Challenge

Texas Orthobiologics, lead by Don Buford, MD, Orthopedic Surgeon, has become a leading center for biological alternatives to treat orthopedic pathology in patients who are resistant to surgical options.  Recognizing “the need for better PRP data everywhere,” they became one of the first centers to start measuring the cellular characterizations of Platelet-Rich Plasma (PRP) in order to better understand clinically important composition factors. According to Dr. Buford, “It’s important to understand how we make, evaluate, and administer PRP clinically.”

In measuring his cellular characteristics, Dr. Buford seeks to ensure he reaches an optimal dose for each patient and evaluate the correlation between cell composition and outcomes.

Solution

Using a hematology analyzer to test the cellular characteristics of PRP prior to administering allows him to dial in the point-of-care considerations for more accurate results:

Platelet Count
Achieving a minimum platelet "dose" in PRP is crucial for effective treatment. Platelet counts can vary widely and ensuring sufficient levels is essential for delivering therapeutic benefit. Precise measurement and adjustment of platelet counts allow for tailored PRP treatments, enhancing the efficacy of the intervention.

Red Blood Cells
While testing whole blood (vs. just the platelets) might seem onerous to some, there are important insights to be gained. Studies from The Biologics Association showed that short term exposure of red blood cells causes the activation of inflammatory pathways and oxidative stress and has a deleterious effect on chondrocytes and synoviocytes, potentially leading to degenerative joint damage.

White Blood Cells
While Neutrophils can upregulate inflammation, monocytes, lymphocytes can contribute to positive outcomes.

In the DataBiologics platform, Whole Blood and PRP cell counts can be entered in conjunction with diagnosis, treatment details and patient characteristics. Texas Orthobiologics then tracks their patient outcomes in the DataBiologics registry database — combining the data in one system allowing them to stratify their results by cellular characterization.

Results

The combination of testing cellular characterizations and tracking patient outcomes gives Texas Orthobiologics invaluable insight into how to administer PRP clinically according to the proper dosage and treatment frequency, as well as when to consider combination and adjunctive treatments. In the future this data will also be leveraged to inform which PRP composition factors impact outcomes the most and to better understand the dosage for various conditions.

At the 2024 Interventional Orthobiologics Foundation (IOF) conference, Dr. Buford presented preliminary findings from his clinic and the global IMPACT Registry that helped provide insight into the optimal number of injections and platelets delivered for patients with knee osteoarthritis.

‍