Mean Platelet Volume in Blood vs. Platelet-Rich Plasma: Demographic Analysis and Intrasubject Variability in PRP Therapy

Document Type : RESEARCH PAPER

Authors

1 1 Instituto Cugat, Hospital Quironsalud Barcelona, Barcelona, Spain -Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain

2 Instituto Cugat, Hospital Quironsalud Barcelona, Barcelona, Spain

3 Instituto Cugat, Hospital Quironsalud Barcelona, Barcelona, Spain.

10.22038/abjs.2025.87073.3950

Abstract

Objectives: To evaluate inter- and intraindividual differences in mean platelet volume (MPV) between blood and platelet-rich plasma (PRP), and to assess the influence of demographic factors (sex, age, body mass index (BMI)).
Methods: A retrospective analysis of 877 patients treated with PRP for musculoskeletal conditions (Nov 2021–Dec 2024). MPV values in blood and PRP were compared. Intrasubject variability was analyzed in a subgroup of 298 patients who received at least three PRP doses.
Results: MPV was significantly lower in PRP compared to blood (p < 0.001). Age, sex, and BMI had no significant effect on MPV. The coefficient of variation (CV) was low in both blood (2.78%) and PRP (3.87%), with the variation in PRP being significantly greater than that in blood (p < 0.001). Intrasubject MPV variability was low (coefficient of variation (CV): 2.78% in blood, 3.87% in PRP; p < 0.001), while intersubject variability was greater in PRP.
Conclusion: Centrifugation significantly reduces MPV in PRP compared to whole blood, indicating that the preparation process alters platelet characteristics. While demographic factors such as age, sex, and BMI do not appear to influence platelet size, the greater intersubject variability—compared to low intrasubject variability—suggests that centrifugation protocols play a key role in determining PRP composition. These findings support the reliability of the single-step PRP preparation method used in this study and highlight the importance of protocol standardization to ensure consistent biological quality, which may ultimately impact the therapeutic effectiveness of PRP in musculoskeletal treatments.
        Level of evidence: IV

Keywords

Main Subjects


  1. Mautner K, Malanga GA, Smith J, et al. A call for a standard classification system for future biologic research: the rationale for new PRP nomenclature. PM R. 2015;7(4 Suppl):S53-S59. doi: 10.1016/j.pmrj.2015.02.005.
  2. Corsini A, Perticarini L, Palermi S, Bettinsoli P, Marchini A. Re-Evaluating Platelet-Rich Plasma Dosing Strategies in Sports Medicine: The Role of the “10 Billion Platelet Dose” in Optimizing Therapeutic Outcomes—A Narrative Review. J Clin Med. 2025;14(8):2714. doi: 10.3390/jcm14082714.
  3. Mazzucco L, Balbo V, Cattana E, Guaschino R, Borzini P. Not every PRP-gel is born equal. Evaluation of growth factor availability for tissues through four PRP-gel preparations: Fibrinet, RegenPRP-Kit, Plateltex and one manual procedure. Vox Sang. 2009;97(2):110-8. doi: 10.1111/j.1423-0410.2009.01188.x.
  4. Milano G, Sánchez M, Jo CH, Saccomanno MF, Thampatty BP, Wang JH. Platelet-rich plasma in orthopaedic sports medicine: state of the art. Journal of ISAKOS. 2019;4(4):188-95.
  5. Manole CG, Soare C, Ceafalan LC, Voiculescu VM. Platelet-rich plasma in dermatology: new insights on the cellular mechanism of skin repair and regeneration. Life (Basel). 2023;14(1):40. doi: 10.3390/life14010040.
  6. Blair P, Flaumenhaft R. Platelet α-granules: Basic biology and clinical correlates. Blood Rev. 2009;23(4):177-89. doi: 10.1016/j.blre.2009.04.001.
  7. Boswell SG, Cole BJ, Sundman EA, Karas V, Fortier LA. Platelet-rich plasma: a milieu of bioactive factors. Arthroscopy. 2012;28(3):429-39. doi: 10.1016/j.arthro.2011.10.018.
  8. Castillo TN, Pouliot MA, Kim HJ, Dragoo JL. Comparison of growth factor and platelet concentrations from commercial PRP separation systems. Am J Sports Med. 2011;39(2):266-271. doi:10.1177/0363546510387517.
  9. Chahla J, Cinque ME, Piuzzi NS, et al. A call for standardization in platelet-rich plasma preparation protocols and composition reporting: a systematic review of the clinical orthopedic literature. J Bone Joint Surg Am. 2017;99(20):1769-1779. doi:10.2106/JBJS.16.01374.
  10. García‐Bordes L, Álvarez‐Díaz P, Alentorn‐Geli E, et al. Demographic, anthropometric and intrasubject variations affect platelet‐rich plasma formulation. J Exp Orthop. 2025;12(1):e70024. doi: 10.1002/jeo2.70024.
  11. Rossi L, Ranalletta M, Pasqualini I, et al. Substantial variability in platelet-rich plasma composition is based on patient age and baseline platelet count. Arthrosc Sports Med Rehabil. 2023;5(3):e853-e858. doi: 10.1016/j.asmr.2023.03.017.
  12. Taniguchi Y, Yoshioka T, Sugaya H, et al. Growth factor levels in leukocyte-poor platelet-rich plasma and correlations with donor age. J Exp Orthop. 2019;6(1):4. doi: 10.1186/s40634-019-0175-7.
  13. Kobayashi Y, Saita Y, Nishio H, et al. The leukocyte concentration and composition in platelet-rich plasma (PRP) influence the growth factor and protease concentrations. J Orthop Sci. 2016;21(5):683-9. doi: 10.1016/j.jos.2016.07.009.
  14. Kushida S, Kakudo N, Morimoto N, et al. Platelet and growth factor concentrations in activated platelet-rich plasma: a comparison of seven commercial separation systems. J Artif Organs. 2014;17(2):186-92. doi: 10.1007/s10047-014-0761-5.
  15. Vogel JP, Szalay K, Geiger F, Kramer M, Richter W, Kasten P. Platelet-rich plasma improves expansion of human mesenchymal stem cells and retains differentiation capacity and in vivo bone formation in calcium phosphate ceramics. Platelets. 2006;17(7):462-9. doi: 10.1080/09537100600758867.
  16. Marx RE, Carlson ER, Eichstaedt RM, Schimmele SR, Strauss JE, Georgeff KR. Platelet-rich plasma: growth factor enhancement for bone grafts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;85(6):638-46. doi: 10.1016/s1079-2104(98)90029-4.
  17. Varol E, Uysal BA, Ersoy I, Ozaydin M, Erdogan D, Dogan A. Mean platelet volume, an indicator of platelet reactivity, is increased in patients with patent foramen ovale. Blood Coagul Fibrinolysis. 2013;24(6):605-7. doi: 10.1097/MBC.0b013e32836029ee.
  18. Wiegmann L, De Zélicourt DA, Speer O, et al. Influence of standard laboratory procedures on measures of erythrocyte damage. Front Physiol. 2017:8:731. doi: 10.3389/fphys.2017.00731.
  19. de Jonge G, Dos Santos TL, Cruz BR, et al. Interference of the in vitro hemolysis on complete blood count. J Clin Lab Anal. 2018;32(5):e22396. doi: 10.1002/jcla.22396.
  20. Weibrich G, Kleis WK, Hitzler WE, Hafner G. Comparison of the platelet concentrate collection system with the plasma-rich-in-growth-factors kit to produce platelet-rich plasma: a technical report. Int J Oral Maxillofac Implants. 2005;20(1):118-23.
  21. Demirin H, Ozhan H, Ucgun T, et al. Normal range of mean platelet volume in healthy subjects: insight from a large epidemiologic study. Thromb Res. 2011;128(4):358-60. doi: 10.1016/j.thromres.2011.05.007.
  22. Rodriguez-Merchan EC. Intraarticular Injections of Platelet-rich Plasma (PRP) in the Management of Knee Osteoarthritis. Arch Bone Jt Surg. 2013;1(1):5-8.
  23. Jivan SJ, Monzavi SM, Zargaran B, et al. Comparative analysis of the effectiveness of intra-articular injection of platelet-rich plasma versus hyaluronic acid for knee osteoarthritis: results of an open-label trial. Arch Bone Jt Surg. 2021;9(5):487-495. doi: 10.22038/abjs.2021.52003.2569.
  24. Kon E, Di Matteo B, Delgado D, et al. Platelet-rich plasma for the treatment of knee osteoarthritis: an expert opinion and proposal for a novel classification and coding system. Expert Opin Biol Ther. 2020;20(12):1447-1460. doi: 10.1080/14712598.2020.1798925.
  25. Söderström AC, Nybo M, Nielsen C, Vinholt PJ. The effect of centrifugation speed and time on pre-analytical platelet activation. Clin Chem Lab Med. 2016;54(12):1913-1920. doi: 10.1515/cclm-2016-0079.
  26. Canapp SO Jr, Leasure CS, Cox C, Ibrahim V, Carr BJ. Partial cranial cruciate ligament tears treated with stem cell and platelet-rich plasma combination therapy in 36 dogs: a retrospective study. Front Vet Sci. 2016:3:112. doi: 10.3389/fvets.2016.00112.
  27. Dório M, Pereira RM, Luz AG, Deveza LA, de Oliveira RM, Fuller R. Efficacy of platelet-rich plasma and plasma for symptomatic

 

        treatment of knee osteoarthritis: a double-blinded placebo-controlled randomized clinical trial. BMC Musculoskelet Disord. 2021;22(1):822. doi: 10.1186/s12891-021-04706-7.

  1. Gato-Calvo L, Magalhaes J, Ruiz-Romero C, Blanco FJ, Burguera EF. Platelet-rich plasma in osteoarthritis treatment: review of current evidence. Ther Adv Chronic Dis. 2019:10:2040622319825567. doi: 10.1177/2040622319825567.
  2. Murray MM, Spindler KP, Devin C, et al. Use of a collagen-platelet-rich plasma scaffold to stimulate healing of a central defect in the canine ACL. J Orthop Res. 2006;24(4):820-30. doi: 10.1002/jor.20073.
  3. Opper C, Weiner N, Xü F, Klotz E, Klinger G, Künzer W. Daily variations in functional parameters and density distributions of human blood platelets. Chronobiol Int. 1994;11(5):309-19. doi: 10.3109/07420529409057247.
  4. Scott A, LaPrade RF, Harmon KG, et al. Platelet-Rich Plasma for Patellar Tendinopathy: A Randomized Controlled Trial of Leukocyte-Rich PRP or Leukocyte-Poor PRP Versus Saline. Am J Sports Med. 2019;47(7):1654-1661. doi: 10.1177/0363546519837954.
  5. Trevissón-Redondo B, Becerro-de-Bengoa-Vallejo R, Sevillano D, et al. Influence of sexual dimorphism, aging, and differential cell capture efficiency of blood separation systems on the quality of platelet-rich plasma. J Clin Med. 2022;11(6):1683. doi: 10.3390/jcm11061683.
  6. Hsu WK, Mishra A, Rodeo SR, et al. Platelet-rich plasma in orthopedic applications: evidence-based recommendations for treatment. J Am Acad Orthop Surg. 2013;21(12):739-48. doi: 10.5435/JAAOS-21-12-739.
  7. Reurink G, Goudswaard GJ, Moen MH, et al. Rationale, secondary outcome scores and 1-year follow-up of a randomized trial of platelet-rich plasma injections in acute hamstring muscle injury: the Dutch Hamstring Injection Therapy study. Br J Sports Med. 2015;49(18):1206-12. doi: 10.1136/bjsports-2014-094250.
  8. Prost D, Bardot T, Baud A, et al. Long-term improvement of knee osteoarthritis after injection of single high/very high volume of very pure PRP: a retrospective analysis of patients optimally managed in dedicated centers. Regen Ther. 2024:25:203-212. doi: 10.1016/j.reth.2023.12.006.
  9. Alsousou J, Thompson M, Hulley P, Noble A, Willett K. The biology of platelet-rich plasma and its application in trauma and orthopedic surgery: a review of the literature. J Bone Joint Surg Br. 2009;91(8):987-96. doi: 10.1302/0301-620X.91B8.22546.
  10. Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA. Platelet-rich plasma: from basic science to clinical applications. Am J Sports Med. 2009;37(11):2259-72. doi: 10.1177/0363546509349921.
  11. Lopez-Vidriero E, Goulding KA, Simon DA, Sanchez M, Johnson DH. The use of platelet-rich plasma in arthroscopy and sports medicine: optimizing the healing environment. Arthroscopy. 2010;26(2):269-78. doi: 10.1016/j.arthro.2009.11.015.