Platelet-Rich also believed in its ability to

Platelet-Rich Plasma Should
Not Be Practised In The Medical Field

            Vampire
facelift is one of the treatments prevalently chosen by Hollywood celebrities
nowadays. Kim Kardashian, Rupert Everett and Anna Friel are some
of them, as reported in The Telegraph newspaper by Chalmers
(2014). The name “Vampire Facelift” was established by Dr. Charles Runels from
Alabama in 2010, when
Vampire Diaries and Twilight Saga were a huge phenomenon at that particular
time. Widely known as platelet-rich plasma (PRP) among
the physicians, it consists of a portion of plasma
fraction of autologous blood having a platelet concentration above baseline
(Lacci & Dardik, 2010).

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A
study conducted by Ferrari et al. (as cited in Sampson,
Gerhardt &
Mandelbaum, 2008) revealed
that the first time PRP was used during an open
heart surgery was
to avoid excessive transfusion of homologous blood products. In early 1990s,
many doctors started
to practice PRP in other areas of expertise
such as maxillofacial dental, periodontal surgery, cosmetic surgery and skin
grafting due to the positive
improvements that were shown in several reports
(Alderman, 2010).

            PRP
was believed to function as a tissue sealant and drug delivery system with the
platelets initiating wound repair by releasing locally acting growth factors
via ?-granules degranulation (Lacci & Dardik, 2010) because it contains a number of proteins,
cytokines and other bioactive factors ?
which was
concluded as a modern version of prolotherapy (Alderman, 2010). According to Alderman and Alexander (2011), prolotherapy
is a nonsurgical treatment which stimulates healing and short for “proliferation
therapy”. It is also known as nonsurgical ligament and tendon reconstruction,
or regenerative injection therapy (Alderman & Alexander, 2011). PRP
was also believed in its ability to reduce
the risk of
having any appalling side effects including infection or allergic reaction
because the source of the
injected substance is from the patient’s own body (Rizk, n.d.).

This has shown that the use of PRP in
medical field has
been acknowledged for a
long time, whether it is in a form of liquid injection or gel-like structure, and was
recently
pointed out by Marwah, Godse, Patil and Nadkarni (2014) that it has attracted attention in the field
of dermatology. People have started
to give it a try in order to
improve and rejuvenate their own skin for beauty. The UK’s Platelet Rich Plasma
Specialist (2015) promoted
the use of PRP instead of botox
or dermal fillers as
it gives the skin
a more natural radiance and the effects last longer.

            In spite of all of these positive effects,
has the use of PRP been approved clinically to not give any complications to the consumers? The question on
PRP’s authenticity is still being argued,
even among the specialists
and physicians because there were no consensus that PRP or related treatments have meaningful
benefit (Lazarovic, 2013). Lazarovic (2013) again emphasised it is highly recommended
that the PRP treatment is to
be restricted to precise clinical studies and not to be used in the general
population. This is to
avoid delivering improper treatments to the patients as it is still very unsure
in terms of administration, dosage and side effects.
Hence, platelet-rich
plasma therapy should not be encouraged
due to uncertainties of
its results, treatment administrations and side effects that can harm the consumers.

Uncertainties of Platelet-Rich
Plasma in Its Results

The
variable and unpredictable results of PRP treatment have situated it in an
uncertain position to be practised in medical field. It was also claimed to be
nothing more than a mere expensive placebo. This idea has been confirmed by the
findings of a few researches. As for the first case, a study was conducted by
Margolis et al. (as cited in Lacci & Dardik, 2010) in investigating the
effectiveness of platelet releasate (PR) in the treatment of diabetic
neuropathic foot ulcers, 21% of the patients were treated with PR. The result
shows that 43.1% of patients healed within 32 weeks, including 41% of patients
not treated with PR treatment and 50% of patients treated with PR. However,
there was a varying timing of PRP treatment as not all patients received 20
full weeks of the treatment. The percentage of healed patients also levelled
off after 20 weeks, which means only little incremental continued healing after
this time.

From
another research finding, it is learned that the use of PRP in treating
jumper’s knee was observed in a 6-months study (Kon et al., 2008). The study
resulted in six men with complete recovery, eight with marked improvement, two with
mild improvement and no improvement in four cases. Statistically, a significant
improvement was observed. Lower results were only shown in patients who did not
follow the post-procedure protocol. In the three of the failed cases, the
patients did not follow the stretching and strengthening programme. In the fourth
case, there was no improvement even after the lengthened programme and
treatment. After six months, a surgery was conducted on him and intratendinous
within the tendinous portion of a muscle calcification was found and removed.
Calcification is one of the side effects that might follow around the injection
site (Johnson, n.d.). This
will be discussed in the later part. Nevertheless, the results of this written
article was from a pilot study, thus the effectiveness of PRP could still be
questioned because of the small sample size used.

Next, an article produced
by University of Michigan claimed that the use of PRP to enhance bone regeneration
has been documented in several cases (Wang & Avilia, 2007). However, a
recent study on bone ingrowth and vascular supply using PRP has been conducted
by Cinotti et al. (2013) in experimental spinal fusion. Subjects of experiment
were rabbits. The aim of the experiment was to create a bony bridge between the
transverse processes of the vertebrae. Although some new bone growth was
observed, none of the rabbits developed a full bony bridge. There was also no
increase in vascular density. Hence, it is clear that PRP does not support in
bone growth and vascularisation.

Moreover, in cases related
to tissues, Randelli, Arrigoni, Ragone, Aliprandi and Cabitza (as cited in
Maffulli et al., 2011) pointed out the use of PRP augmentation for “rotator
cuff repair do not show improved functional outcomes when compared with a non-augmented
repair at medium and long-term follow up”. This shows that uncertainty still
exists due to its capability in yielding improved results. Although several
authors advocated the use of PRP, the current literature on tissue engineering
application for rotator cuff repair is scanty (Randelli, Arrigoni, Ragone,
Aliprandi & Cabitza as cited in Maffulli et al., 2011).

In brief,
the overall of PRP treatment provides such weak evidence. This is based on many
of the case reports which were lacking in control. The weak evidence presented
to support the increasing clinical use of PRP as a treatment for various
injuries makes the validity and effectiveness of PRP uncertain. 

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