Platelet gel in the treatment of cutaneous ulcers: the experience of the Immunohaematology and Transfusion Centre of Parma

Background Platelet gel is being ever more frequently used to promote healing of cutaneous ulcers However the factors that determine the often variable clinical outcome of this procedure ire still incompletely understood Aims The aims of this study wet e to demonstrate that platelet gel even when obtained under strictly controlled conditions produces highly variable outcomes in p Merits with cutaneous ulcers and to propose a method for in vino standardisation of the biological properties of platelet gel Material and methods Patients were em oiled on the basis of a pie-defined protocol Platelet concentrate was produced with standard methods with a variability n platelet count among the different samples of less than 10% The platelet gel for clinical use was obtained under strictly standardized conditions by adding thrombin and calcium gluconate to the concentrates For in vitro studies platelet gel obtained from platelet-rich plasma from tour donors was frozen and thawed twice so as to increase gel contraction The supernatant was used to modify cell poliferation protein synthesis and the expression of selected genes in cultures of human diploid fibroblasts Results Seventeen patients (aged 44-78 years) with ulcers (4 diabetic 11 vascular I post-traumatic I decubitus) were treated with platelet gel (4 autologous 3 homologous) Complete re-epithelialisation of tour ulcers (1 diabetic 1 post-traumatic 2 vascular) was obtained affect applications of platelet gel (2 autologous 2 homologous) in 11 other crises there was a greater than 50% reduction in the size of the ulcer Two patients had no bent fit The supernatant of the platelet gel was able to promote dose-dependent proliferation and changes in gene expression is well as in metabolic activities I elated to protein synthesis Conclusions Although the use of platelet gel in the treatment of cu aneous ulcers is increasing and conditions for its production are better standardised very considerable variability of clinic it outcomes is still observed even within single centres suggesting that there are differences in biological properties of platelet concentrates horn individual patients which cannot be readily controlled with current techniques The biological effects of the platelet gel supernatant described in this article may provide the basis for a simple biological validation of platelet preparations before then clinical use so is to reduce this potentially important source of variability