Upon an injury, the blood, by virtue of its circulation, delivers platelets to the injured area. However, there are times when the body has sustained more serious injury and needs a lot more platelets to heal. This is especially true when ligaments and tendons are involved. They have limited healing capabilities due to already very limited blood flow to them. In fact, you can actually tell if a tissue isn’t getting enough of a blood supply if you look at them. If you look at tendon, ligament, or cartilage, they are white. This is due to the limited blood supply. On the other hand, the liver is deep red because of the abundant blood supply. A rule of thumb is that if tissue gets a good blood supply, that tissue heals faster. If the area is restricted in blood supply, the healing is very slow.

This is why the joints do not heal well on their own. This is why a sprained ankle (typically the lateral ankle ligaments between fibula and tibia, talus or calcaneus) or a low back pain (typically sacroiliac ligament tear) is slow to heal.  Not much blood reaches ligaments and other poorly vascularized tissues.

Platelet rich plasma (PRP) allows healing to take place in regions where healing would have been too slow. PRP directly supplies the concentrated platelets (the yellow blood cells) to the injured ligaments. A commonly used reason for PRP is to heal the tendons and ligaments. But also it is used to help regrow hair in bald spots in people by increasing the growth phase of hair.

 

Platelet Rich Plasma Therapy

Figure 2. White blood cells amongst red blood cells. Credit: Ryan Etter

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Figure 4. Whole blood is drawn and centrifuged to create artificial gravity to separate the blood into 4 layers. At the very bottom is (1) collection of the red blood cells, then above it is (2) the “buffy coat” made of the white blood cells, and above it is (3) the platelet rich plasma, then finally at the top is (4) the plate poor plasma. 

Third, in order to heal, we need the “work order” messages to start repairing and growing brand new cells and tissues. They are largely known as “growth factors.” They include:

Platelet-derived growth factor
Transforming growth factor
Insulin like growth factor 1
Insulin like growth factor 2
Fibroblast growth factor
Vascular endothelial growth factor
Epidermal growth factor
Connective tissue growth factor
Keratinocyte growth factor

All these are contained in tiny cells called the yellow blood cells. They are now better known as platelets because they resemble “tiny plates” under the microscope, or thrombocytes because they cause clotting (thrombos is Greek for “blood clot” and cyte is another word for cell). Whether they are called the yellow blood cells, platelets or thrombocytes, they are referring to the same thing.

 

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Figure 1: Red blood cells circulating through a blood vessel. Credit: Spanteldotru.



































































































































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Figure 3. From left to right. Red blood cell, yellow blood cell (aka platelet), and white blood cell. Credit: National Cancer Institute at Frederick.

​Second, in order to heal, we need to deal with the germs that have “slipped in” through the wound. Healthy skin normally forms a barrier between the body’s internal world of cells and the external world. When a break occurs in the skin or the gut, the white blood cells move into the region, and eliminates the germs. This prevents the body from being used as food, shelter, or a breeding ground for hostile germs. ​

How an injury heals

Our bone marrow produces 3 major types of cells from the bone marrow. They are (1) red blood cells, (2) white blood cells, and (3) yellow blood cells. 

I have had chronic backpain due to a car accident. I have got many treatments for my back by chiropractors, physiotherapists and many other types of health care professionals with little or no result. PRP with ozone therapy was the only method that really treated my pain. I am really thankful of Dr. Kim for his accurate diagnosis and wonderful professional care. Shahrad Hakimi





First, in order to heal, we need energy. This is why we need the red blood cells. A RBC picks up oxygen from the lungs and delivers them to the body tissues. Presence of oxygen makes a 1,800% increase in energy productivity. For example, without oxygen, cells will have to rely on anaerobic respiration to produce that which gives only 2 units ATP per glucose molecule; but with oxygen, the cell can produce 36 units of ATP.

Just like a car, the human body requires energy to grow, heal, fight infection, think, and feel. In fact, for life to go on, we need oxygen.