Monday, August 24, 2009

Huh? Plasma Replacement Therapy

After Doug Brocail marched back from a sheared hamstring earlier than expected (I made the "sheared" part up), Mike Hampton is reportedly considering the same treatment. What the heck is it?

Well, blood is made of red blood cells, white blood cells, platelets, and plasma. I'll let Los Angeles orthobiologist Dr. Sampson take over from here:

Platelets were initially known to be responsible for blood clotting. In the last 20 years we have learned that when activated in the body, platelets release healing proteins called growth factors. There are many growth factors with varying responsibilities, however cumulatively they accelerate tissue and wound healing. Therefore after increasing the baseline concentration of these platelets, we are able to deliver a powerful cocktail of growth factors that can dramatically enhance tissue recovery.

The New York Times breaks it down a little bit more clearly:
The method, which is strikingly straightforward and easy to perform, centers on injecting portions of a patient’s blood directly into the injured area, which catalyzes the body’s instincts to repair muscle, bone and other tissue. Most enticing, many doctors said, is that the technique appears to help regenerate ligament and tendon fibers, which could shorten rehabilitation time and possibly obviate surgery...

...Platelet-rich plasma is derived by placing a small amount of the patient’s blood in a filtration system or centrifuge that rotates at high speed, separating red blood cells from the platelets that release proteins and other particles involved in the body’s self-healing process, doctors said. A teaspoon or two of the remaining substance is then injected into the damaged area. The high concentration of platelets — from 3 to 10 times that of normal blood — often catalyzes the growth of new soft-tissue or bone cells. Because the substance is injected where blood would rarely go otherwise, it can deliver the healing instincts of platelets without triggering the clotting response for which platelets are typically known.

Dr. Allan Mishra, Stanford University Medical Center:
“It’s a better option for problems that don’t have a great solution — it’s nonsurgical and uses the body’s own cells to help it heal. I think it’s fair to say that platelet-rich plasma has the potential to revolutionize not just sports medicine but all of orthopedics. It needs a lot more study, but we are obligated to pursue this.”

Dr. Neal ElAttrache, LA Dodgers' team physician (who did this procedure on Takashi Saito):
“For the last several decades, we’ve been working on the mechanical effects of healing — the strongest suture constructs, can we put strong anchors in? But we’ve never been able to modulate the biology of healing. This is addressing that issue. It deserves a lot more study before we can say that it works with proper definitiveness. The word I would use is promising.”

Fantastic, right? "Not so fast," say the heroes at the U.S. Anti-Doping Agency:
Guidelines published by the U.S. Anti-Doping Agency and the World Anti-Doping Agency do not address PRP therapy by name. The USADA rules imply that the injection of one's own blood could constitute a form of blood doping, even though the injected platelets are not put into the bloodstream. WADA rules prohibit the use of a growth factor called IGF-1, a component of platelet-rich plasma, but a spokesman for that agency declined to clarify whether PRP therapy inherently violated that rule.

Both organizations allow for exemptions for legitimate medical purposes. Spokesmen for WADA and USADA declined to clarify whether PRP therapy's use for a ligament tear or muscle strain would be considered a legitimate medical purpose or whether it had been already.

Medicine, or doping? You decide...

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