.
• Transfer the top remaining half (leukocyte poor) into a 10mL syringe
• Transfer the bottom remaining half, including some of the leukocytes into another 10mL syringe.

Procedure

Joint

• Infiltrate the skin and capsule with local anaesthetic but not the joint space
• Inject into the joint space or joint structure with the leukocyte poor solution

Tendon

• Inject around the tendon with the leukocyte rich solution

Aftercare

• Leukocyte rich PRP can cause a pain flare for a few days.
• Advise to wait for minimum 4 weeks before assessing efficacy.
• Use joint gently after procedure (e.g. low resistance cycling).
• 3 x injections for maximal effect
• Stop NSAIDs and potentially anti-platelet prior to and just after (as long as not contraindicaFilename.extted to stop).

Resources

{{#l:File:Platelet-rich plasma (PRP) for knee disorders.pdf}}