Epidural patch with autologous platelet rich plasma: a novel approach

Abstract

We aimed to perform an epidural patch using platelet rich plasma (PRP), which has the potential to regenerate and heal tissues via degranulation of platelets, in a 34-year-old parturient suffering from persistent post-dural puncture headache (PDPH) after failed epidural blood patch (EBP). After her admission to our unit, we reconfirmed the clinical and radiologic diagnosis of PDPH. Cranial MRI with contrast showed diffuse pachymeningeal thickening and contrast enhancement with enlarged pituitary consistent with intracranial hypotension. Clinical and radiological improvements were observed 1 week after the epidural patch using autologous PRP. Therefore, we recommend using autologous PRP for epidural patching in patients with incomplete recovery after standard EBP as a novel successful approach.

Can Platelet Count and Mean Platelet Volume be Used as Markers of Postdural Puncture Headache in Obstetric Patients?

“…Although no report directly supports a relationship between headache and platelet indices after dural puncture, epidural blood patch and platelet-rich plasma-based methods involve platelets [19,36,37]; the healing properties of platelets may have contributed to the positive responses to these procedures obtained when applied in PDPH cases. Dodge et al evaluated the relationship between smoking and PDPH and found that PDPH was less common in their smoker group.…”

“…e epidural patching with platelet-rich plasma was not effective in preventing mechanical CSF leakage. Nevertheless, platelets play an important role in regeneration and healing through the inflammatory pathway in this area [19]. e platelet count (PC) and functions are very important for hemostasis in normal physiological and pathological processes.…”

“…Furthermore, in a recent cadaver study, electromicroscopic examination of lesions formed after spinal puncture performed with different types (and angles) of needles showed that spinal needles cause traumatic lesions on the dura and arachnoid membranes [ 18 ]. In another study, a patient with postspinal headache who did not respond to epidural blood patch treatment, which is commonly used for PDPH, was treated with platelet-rich plasma as an alternative [ 19 ]. The epidural patching with platelet-rich plasma was not effective in preventing mechanical CSF leakage.…”

“…The epidural patching with platelet-rich plasma was not effective in preventing mechanical CSF leakage. Nevertheless, platelets play an important role in regeneration and healing through the inflammatory pathway in this area [ 19 ].…”

Risks in Induction of Platelet Aggregation and Enhanced Blood Clot Formation in Platelet Lysate Therapy: A Pilot Study

“…PL and PC contain cytokines involved in platelet aggregation and thrombus formation, and arterial thrombotic occlusion causes ischemia or infarction [ 15 ]. The implementation of PL and PC in the treatment of diseases of internal organs is under development or being investigated in pilot studies [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. On the other hand, irreversible blindness caused by ophthalmic artery occlusion was found in several patients following PC injection into facial skin [ 26 , 27 ].…”