The effect of age, gender, and time between blood draw and start of centrifugation on the size outcomes of platelet-rich fibrin (PRF) membranes

Abstract

Objectives Platelet-rich fibrin (PRF) has been utilized in regenerative dentistry as a supra-physiological concentrate of autologous growth factors capable of stimulating tissue regeneration. Due to the variability in the macroscopic morphology/size of PRF membranes observed between patients, we were interested in studying the effects of patient age, gender, and time between blood draw and the start of centrifugation on the size outcomes of PRF membranes. Despite PRF therapy being increasingly more popular in private practice, to date, no study has investigated the effects of the delay between blood draw and the start of centrifugation in a clinical setting. Materials and methods A total of 60 patients enrolled in this study were divided into 6 groups of 10 patients each, including male and female patients categorized into age groups 21-40, 41-60, and 61-80 years. From each patient, a total of five PRF membranes were fabricated from 10-mL tubes following centrifugation starting after 0, 30, 60, 90, and 120 s. In total, 300 PRF membranes were produced in this study to investigate the effects of patient age, gender, and time on the size outcomes of PRF membranes. Results A longer delay by the clinician before starting centrifugation following blood draw led to a smaller final size of PRF membranes. At 90 s following blood draw, a significant (13%) reduction in PRF membrane size was observed. After 120 s, a significant (23%) reduction was observed. Additionally, female patients had on average 17% larger membranes compared to men (p < 0.05, 300 samples). Lastly, the size outcomes of the PRF membranes was largest in patients aged 61-80, followed by those aged 41-60 and 21-40. However, no statistically significant differences in PRF membrane sizes were reported between age groups. Conclusions The time at which a centrifugation procedure begins following blood draw is critical to optimize the size outcomes of PRF membranes. In general, approximately 15 s is required per tube to harvest 9-10 cc of blood. Therefore, a 60-to 90-s interval between blood draw and the start of centrifugation should be a parameter that is respected by clinicians to avoid significant changes in the macroscopic morphology/size of fabricated PRF membranes. Furthermore, females and older patients produced larger membranes, likely due to lower red blood cell counts derived from their peripheral blood. Clinical relevance The findings from the present study demonstrate that on average, a clinician has approximately 60-90 s between blood draw and the start of the centrifugation cycle to produce standard-sized PRF membranes. Shortly thereafter, a significant reduction in size is observed. Additionally, females and older patients were found to produce larger PRF membranes. Centrifugation protocols may therefore be adapted accordingly.

Evaluation of 24 protocols for the production of platelet-rich fibrin

“…As erythrocytes and other blood components also play a role in coagulation, as well as the hematocrit counts vary between patients and affect the size of PRF membranes [20], the present study also showed that not only the total plasma volume but also the cellular content of the layers were altered (Supplemental Figures 1-3). We have previously shown that both females and patients above the age of 65 typically have larger membranes as a result of their lower hematocrit counts [20]. Future research is needed to better understand how centrifugation speed and time may be further optimized to result in similar final cell concentrations from patients with different starting blood cell counts.…”

Evaluation of 24 protocols for the production of platelet-rich fibrin

“…Interestingly, there was also variability reported between patients. As the hematocrit counts vary between patients and affect the size of PRF membranes [20], the present study also showed that not only the total plasma volume but also the cellular content of the layers were altered (Supplemental Figs. 1-3).…”

“…1-3). We have previously shown that both females and patients above the age of 65 typically have larger membranes as a result of their lower hematocrit counts [20]. Future research is needed to better understand how centrifugation speed and time may be further optimized to result in similar final cell concentrations from patients with different starting blood cell counts.…”

Relative Centrifugal Force (RCF; G-Force) Affects the Distribution of TGF-β in PRF Membranes Produced Using Horizontal Centrifugation

“…Activated clotting time is usually around 2 min [ 17 ]; thus, the coagulation is rapidly advancing even before the tubes are exposed to centrifugation forces. Usually, the recommended time between the blood drawing and start of centrifugation is 60–90 s; otherwise the size of the PRF membrane is negatively affected [ 18 ]. Noteworthy, it is not only the size of the PRF membrane that matters but attention has also been paid to the distribution of platelets within the PRF membranes [ 8 ], as platelets are rapidly activated during the coagulation cascade and thereby entrapped in the developing fibrin-rich extracellular matrix.…”