Trends in Biotechnology
ReviewClassification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF)
Section snippets
History and techniques
In transfusion medicine, platelet concentrates were originally used for the treatment and prevention of haemorrhage due to severe thrombopenia, which is often caused by medullar aplasia, acute leukaemia or significant blood loss during long-lasting surgery. The standard platelet concentrate for transfusion has been named platelet-rich plasma (PRP) and classically contains 0.5 × 1011 platelets per unit.
The use of blood-derived products to seal wounds and stimulate healing started with the use of
Definition of relevant parameters and classification
Three main sets of parameters are necessary for a clear classification of platelet concentrates (Table 1). The first set of parameters (A) relates to the preparation kits and centrifuges used. The size of the centrifuge (parameter A1), the duration of the procedure (parameter A2) and the cost of the device and kits (parameter A3) are significant factors when considering the repetitive use of these techniques in daily surgical practice. The ergonomy of the kit and the complexity of the procedure
Leucocyte-poor or pure platelet-rich plasma (P-PRP)
Pure platelet concentrates for topical use were first developed as an additional application of the classical transfusion platelet units and were first reported for maxillofacial surgery 3, 7.
Leucocyte- and platelet-rich plasma (L-PRP)
The initial objective of developing alternative easy-to-handle methods was to make it possible to use platelet concentrates in daily practice without having the support of a transfusion laboratory. Without a cell separator, elimination of leucocytes becomes more difficult, and the resulting platelet concentrates therefore contain a high quantity of leucocytes, which were not initially desired. However, through changes in the collection parameters, the same protocols might also be used to
Leucocyte-poor or pure platelet-rich fibrin (P-PRF) concentrates
In this category, there is only one method available. The Fibrinet PRFM kit by Cascade Medical (New Jersey, USA) contains two tubes, one for blood collection and another for PRFM clotting, together with a transfer device. A small amount of blood (typically 9 mL) is drawn into a collection tube, which contains tri-sodium citrate as an anticoagulant and a proprietary separator gel, and centrifuged for six minutes at high speed. The three typical layers of RBCs, buffy coat and PPP are obtained.
Leucocyte- and platelet-rich fibrin (L-PRF) concentrates: Choukroun's PRF
Choukroun's PRF protocol is a simple and free technique developed in France by Choukroun et al. [21]. It can be considered as a second-generation platelet concentrate because the natural concentrate is produced without any anticoagulants or gelifying agents [22]. Venous blood is collected in dry glass tubes and centrifuged at low speed (Process protocol, Nice, France) [23]. In the absence of anticoagulants, platelet activation and fibrin polymerization are triggered immediately. Therefore,
P-PRP or L-PRP? Potential applications and controversies
Most studies involving the use of PRPs have employed different in-house protocols in which the basic two-step centrifugation process was varied with regard to centrifugation forces (from 160 g to 3000 g) and time (from 3 to 20 min for the first centrifugation step). The definition of these parameters frequently seems to be empirical, and cross-examination of these technical data is an impasse. Moreover, it is very difficult to judge whether the actual experiments have been performed with P-PRP or
Leucocytes and fibrin: the two key parameters
The literature dealing with platelet concentrates often ignores the impact of leucocytes and fibrin, which are the two key parameters in our classification (Figure 4). Some authors even recommend, without any scientific evidence, the elimination of leucocytes [11]. However, several studies have already pointed out the key role of leucocytes in PRP [31], both for their anti-infectious action 56, 57 and immune regulation 25, 58. Apart from an anti-infectious effect, leucocytes produce large
Conclusions
The world of platelet concentrates for surgical use is actually a jungle of commercial proposals and unclear products. Under the same name, more than ten different autologous glues or biomaterials are available. The technological classification presented here aimed to provide an overview of the available systems and to categorize them with respect to three main parameters: fibrin density, leucocyte content and degree of standarization of the procedure. PRPs are often considered as improved
Acknowledgements
This work was partially supported by a grant from the LoB5 Foundation for Research, AP-HP, Paris, France. The authors declare no competing financial interests.
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