How RBCs Affect PRP Efficacy

• Red Blood Cells (RBCs) are often present in PRP depending on the preparation method.
• High RBC content in PRP is increasingly recognized as detrimental, primarily due to its pro-inflammatory and cytotoxic effects 1,4.

Implications of RBC in PRP Systems

Inflammatory and Cytotoxic Consequences

• Eryptosis and Hemolysis: Administration of RBCs with PRP leads to eryptosis (RBC death), releasing hemoglobin and iron, which triggers macrophage migration inhibitory factor (MMIF)—a potent pro-inflammatory cytokine 1,4.
• Cytokine Correlation: Studies show a significant positive correlation between RBC concentration and inflammatory cytokines such as IL-1β and IL-18 in PRP samples (Mini GPS III system: RBC and IL-1β, IL-18, *P < 0.001) 5.
• Cellular Dysfunction: High RBC content hinders fibroblast proliferation and stem cell migration, likely causing cellular dysfunction and impaired healing 1,4.

Clinical and Biological Implications

• Inflammatory Cytokines: Higher RBCs correlate with increased IL-1β, MCP-1, IL-8, IL-18, all of which are linked to inflammation and tissue catabolism 5.
• Growth Factor Correlations: While RBCs may correlate with some growth factors (e.g., EGF, VEGF, PDGF-AA), the net effect is negative due to the associated inflammatory milieu and cytotoxicity 5.
• Best Practice: Use PRP systems that minimize RBC contamination for musculoskeletal and other regenerative applications 1,5.

Summary

Quantitative data confirm that PRP systems with lower RBC contamination (e.g., Arthrex ACP, Dr. PRP, Juventix) provide a better balance of efficacy and safety, while systems with higher RBCs (e.g., Mini GPS III) may yield more platelets but at the cost of increased inflammation and reduced therapeutic benefit 1,5,7.