Platelet-Rich Plasma (PRP)

The healing of resistant wounds is a daunting challenge. Chronic wounds, which include diabetic ulcers, pressure sores, and venous ulcers represent a $6 billion dollar healthcare problem each year. These wounds lead to over 60,000 amputations annually in the United States. There are some 25 million U.S. patients that require some form of care including 2 million outpatient burn cases, 80 thousand inpatient burns and more than 1 million ulcer patients.

Con Cell Corp is comprised of trained technicians experienced in various PRP applications. A technician can be provided to perform the entire blood collection and processing procedure or simply train the doctor and staff.

Perioperative Platelet-Rich Plasma Procurement Protocol

Principle

To provide safe and rapid preparation of autologous platelet-rich plasma (PRP), rich in autologous human growth factors (AGF), in the form of a platelet gel, to promote bone growth and general healing. (Note: The administration of blood products is the responsibility of the medical / surgical nursing staff, not the PA-Tech.)

Scope

The preparation allows PRP to be mixed with allogeneic or autogeneic bone grafting materials for delivery to site of bone graft, to promote bone growth, graft stabilization wound healing and hemostasis. This application may be used in, but not limited to, Periodontics, Oral Surgery, ENT and Plastic Surgery.

Responsible Personnel

Perioperative Autotransfusion Technology Staff / Medical, Surgical and/or Nursing Staff. Hospital Blood Bank Medical Director oversees staff trained to perform these tasks and PAT staff is required to follow this and all applicable SOPs.

Definitions

Platelet-Rich Plasma - The part of plasma containing a higher than normal concentration of platelets.

Platelet-Poor Plasma - The part of plasma that does not contain platelets.

AGF - Autologous Growth Factors: Factors found in concentrated autologous platelets that have the potential to accelerate bone growth and healing.

Equipment and Supplies

Supplies needed for PRP preparation include the Medtronic Magellan Autologous Platelet Separation System and the Platelet Separation Disposable Kit, which may include the following:

One Separation chamber;
One 10 ml syringe;
One 60 ml syringe;
One 18 gauge needle w/tubing;
One 30 ml vial of ACD-A anticoagulant;
One IV Prep Kit.
Forms Required

QC/Maintenance Log Sheet
PRP Procedure Record

Procedure

Remove the separation chamber package from the tray.
Peel open the lid on the chamber package.
Holding the platelet separation chamber with the vent facing upward, thread the attached tubing through the center of the chamber caddy.
Snap the platelet separation chamber into the centrifuge caddy making certain that both ends of the chamber are properly located in the caddy notches. Place T-connector in slot and tubing under retainer on top surface of caddy. Press tubing down into grove on outer edge of chamber caddy.
Rotate the tubing collar so that its shape aligns with the opening in the support arm. Slide the tubing collar into support arm and close the latch.
Press tubing down into groove on support arm, and place tubing through notch in centrifuge ridge.
Prepare the syringe pumps on the front of the instrument by rotating the plunger drivers to the open position while sliding them to the lowest points.
Prepare the patient for veni-puncture according to standard clinical practice using the IV site Prep Kit.
Using aseptic technique, the Anesthesiologist will draw the appropriate volume of anticoagulant from the ACD-A anticoagulant vial into the 60 ml syringe using the 18 gauge needle. (Refer to table 1 for appropriate volumes of ACD-A and blood.)

Table 1: Volumes of ACD-A and corresponding volumes of blood to achieve anticoagulated blood containing - 7 parts blood: 1 part ACD-A.

Total Volume of Anticoagulated Blood (ml)
Volume of ACD-A (ml)
Volume of Blood Drawn (ml)
            30

        4.0
26.0
            40
        5.0

35.0
            50

        6.0
44.0
            60
        8.0

52.0

Following veni-puncture with 18 gauge needle, the Anesthesiologist slowly draws the appropriate volume of whole blood from the patient.
Gently mix the blood with the ACD-A for thorough distribution.
Disconnect syringes from IV tubing. Set aside syringe and discard needle and IV tubing.
Remove the luer connector cap from the shorter length of chamber tubing and attach the empty 10 ml syringe.
Place syringe into the appropriate syringe pump receptacle.
Rotate and slide the plunger driver to engage the syringe.
Remove the luer connector cap from the longer length of chamber tubing and attach the empty 60 ml syringe.
Place syringe into the appropriate syringe pump receptacle.
Rotate and slide the plunger driver to engage the syringe.
Close the centrifuge cover on the instrument. Confirm that all indicator lights are green.
Press green start button and the Magellan will automatically separate the platelets.

References:

Magellan Platelet Separation System Operator's Manual. Medtronic, 7611 Northland Dr., Minneapolis, MN 55428 ã 2006.
American Association of Blood Banks, Standards for Perioperative Autologous Blood Collection, 2^nd ed. (Bethesda, MD: American Association of Blood Banks, Nov, 2006).