A colleague in Maryland wonders if others would comment on their use of 'platelet gel', including any methods to perform QC on the product.

The following comments have been received.

ADDENDA Jan. 20, 2005

1. A Certified Clinical Perfusionist who has both a clinical and business interest in the use of platelet gel reports that substantial studies in a wide array of specialties do not exist for the use of this product, but in her experience there are benefits to using Autologous Platelet Gel (APG). In her practice APG is applied to open wounds as a means to spur hemostasis and to encourage healing via the presence of platelet-derived growth factors. She cautions that in her experience there is one clinical circumstance where APG might be contraindicated, specifically, in the presence of cancerous cells, because "platelet rich plasma contains properties which may lead to the proliferation of said cells". As to the "QC" of APG, she claims that the key to a consistent yield is in the quality of contributing factors, including the blood draw (both quality and quantity), method of suspension/centrifuge/collection equipment, operator knowledge and training, and the length of time PRP/PPP sits prior to application.

ADDENDA Feb. 1, 2005

2. K.C. Roberts, MS, CP, CCA (attribution used with permission) who works at a hospital in Georgia reports that in his experience the perioperative use of autologous platelet-rich plasma and calcified thrombin to produce autologous platelet-gel has great potential for increasing the healing of bone and soft tissue. However, a question that needs to be considered is the safety and efficacy of topical application of autologous platelet-gel in surgical procedures where tumors, malignant or benign, are present. Manufacturers typically list the use of platelet-gel in the presence of tumor as a contraindication. One theoretical concern is that after the removal of a known cancerous tumor, secondary tumor cells in the margins might be stimulated by an application of a concentration of autologous growth factors to the site, which in Mr. Robert's opinion, could be tantamount to applying fertilizer to a weed garden. He reports having posed this question to "well-published, highly respected pathologists and transfusion specialists from around the country", with similar responses.

In terms of quality control of autologous platelet-gel, he comments that QC is an important aspect of the new AABB Perioperative Standards for Autologous Blood Collection and Administration. Manufactures of cell-separation devices have historically promoted measuring platelet count as a QC metric. He would like to suggest that it is equally important to know when and how much platelet activation is occurring during the entire process. Platelet activation, he believes, should be kept to a minimum during the blood draw and the actual processing/concentration portion of this service. Activation should only occur at high levels during the actual application phase. A question he has pursued is what test can be done to measure platelet activation, which would be inexpensive enough to be done several times a year during the quality control process and available in most hospital laboratories across the US. One thought might be to measure P-selectin, but many hospitals no longer provide that test. Thromboelastographs (TEG) might also suffice, but this test is not available in every hospital.

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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator