PRP GUIDE FOR VETS | 1 – Blood Extraction | 2 – Separation | 3 – Activation | 4 – Application
Application, being the last and definitive step of the process, is the most difficult one to describe, since PRP can be used basically on every species and in a large variety of organs, with plenty of different methods.
In this last step, we will provide a general outlook of species, medical specialties and some techniques; if you’re looking for specific details, you can check out our Conditions Links to review the exact diseases and procedures you need PRP for.
Academically speaking, journal papers and clinical reports have studied the veterinary use of PRP in horses, dogs, cats, rabbits, birds and some reptiles. Nevertheless, it would be foolish to believe that PRP Therapy is limited to what has been officially reported.
Thinking outside of the box, and already knowing the basic concepts and action mechanism of Platelet-Rich Plasma Therapy, we can assume that EVERY animal that has platelets in its blood is a candidate for this type of treatment. The factors that can lead us to—and guide us through— this thinking are:
PRP is a product derived from the patient’s own blood. In a few words, we apply a blood product that the patient already has; we are not introducing new or strange cells. We are basically just enhancing the platelet activity and focusing the area where we want this improved activity on.
Our medical judgment as veterinarians is the one that should help us calculate volume blood draw and treatment dosages in species that have not been studied, comparing them in weight and blood counts with the already tested species.
We already know that autologous PRP will not cause allergic reactions. The one thing that could bother us regarding secondary effects is the use of a platelet activator, so the general recommendation would be to investigate if the activator in mind has already been used in that species before (even though if it has been for other treatments of procedures) and search for unwanted reactions. If there is no available information about this, then the logical suggestion would be to go for the physiological activation method, unless being under experimental /laboratory /research circumstances.
Every organ receives blood perfusion; therefore, each one receives platelets as well. This implies a very simple but important idea: we can try PRP anywhere. Will it work in unstudied organs? We don’t know, but what we do know is that, at least with physiological activation we won’t cause major harm. There is still a lot to do and learn, and at www.PRPtreatments.org we will keep you up to date.
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Diseases and Techniques
As already appointed, PRP can be used in many body parts and structures. The techniques for the application will vary between species and
anatomy of the treated area.
The first veterinary medical specialty where PRP was used is orthopedics, mainly in equine sports medicine to treat bone and ligament injuries. Over the years, PRP proved to completely regenerate tissue and began to be explored in other type of bone diseases and species. Techniques for orthopedics application are incredibly widespread.
One of the most common procedures in equines and canines is intra-articular injection. The materials and techniques are different depending on the weight of the patient, as well as the joint that will be treated. Most needle gauges used go from 18 to 22. It is very important to highlight that during intra-articular injections, sedation and local anesthesia are imperative, regardless how cooperative the patient may be. Aseptic technique is also a must. The joint should be penetrated with the needle, and synovial fluid should be aspirated to ensure the needle is correctly located, to minimize effusion if presented, and to send sample for lab analysis. After this, the needle should be kept in place and the syringe with the PRP switched with the one containing the synovial fluid. Injection should not manifest resistance. In most intra-articular treatments, PRP Therapy can be combined with steroid, antibiotic and/or analgesic infiltrations.
In small breed dogs, the most common joint diseases are found in the stifle joint, though horses and cats may also present trouble in this area. The limb should be positioned in flexion, and the PRP injection should be administered between the patella and the tibial ruberosity, or from a parallel position to the patella. Patellar ligaments can also be injected, but preferably intra-surgically.
Another common area for injection is the hip, where large breed dogs are genetically prone to dysplasia, and any other pet can present trauma with fractures due to automobile accidents, on purpose injuries, among other causes that make this one of the almost daily conditions veterinarians treat. When injecting the coxofemoral joints, the hip should be neutrally positioned with a little bit of traction, so that the needle can be introduced perpendicular to the limb, cranial to the greater trochanter. Shoulder injections require almost the same limb positioning, but with a longer needle so that we can reach a distal position from the acromion, or between the acromion and the greater tubercle, from cranial to caudal.
Elbow (commonly damaged in large breed dogs, especially the Great Dane breed) and hock injections (often performed in horses) require the same, neutral limb position. The elbow joint should be injected between the lateral epicondyle and the olecranon; while for the hock joint procedure we should palpate the depression between the tibia and the talus, and inject at that exact location.
Carpus joint injections are also commonly performed, mostly in horses and cats, where flexion of the limb is necessary at 90 degrees, smaller needles should be used, and a lesser amount of synovial fluid should be aspired. The needle should be inserted into the palpable depression between the radius and the radiocarpal bone.
Techniques involving tendon injections have the same requirements as intra-articular, with the only difference relying on anatomy and not needing prior fluid aspiration. Bone marrow and intra-surgical techniques should be carefully studied and reviewed with a specialist before applying; although most of them involve the same materials and follow a similar logic. For spine application, technique is very similar to that of anesthetic blockage.
The ophthalmological applications are very simple to apply, and are extremely helpful for any species with eye conditions. Even reports of topical PRP Therapy in snakes with eye infections secondary to molting problems have shown amazing results.
The main concern in ophthalmology, rather than the species or the application technique, is to preserve the PRP the longest, so that the preparation process has to be repeated the least amount of times for chronic disorders.
The PRP preparation should be placed inside an empty and sterile eyedropper, and applied topically.
For intra-ocular injection, sedation of the patient is needed, lidocaine or other anesthetic eye drops should be applied, and the eye to treat has to be cleaned with iodine solution. The needle gauge should be the smallest, and the application should be directly into the sclera. After the procedure, it is normal to see a red spot on the site of injection. A very slight burning sensation may be felt by the patient, so an elizabethan collar or close supervision are indicated in dogs and cats, so they don’t over-irritate the eye with their paws or floor.
Reports of topical PRP Therapy in snakes with eye infections secondary to molting problems have shown amazing results.
This veterinary specialty has been widely explored, and the information we get from the PRP uses in Human Medicine has definitely helped us to expand ourselves in the area and adapt the techniques used for esthetic human procedures to chronic dermatological diseases in dogs. Also, PRP has been proven to be an invaluable help in treating burn patients, animal or human.
PRP can be applied on any layer of the skin, although, the layer that responds the best to PRP is the dermis, for it contains a lot if fibroblasts, which are stimulated to produce collagen with the application, resulting in a very effective physiological activation of resting platelets.
The topical application is frequently used for burn patients, and has proven to regenerate tissue and skin faster than any other product.
Other common techniques are: a) intradermal papule, where 0.1 cc of PRP are injected at the very junction of the epidermis and the dermis; b) intradermal injection, where a small needle is inserted within 1 to 2 mm at an angle of 30 degrees; c) intradermal NAPPAGE, a series of injections—generally from 2 to 4—, inserting the needle at a 30 to 60 degree angle, 2 to 4 mm apart from each other, and to a 2 to 4 mm depth; d)deep intradermal or hypodermal, where a perpendicular angle is preferred, and depth can vary from 4 to 15 mm.
Anything applied subdermally will increase the reproduction of stem cells (abundant in adipose tissue), and help generate re/neovascularization. This is a very important concept to consider when treating deep skin burns or injuries, as well as when performing skin grafts. PRP also increases the production of elastin and hyaluronic acid.
PRP Therapy has also been explored in cardiovascular surgery, helping a lot during bypass and blood transfusions.
There is still a lot to explore in neurology, but the information available is astounding regarding nerve regeneration after severe trauma.
Odontology is a daily practice for equine veterinarians, and has been growing as well in the small animal practice. PRP is a very helpful tool after surgery and extractions.
PRP is being currently investigated for treatment of chronic renal disease in cats and hepatic disease in dogs.
Veterinary is wide. PRP is wide. This could be a never ending story with tons of happy endings. There is still a lot to come for veterinary regenerative medicine.
*NOTE: Remember that PRP helps heal, but does not substitute other therapies (antibiotic, surgical, analgesic, etc.).