PRP

NOT ALL PRP IS THE SAME

Claudia McGloin explains how to understand leukocyte-rich and leukocyte-poor preparations

One of the most common questions I am asked during PRP training is whether leukocyte-rich or leukocyte-poor PRP is better. The choice depends on what you are treating, the desired outcome and what is contained within the syringe.

Clinicians are becoming increasingly aware that not all PRP preparations are the same. Less attention is paid to an important component: leukocytes, or white blood cells.

Several classification systems have been proposed to categorise PRP preparations based on platelet concentration, leukocyte content and red blood cell contamination, highlighting the complexity and variability that exists between devices.

WHAT ARE LEUKOCYTES?

Leukocytes are white blood cells that form part of the body’s immune system. Their primary role is to defend against infection, regulate inflammation and support tissue repair.

The main leukocyte components include neutrophils, lymphocytes and monocytes, and each contribute differently to healing. When these cells are present within PRP preparations, they can influence the biological activity of the final product. The ongoing debate centres on whether these effects are beneficial, detrimental or simply dependent on the indication being treated.

WHAT IS LEUKOCYTE-RICH PRP?

Leukocyte-rich PRP (LR-PRP) contains concentrated platelets alongside increased numbers of white blood cells. This type of PRP is typically produced by systems that capture the buffy coat layer during centrifugation.

The buffy coat sits between the plasma and red blood cell layers and contains a significant proportion of both platelets and leukocytes. By including this layer, manufacturers can produce a PRP preparation that contains higher levels of both cell types.

Advocates of LR-PRP suggest that leukocytes may contribute to tissue healing through antimicrobial activity, immune regulation and support of the inflammatory phase of repair. This may be particularly relevant in certain orthopaedic and musculoskeletal applications where a controlled inflammatory response is considered part of the therapeutic mechanism.

However, some leukocyte populations, particularly neutrophils, release inflammatory cytokines and enzymes that may contribute to tissue breakdown if present in excessive concentrations. This has led to questions around whether high leukocyte levels are always desirable.

WHAT IS LEUKOCYTE-POOR PRP?

Leukocyte-poor PRP (LP-PRP) aims to concentrate platelets while minimising white blood cell content. These preparations are usually obtained from the plasma layer above the buffy coat, deliberately avoiding significant leukocyte collection.

Platelets contain growth factors including platelet-derived growth factor, transforming growth factor-beta, vascular endothelial growth factor and epidermal growth factor, which are important in tissue regeneration.

By reducing leukocyte content, LP-PRP seeks to deliver these regenerative growth factors while minimising unnecessary inflammation. For this reason, many clinicians favour leukocyte-poor preparations when treating the face, scalp and other aesthetic indications.

IMPORTANCE IN AESTHETIC MEDICINE

Aesthetic medicine generally aims to achieve regeneration with minimal downtime and minimal inflammation.

Patients seeking facial rejuvenation want improved skin quality, elasticity and texture – not prolonged inflammation.

Understanding these differences is important, as the biological environment required for skin rejuvenation differs from that required for tendon or joint repair.

Many clinicians are unaware of the cellular composition of the PRP they are using.

This becomes particularly important when comparing outcomes.

THE STANDARDISATION CHALLENGE

As clinicians, we have become accustomed to discussing PRP as though it were one product. In reality, different systems can produce dramatically different preparations despite all being marketed as PRP devices.

When evaluating a system, clinicians should be asking several important questions:

• What platelet concentration is achieved?

• Is the PRP leukocyte-rich or poor?

• Is there red blood cell contamination?

• Is the product reproducible?

• Are independent validation studies?

LOOKING BEYOND THE PLATELET COUNT

For many years, the conversation around PRP has focused primarily on platelet concentration. However, platelet numbers alone do not tell the whole story.

Leukocytes, red blood cells, plasma proteins and growth factor release all contribute to the biological activity.

The more important question is whether the PRP preparation being used is appropriate for the indication being treated.

Only then can we deliver truly personalised regenerative treatments, improve consistency of outcomes and move closer to the standardisation that regenerative medicine urgently requires.

CLAUDIA MCGLOIN

Claudia McGloin, is a registered nurse with dual registration in Ireland and the UK with more than 28 years of clinical experience. She is one of Ireland’s leading PRP experts, an international speaker, author and educator specialising in regenerative medicine, orthopaedics and medical aesthetics. Through her clinic in Sligo, she has performed thousands of PRP treatments and is committed to advancing education, innovation and patient safety in regenerative healthcare. You can contact Claudia via email: claudiamcgloin@icloud.com