Tuesday, December 29, 2009

Differentiating "Blood Doping" and "Blood Spinning"

Platelet-Rich Plasma Therapy (PRP) has begun to adopt the appropriate title of "blood spinning." This post aims to differentiate that label from "blood doping," a separate treatment performed for a completely different purpose. While a blood transufussion means of doping relies on an athlete's blood being spun in a centrifuge similar to PRP, the materials being extracted from the centrifuge are different in both procedures, with seperate uses and intentions. Simply stated, PRP aims to repair soft-tissue tears naturally, blood doping attempts to enhance red blood cell counts artificially.

PRP is the removal of a small amount of blood from a patient with a soft tissue injury (tendon, ligament, muscle, etc.). The blood contains healing components called platelets that release growth factors used by the body to grow and create cells. These platelets are not normally used by the body in large enough concentrations in such injuries. Patients' blood is thus spun in a centrifuge, which extracts these natural platelets. The platelets are then concentrated in a specific dose and injected directly into the injury, catalyzing the body's natural healing abilities. This entire process takes roughly an hour.

If you were trying to fuse a split 2 x 4 with a small drop of wood glue, it may stick momentarily, but when used, it would be unstable and likely break again. PRP gives the woodworker the entire bottle of wood glue to fuse the split wood. The process is very safe with almost no risk of side effects because the platelets are natural and come from the patient. The World Anti-Doping Agency (WADA) has approved the use of PRP in all soft tissue excluding intramuscular injection. When injected directly into muscle, it is possible PRP can enhance growth, thus creating a similar outcome to steroid use.

PRP has been widely used in professional athletics and deemed a legal form of therapy for soft tissue tears and tendinitis but the therapies true potential lies in healing injuries for the weekend warrior and the construction worker with a torn elbow tendon.

"Blood Doping" of the other hand has various means and a multitude of procedures, all with the same intention: to increase red blood cells in the blood stream. It has been deemed illegal by WADA, the International Olympic Committee and International Cyclist Union and can have life threatening side effects. Red blood cells carry oxygen to muscles and increases red blood cell count resulting in oxygen being taken to muscles more efficiently. This gives aerobic athletes a significant advantage over competition as they battle less fatigue.

While red cell counts can be increased naturally by training at high altitudes where less oxygen is present, blood doping gives athletes an increased and illegal boost. To gain the higher count through doping, athletes inject themselves with erythropoietin (EPO), a hormone that stimulates red blood cell production. EPO has been pervasive in the top levels of cycling for the past two decades. Because it thickens the blood, it has dangerous side effects such as blood clotting that can cause heart attacks and strokes. An abnormally high red blood cell count can also result in impaired blood flow and death.

Athletes can also have four units of blood removed a month prior to competition and spun through a centrifuge to remove the red cells. Three weeks later, the concentrated red blood cells are transfused back into the athlete. Thus, the blood spinning is inherent to this process but the material being collected is unique and for a different purpose.

If PRP is the wood glue that reconnects the severed 2 x 4 making it once again useful, blood doping is taking a pristine 2 x 4 and infusing it with graphite for artificial strengthening.

Where PRP is described as "blood spinning" it should not be confused with or categorized as "blood doping."

Monday, December 28, 2009

CNN's Platelet Rich Plasma and Tiger Woods Segment

Anderson Cooper and Dr. Sanjay Gupta explained PRP and the treatment of Tiger Woods on AC360 on December 17. The PRP segment is informative and easy to understand. Cooper and Dr. Gupta discuss Dr. Anthony Galea use of PRP in Woods' knee following surgery. Although Dr. Galea has been arrested for distribution of Human Growth Hormone in the US, there has been no indication Tiger had any association with this practice.

While PRP is "blood spinning," it should not be confused with "blood doping." This segment distinguishes blood spinning as acceptable and beneficial practice.

Wednesday, December 16, 2009

Monday, December 7, 2009

Ultrasound's Importance in Measuring Platelet-Rich Plasma Therapy Results

In a European PRP study using horses as test subjects, utilizing ultrasound to measure healing levels proved to be very useful. Ultrasound uncovered the improvement in tissue alignment during healing with PRP as opposed to placebo. Ultrasound also confined the healing course is more efficient using PRP (Bosch et al).

Excerpt from Study:

"The effectiveness of new therapies to treat tendon injuries is difficult to determine and is often based on semi-quantitative methods, such as grey level analysis of ultrasonographic images or subjective pain scores. The alternatives are costly and long-lasting end-stage studies using experimental animals. In this study, a method of ultrasonographic tissue characterisation (UTC), using mathematical analysis of contiguous transverse ultrasonographic images, was used for intra-vital monitoring of the healing trajectory of standardised tendon lesions treated with platelet rich plasma (PRP) or placebo. Using UTC it was possible to detect significant differences between the groups in the various phases of repair. At end stage, over 80% of pixels showed correct alignment in the PRP group, compared with just over 60% in the placebo group (P<0.05). UTC also showed significant differences in the course of the healing process between PRP treated and placebo treated animals throughout the experiment. It was concluded that computerised analysis of ultrasonographic images is an excellent tool for objective longitudinal monitoring of the effects of treatments for superficial digital flexor tendon lesions in horses."

Researchers: Bosch G, René van Weeren P, Barneveld A, van Schie HT.

Article Title: "Computerised analysis of standardised ultrasonographic images to monitor the repair of surgically created core lesions in equine superficial digital flexor tendons following treatment with intratendinous platelet rich plasma or placebo"

Location and Publisher: Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.

Date Published: 2009, Nov 19

Implant Dentistry Reports Platelet-Rich Plasma Enhances Bone and Tissue Growth

At the American Academy of Implant Dentistry prominent researcher and Journal of Oral Implantology editor, James Rutkowski, DMD, PhD, reported the potential for accelerated healing of dental implants using platelet-rich plasma. While this is not an orthopedic study, Dr. Rutkowski noted its continued success in sports injuries and orthopedics.

Dr. Rutkowski said about PRP in dental implants, "...PRP treatments can jump start bone growth and implant adherence in just two weeks...Accelerated healing is a goal we've been seeking in implant dentistry and we now have treatment that activates the natural healing process. It is a very promising development..."

He estimated 10 percent of implant dentists have used PRP and that number will continue to rise.

It seems increasingly numbers of prominent doctors believe PRP is effective and that trend will continue.