Source: https://patents.google.com/patent/US8105495B2/en
Timestamp: 2019-04-21 11:32:55+00:00

Document:
2011-04-13 Assigned to BIOMET BIOLOGICS, INC. reassignment BIOMET BIOLOGICS, INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: LEACH, MICHAEL D.
2011-04-13 Assigned to BIOMET BIOLOGICS, LLC reassignment BIOMET BIOLOGICS, LLC CHANGE OF NAME (SEE DOCUMENT FOR DETAILS). Assignors: BIOMET BIOLOGICS, INC.
A process for separating platelet rich plasma from a blood sample using a platelet rich plasma separator system is disclosed. The system includes an inner wall having a top edge and a central axis that is surrounded by a depth filter having a capacity to receive all of the erythrocytes in the blood sample, where an inner surface of the inner wall has an angle of about 0.2° from the central axis of the inner wall. The process includes spinning the inner cylinder at its central axis at a speed that separates the erythrocytes from plasma and platelets and causes the erythrocytes to collect against an inner surface of the depth filter. The cylinder is continually spun for a sufficient time to allow substantially all of the erythrocytes to flow up the inner surface and over the top edge into the depth filter, leaving platelet enriched plasma (PRP) in the inner cylinder, such that upon discontinuing the spinning, permits the platelet enriched plasma to flow to the bottom of the inner cylinder.
This application is a divisional of U.S. patent application Ser. No. 11/831,605 filed Jul. 31, 2007, now U.S. Pat. No. 7,866,485, issued on Jan. 11, 2011, which is (a.) a continuation-in-part of U.S. patent application Ser. No. 11/342,749 filed Jan. 30, 2006, now U.S. Pat. No. 7,824,559 issued on Nov. 2, 2010, which claims the benefit of (1.) U.S. Provisional Application No. 60/723,312, filed on Oct. 4, 2005; (2.) U.S. Provisional Application No. 60/654,718, filed on Feb. 17, 2005; and (3.) U.S. Provisional Application No. 60/651,050, filed on Feb. 7, 2005; and (b.) also claims the benefit of the U.S. Provisional Application No. 60/834,550, filed on Jul. 31, 2006. The disclosures of the above applications are incorporated herein by reference.
This disclosure relates to a device and method for preparing platelet-plasma concentrates with wound healing properties for use as a tissue sealant, adhesive, etc. The concentrates have a fully active (un-denatured) fibrinogen concentration that is greater than the concentration of fibrinogen in whole blood and a platelet concentration that is greater than the concentration of platelets in whole blood.
Blood can be fractionated, and the different fractions of the blood are useful for different medical needs. Under the influence of gravity or centrifugal force, blood can separate into three layers. At equilibrium, the top low-density layer is a straw-colored clear fluid called plasma. Plasma is a water solution of salts, metabolites, peptides, and many proteins ranging from small (insulin) to larger molecules (complement components).
The bottom, high-density layer is a deep red viscous fluid comprising unnucleated red blood cells (erythrocytes) specialized for oxygen transport. The red color is imparted by a high concentration of chelated iron or heme that is responsible for the erythrocytes' high specific gravity. The relative volume of whole blood that consists of erythrocytes is called the hematocrit, and in normal human beings this can range from about 30% to about 60%, such as about 37% to about 52% of whole blood.
The intermediate layer can be the smallest, appearing as a thin white band above the erythrocyte layer and below the plasma layer; this is called the buffy coat. The buffy coat itself has two major components, nucleated leukocytes (white blood cells) and a nuclear smaller bodies called platelets (or thrombocytes). Leukocytes confer immunity and contribute to debris scavenging. Platelets seal ruptures in blood vessels to stop bleeding, and deliver growth and wound healing factors to a wound site. Slower speed centrifugation or shorter duration centrifugation permits separation of erythrocytes and leukocytes from plasma, while the smaller platelets remain suspended in the plasma, resulting in platelet rich plasma (PRP).
U.S. Pat. No. 5,585,007 identifies methods for making plasma concentrates from whole blood for use in wound healing and as a tissue sealant. This patent is hereby incorporated by reference in its entirety. This device, designed for placement in a medical laboratory or surgical amphitheatre, uses a disposable cartridge for preparing tissue sealant. The device was particularly applicable for stat preparations of autologous tissue sealants. Preparation in the operating room of about 5 ml of sealant from about 50 ml of patient blood required less than about 15 minutes. There was reduced risk of tracking error because preparation could take place in the operating room during the surgical procedure. Chemicals added could be limited to anticoagulant (e.g., citrate) and calcium chloride. The disposable cartridge could fit in the palm of the hand and was hermetically sealed to reduce exposure to patient blood and to ensure sterility. Adhesive and tensile strengths of the product were comparable or superior to pooled blood fibrin sealants made by precipitation methods. Use of antifibrinolytic agents (such as aprotinin) was not necessary because the tissue sealant contained high concentrations of natural inhibitors of fibrinolysis from the patient's blood.
Small, self-contained centrifugal devices for obtaining platelet concentrates from blood are described in, copending U.S. patent application Ser. No. 10/394,828 filed Mar. 21, 2003, the entire contents of which are hereby incorporated by reference. This device separates blood into erythrocyte, plasma, and platelet layers. The device can be used to selectively remove the platelet layer as a platelet concentrate, that is, platelets suspended in a minimal amount of plasma.
Platelet rich plasma is a concentrated platelet product that can be produced from whole blood through commercially available systems, resulting in varying levels of platelet concentration. Platelets play a crucial role in the signaling cascade of normal wound healing. Activated platelets release the contents of their α-granules resulting in a deposition of powerful growth factors such as platelet derived growth factor (PDGF), transforming growth factor ‘β-(TGF-β)’, vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF). PRP has been used in many different clinical applications, demonstrating the effectiveness and importance of the product for a variety of medical procedures. For example, percutaneous application of PRP to patients with severe lateral epicondylitis, ‘i.e. tennis elbow’ resulted in improved elbow function and reduced pain. Early maturation of bony fusion was observed when platelet concentrate was used during lumbar spinal fusions. Chronic diabetic foot ulcers treated with PRP achieved increased healing rates compared to the control group receiving standard care. Studies by S. Bhanot, and J. C Alex, FACIAL PLASTIC SURGERY, 18(1): 27-33 (2002) show decreased formation of hematoma and seroma, decreased postoperative swelling, and improved healing time for plastic surgeries that included PRP in the treatment. Further, during dental surgeries, the use of PRP has improved bone regeneration around implants.
PRP have demonstrated numerous clinical benefits to patients. Concentrations of at least about 1,000×103 platelets/μL may be useful. The system described in copending U.S. patent application Ser. No. 10/394,828 can provide platelets up to about 8 times baseline concentration, and the normal human platelet range is about 200×103 platelets/μL to about 400×103 platelets/μL. This means a highly effective concentrate in a range of about 1,600×103 platelets/μL to about 3,200×103 platelets/μL.
A PRP (Platelet Rich Plasma) separator assembly can comprise a cylindrical outer wall closed at the top by an upper plate and closed at the bottom. The outer wall has an inner surface. A cylindrical inner wall concentric with a cylindrical outer wall can having a top edge and a bottom. The inner wall defines a central axis. The bottom of the inner wall is closed by a sloped bottom plate having a central opening, the bottom plate has an upper surface sloped down to a central opening. The top edge of the inner wall terminates at a distance from the upper plate to define an annular erythrocyte passageway therebetween. The inner wall has an outer surface and an inner surface that slopes radially inward from a top edge to a bottom at an angle of from about 0.2 to about 5 degrees relative to a central axis of the inner wall. A cylindrical depth filter is positioned between the inner surface of the outer wall and the outer surface of the inner wall in communication with the inner wall through the erythrocyte passageway.
The distance between the top of the inner wall and the upper plate can be from about 0.02 to about 50 mm, such as about 0.02 mm to about 10 mm. The depth filter can extend beyond the top edge of the inner wall. According to various, embodiments, the upper plate has a bottom surface, and the depth filter extends to the bottom surface.
For producing platelet rich plasma concentrate for wound healing, the depth filter can have the capacity to accept up to or more than about 85 percent of the hematocrit value of a patient's blood and less than a major portion of the platelet rich plasma remaining after the erythrocytes separation from a patient's blood.
For producing platelet rich plasma concentrate for hemostasis, the depth filter can have the capacity to accept up to or more than about 97 percent of the hematocrit value of a patient's blood and less than a major portion of the platelet rich plasma remaining after the erythrocytes separation from a patient's blood.
For all applications, the depth filter can have the capacity to accept up to or more than about 99 percent of the hematocrit value of a patient's blood and less than a major portion of the platelet rich plasma remaining after the erythrocytes separation from a patient's blood.
The depth filter can have the capacity to accept about 100 percent of the hematocrit value of a patient's blood and less than a major portion of the platelet rich plasma remaining after the erythrocytes separation from a patient's blood.
The PRP separator can be mounted for rotation about an outlet tube concentric with the central axis.
The separation chamber can include a balanced array of separator plates extending radially inward from the inner wall and upward from the bottom plate, the separation chamber can be balanced for substantially vibration-free rotation about the central axis.
The PRP separator-concentrator assembly can comprise the PRP separation assembly described above in combination with a PRP concentrator assembly. The concentration assembly has a PRP concentration sump; an axially concentric rigid stationary outlet tube secured to the housing and extending through the PRP separation assembly to the PRP concentrate sump; and the PRP separation assembly is attached to and positioned above the PRP concentration assembly to form a combined separator-concentrator assemblage that is rotatable about the outlet tube.
A PRP separator-concentrator can include a PRP concentrator that comprises a concentration chamber having a floor for supporting desiccating beads and a wall with at least one opening covered or closed with a screen, the screen having openings that are sized to retain the desiccating beads in the concentration chamber, the concentration chamber being surrounded by an outer wall with a sloped floor secured thereto, the sloped floor including at its center, a PRP concentrate sump.
A PRP separator-concentrator can include a stationary bead rake that is secured to a stationary tube and extends outward therefrom, the rake having distal ends that are spaced at a distance from the upright screen supports. The concentrator chamber can contain sufficient desiccating beads to remove enough water to produce a product having from above one time up to about four times a base concentration or higher.
A process for separating platelet rich plasma from blood comprising a plasma, erythrocytes and platelets employs a device comprising cylindrical inner wall having a top edge and a central axis surrounded by a depth filter having a capacity to receive all of the erythrocytes in the blood but insufficient to receive all of the plasma in the blood, the inner surface of the inner wall having an angle of from about 0.2 degrees, including about 0.2 to about 20 degrees, such as about 0.2 degrees to about five degrees, from the central axis of the inner wall. The process can include: a) spinning the inner cylinder about its central axis at a speed that centrifugally separates the erythrocytes from the plasma and platelets and causes the erythrocytes to slide up the inner surface; b) continuing spinning for a time sufficient to allow the erythrocytes to flow up the inner surface and over the top edge into the depth filter, leaving platelet enriched plasma behind in the inner cylinder; c) slowing or discontinuing the spinning to permit the platelet enriched plasma to flow to the bottom of the inner cylinder.
The inner surface of the inner wall can be segmented by radially extending plates into separation zones, the plates maintaining substantially balanced distribution of the blood in the separation zones during rotation of the separation chamber, thereby reducing vibration and erythrocyte displacement from the depth filter. The rotational speed of the separation chamber can be accelerated to centrifugal speeds at a rate that allows balanced distribution of blood in the separation zones. After the centrifuging is complete, the rotation speed of the separation chamber can be decelerated to below centrifugal speeds at a rate that allows balanced distribution of the PRP in the separation zones. The acceleration and deceleration process can reduce vibration and erythrocyte displacement from the depth filter. The process can include separating platelet rich plasma from blood according to the above process and then concentrating the platelet rich plasma by contacting the platelet rich plasma with desiccating beads in a rotating concentrating chamber while the beads are stirred with a rake to form a platelet rich plasma concentrate.
When the concentrating chamber includes an outer screened cylinder confining the desiccating beads, the platelet rich plasma concentrate can be separated from the beads by rotating the concentrating chamber about its central axis at a speed that separates platelet rich plasma concentrate from the beads.
According to various embodiments, a process for preparing platelet rich plasma concentrate for wound healing, at least about 85 volume percent of the hematocrit value of the blood and less than a major portion of the erythrocyte depleted platelet rich plasma can remain after the erythrocyte fraction is retained by the depth filter.
According to various embodiments, a process for preparing platelet rich plasma concentrate for hemostasis, at least about 97 volume percent of the hematocrit value of the blood and less than a major portion of the erythrocyte free platelet rich plasma can remain after the erythrocyte separation is retained by the depth filter.
According to various embodiments, a process for preparing platelet rich plasma concentrate for all applications, at least about 99 volume percent of the hematocrit value of the blood and less than a major portion of the erythrocyte free platelet rich plasma can remain after the erythrocyte separation is retained by the depth filter.
According to various embodiments, a process for preparing platelet rich plasma concentrate for all applications, about 100 volume percent of the hematocrit value of the blood and less than a major portion of the erythrocyte free platelet rich plasma can remain after the erythrocyte separation is retained by the depth filter.
In the above processes for preparing platelet rich plasma concentrate for hemostasis, optionally less than a significant portion of the erythrocyte free platelet rich plasma remaining after the erythrocyte separation is retained by the depth filter.
A Platelet Rich Plasma separator assembly comprising a cylindrical outer wall closed at the top by an upper plate and closed at the bottom. The outer wall has an inner surface; a cylindrical inner wall concentric with the cylindrical outer wall and having a top edge and a bottom. The inner wall has a central axis. The bottom of the inner wall is closed by a sloped bottom plate having a central opening, the bottom plate having an upper surface sloped down to a central opening. The top edge of the inner wall terminates at a distance from the upper plate to define an annular erythrocyte passageway therebetween. The inner wall has an outer surface and an inner surface that slopes radially inward from its top edge to its bottom at an angle of from about 0.2 degrees, including about 0.2 to about 5 degrees with the central axis of the inner wall. A cylindrical depth filter is positioned between the inner surface of the outer wall and the outer surface of the inner wall in communication with the inner wall through the erythrocyte passageway. The device can be combined with a PRP concentrator assembly. The concentration assembly has a PRP concentration sump; an axially concentric rigid stationary outlet tube secured to the housing and extending through the PRP separation assembly to the PRP concentrate sump; and the PRP separation assembly is attached to and positioned above the PRP concentration assembly to form a combined separator-concentrator assemblage that is rotatable about the outlet tube.
FIG. 1 is a cross-sectional view of a disposable separation and concentration assembly and a permanent drive assembly, with desiccating beads shown in only half of the concentration subassembly.
FIG. 2 is a front plan view of the outer housing of the separation-concentration assembly of this invention.
FIG. 11 is a top plan view of the top bucket subassembly of the separation-concentration assembly shown in FIG. 4.
FIG. 12A is a cross-sectional exploded sectional view of an upper portion of the separation-concentration sub-assemblies shown in FIGS. 11 and 12.
FIG. 13 is a front plan view of the valve assembly of the separation-concentration assembly shown in FIG. 4.
FIG. 17 is a front plan view of the basket subassembly of the separation-concentration assembly shown in FIG. 4.
FIG. 19 is a top plan view of the mixer assembly of the separation-concentration assembly shown in FIG. 4.
The apparatus and method can prepare a PRP concentrate that combines enhanced platelet levels in a plasma concentrate, in which the fibrinogen levels have not been significantly denatured. The product can combine the sealant and properties of the plasma concentrates for use in certain types of surgery with the healing properties provided by elevated platelet levels.
FIG. 1 is a cross-sectional view of a disposable separation and concentration assembly and a permanent drive assembly, with desiccating beads shown in half of the concentration subassembly. Details of the sub-sections of this assembly are hereinafter described in conjunction with more detailed drawings.
The upper housing 2 isolates the sterile separation and concentration systems shown in FIG. 1. The upper portion of the outer housing 2 is sealed with an outer cap subassembly 34 having a blood inlet tube 86 and a PRP concentrate outlet port 62 and cap 66. Referring to FIG. 3, the lower assembly connector has a drive recess 42 shaped to engage the motor subassembly, and with spacer receptors 44 for holding spacers 46. The outer housing 2 and its enclosed separation components are a disposable unit and can be used with a permanent drive assembly shown in FIGS. 1 and 22 to 24. The lower assembly includes an axially concentric motor drive receptor 48 and a plurality of tapered engagement and locking slots 50 that engage with corresponding mounting projections of the motor drive assembly (not shown).
The bucket cap 10 shown in FIG. 4 is described in greater detail with regard to FIGS. 8-10. FIG. 8 is a top view of the top bucket cap subassembly 10 of the separation-concentration assembly shown in FIG. 4, and FIG. 9 is a cross-sectional view of the top bucket cap subassembly shown in FIG. 10, taken along the line 9-9. The cap subassembly 10 closes the top separation bucket 8 shown in greater detail with respect to FIGS. 11 and 12. The top bucket cap 10 comprises a circular plate 76 with a connecting flange 78 that extends downward from the lower edge of plate 76. The upper plate 6 is fixed to the outer housing 2 (FIG. 4) and is stationary during the separation and concentration processes. Top bucket cap 10 is secured to the top bucket 8 during the separation and concentration processes.
The circular cap 10 has an axially concentric hole with a valve assembly guide tube 80 extending downwardly therefrom. The lower end of the guide tube 80 has a valve assembly stop flange 82 secured thereto. The upper end of the guide tube 80 supports sleeve bearing 84. The sleeve bearing 84 can be formed of materials that are wear resistant and can be sterilized in an appropriate manner. Materials that can be used for the sleeve bearing include polyaryletherketone such as TECAPEEK™ Classix™, and the like.
FIG. 10 is an exploded view of the sample inlet subassembly 86. The sample inlet subassembly 86 comprises an inlet tube 92 mounted in the plate 76, the top of the inlet tube 92 including an annular receptor 94. A sterile filter 96 can be positioned in the lower end of the passageway 97 of tube 92.
The subassembly 86 includes a removable inlet tube 98. Inlet tube 98 comprises a central tube 100 having at its upper end an integral Luer fitting 102. At an intermediate level of the tube 100, an annular plate 103 extends outward from the tube 100. An integral cylindrical flange 104 extends downward from the outer edge of the plate 103. The flange 104 is sized to engage the receptor 94. The lower end 105 of the tube 100 is sized to engage the upper end of the passageway 97.
The inlet tube is provided with a cap 106 that engages the Luer fitting 102 to provide a sterile closure of the removable inlet tube 98 prior to use, such as during shipment and handling.
Referring to FIG. 12A, the separation zone can be further limited by an inner cylinder 135 extending from the upper surface of the bottom plate 116 upward to an upper lip 137. The inner surface of the cylinder 141 can have a slope “a” of from about 0.2 degrees, including between about 0.2 to about 5 degrees and optionally between about 0.2 to about 2 degrees relative to the central axis. This slope can be selected to facilitate flow of erythrocytes along the surface and beyond the lip 137 into the depth filter 138. Because the slope can be selected to be small, the separation of platelets trapped by the erythrocytes is facilitated, leaving a maximum quantity of platelets suspended in the plasma phase.
The depth filter 138 can extend from the bottom surface 145 past top edge 137 to completely block the opening defined by the top lip 137 and the bottom surface 145. This can be provided to assist in preventing the return of erythrocytes to the plasma from the volume between the outer cylinder 3 and the inner cylinder 135. In various embodiments, the depth filter can extend to the bottom plate 116 which can insure complete capture of erythrocytes. In various embodiments, if the space between the upper edge 137 and lower surface 145 is sufficiently small and risk of a return of a small amount of erythrocytes to the plasma is acceptable, the depth filter can be omitted.
A plurality of radially inwardly extending separation plates 130 are secured to the inner surface of the cylindrical outer wall 112 and the sloped floor plate 116. Each adjacent pair of these plates defines a separation zone 132. The plates 130 can be evenly spaced around the cylindrical outer wall to provide a balanced subassembly. They can be in matched, opposed pairs, for example the three matched sets as shown in FIG. 11. The top edge 134 of each of the separation plates 130 is spaced at a distance below the top edge 114 to permit overflow of blood in order to achieve an even distribution of blood between each the separation zones 132 during the spin acceleration stages and during the spin deceleration stages. This can maintain balance and minimize vibration of the rotating assembly.
The space between the interior surface 136 of the cylindrical outer wall segments and the outer surface 143 of the inner cylinder in each of the each separation zones 132 contains the open-cell foam segment or depth filter segment 138. The foam segments 138 have pores and passageways sized to allow infiltration of erythrocytes into the foam and subsequent entrapment of erythrocytes during the high speed centrifugation of the separation stage. The pores and passageways are sized to retain entrapped erythrocytes thereafter when the spinning slows or stops and the erythrocyte-free platelet-plasma suspension flows downward through the opening 118.
The distance between the lip 137 and the lower surface 145 of the upper plate is sufficient to permit flow of all erythrocytes into the depth filter 138 during the separation phase. It can be between about 0.02 and about 50 mm, such as about 0.02 mm to about 10 mm, or another dimension that facilitates a selected amount, such as complete erythrocyte removal while trapping a minimum portion of the platelets.
The provision of the inner sloped cylinder can increase the proportion of platelets remaining in the plasma.
FIG. 13 is a front view of the valve assembly 12 of the separation-concentration assembly shown in FIG. 4, and FIG. 14 is an exploded, isometric view of the valve assembly of FIG. 13. The valve assembly 12 comprises a central tube 140, the lower end constituting a valve face 142. The valve face 142 comprises an annular receptor 144 that receives and holds an O-ring 146. The outermost surface of the O-ring 146 can be sized to form a sealing engagement with the valve seat 119 (See FIGS. 11 and 12).
An axially concentric drive receptor 168, shown in detail in FIG. 16, is secured to the bottom surface of the bucket bottom 160. The drive connector receptor 168 can have any configuration that will releasably couple with a suitably configured motor drive connector. In the configuration shown in FIGS. 15 and 16, the drive receptor 168 comprises an outer cylinder 170 and a plurality of ridges 172, each ridge having a tapered leading engagement surface 174, an abutment surface 176 and an upper plate 178. The upper plate 178 transmits the torque from the drive motor (described hereinafter with respect to FIGS. 22-24) to the lower bucket bottom 160 and from there to the concentrating and separating subassemblies, all of which are secured together to form a unitary rotatable assembly.
FIG. 17 is a front view of the basket subassembly 18 of the separation-concentration assembly shown in FIG. 4, and FIG. 18 is a cross-sectional view of the basket subassembly of FIG. 17, taken along the line 18-18. The basket subassembly 18 comprises a cylinder 180 secured to a circular floor plate 182. A slip bearing 184 is positioned in the axial center of the circular plate 182 for engaging the rigid tube 74 (FIG. 4). The slip bearing 184 can be formed of a material that is wear resistant and can be sterilized in an appropriate manner, these materials can be the same or similar to those that form the sleeve bearing 84. The cylinder 180 has an array of windows or openings 186 around its circumference, each window closed or coveted with a fine screen 188 having a mesh size sufficiently small to prevent escape of hydrogel beads 19 (FIGS. 1 and 4) from the basket during spinning.
FIG. 19 is a top view of the mixer assembly of the separation-concentration assembly shown in FIG. 4. FIG. 20 is a cross-sectional view of the mixer assembly of FIG. 18, taken along the line 20-20, and FIG. 21 is an isometric view of the mixer assembly of FIGS. 19 and 20. The mixer assembly 20 comprises a rake 190 secured to stationary tube 74. The upper end 192 of the stationary tube 74 is secured to the upper cap subassembly 34 to secure it against rotation. At the lower end 194 of the stationary tube 74 is a port for removal of platelet-plasma concentrate from the sump 162 (FIG. 15). The rake 190 comprises a radially extending spine 196 from which integral rake elements 198 extend downward to an elevation short of the bottom plate 182 of the basket subassembly 18 as shown in FIGS. 4, 17 and 18. The spine 196 can have optional breakaway notches 200 adjacent its center. The notches 200 weaken the spine and direct fracture of the spine 196 at the location of the notches in the event that the pressure produced by contact of the beads 19 with the rake elements 198 during the final centrifugal spin becomes excessive.
Concentrating desiccating hydrogel beads 19 fill the lower half of the basket 18 (only one side is shown empty to enable unobstructed viewing of the windows 186 and screen 188 elements (FIGS. 1, 17 and 18).
The concentrating desiccating hydrogel beads 19 can be insoluble beads or disks that will absorb a substantial volume of water and low molecular weight solutes while excluding high molecular weight solutes and particulates and will not introduce undesirable contaminants into the plasma. They can be dextranomer or acrylamide beads that are commercially available (appropriate materials include Debrisan from Pharmacia and BIO-GEL P™ from Bio-Rad Laboratories, respectively). Alternatively, other concentrators can be used, such as SEPHADEX™ moisture or water absorbents (available from Pharmacia), silica gel, zeolites, cross-linked agarose, etc., in the form of insoluble inert beads.
FIG. 4 in conjunction with subassembly FIGS. 5-21 shows the assembly prior to use with the valve assembly 12 secured for shipment by the sleeve 80 into which the valve assembly tube 140 extends and the abutment flange 82 is secured to the bottom of the sleeve 80. The valve face 142 is shown in position against the seat 119. This confines the beads to the basket 18 and prevents escape of beads into the upper separation chamber 64 if the device is inverted or shaken during transport or handling.
The upper edge of the cylinder 180 of the basket assembly 18 is secured against the lower surface of the tapered bottom 116, and the lower surface of the plate 182 is secured against the upper edge surfaces 166 (FIG. 15) of the supports 164.
Thus assembled, the upper separation subassembly 3 and the lower concentration subassembly 11 rotate as a single unit around the fixed tube 74. The upper separation subassembly is positioned on the central tube 74 by the slip bearing 84 through which the fixed tube 74 extends. The lower separation subassembly is positioned on the central tube 74 by the slip bearing 184 through which the fixed tube extends. The rake assembly 20 including the tube 74 remains stationary during rotation of the separation and concentration subassemblies 3 and 11 in the separation and concentration phases, to be described in greater detail hereinafter.
FIG. 22 is a perspective view of the motor drive assembly. FIG. 23 is a cross-sectional view of the motor drive assembly taken along the line 23-23, and FIG. 24 is a cross-sectional view of the motor drive assembly taken along the line 24-24.
FIG. 27 is a cross-sectional view of the upper bucket and valve assembly of FIGS. 25 and 26, after the centrifugal action of the spinning upper bucket has extended the arms of the valve assembly and opened the valve, and FIG. 28 is a cross-sectional view of the view of upper bucket and valve assembly of FIG. 27, taken along the line 28-28. After the desired volume of patient blood has been introduced into the top bucket 8, the separation and concentration assembly is rotated around the tube 74 at a high speed, the centrifugal force created by this rotation causing the blood to flow outward where it can be distributed evenly by the separation plates into the separation zones 132. The centrifugal force pools the blood against the outer surface of the foam segments 138 where the more dense materials, such as erythrocytes, preferentially move into the foam, leaving behind less dense material, such as erythrocyte-free plasma which can also contain the less dense platelets.
The operation of the device including the separation phase and concentrating phase of a material, such as whole blood, are described hereinafter in conjunction with FIGS. 32-36. Although the separation and concentration of whole blood are described in detail, other materials can also be separated and concentrated.
FIG. 33 is a cross-sectional view of the separation and concentration assemblies of FIG. 32 as erythrocytes are separated from the plasma-platelet mixture during high speed centrifugation. As the separation and concentration assemblies turn at a high speed, the blood is forced against the foam 138. The erythrocytes, being denser than other blood components, migrate into the pores and passageways of the foam. The valve subassembly opens the valve 142 as the centrifugal forces pivot the outer ends of the arms 148 away from the center, raising the valve face 142 face from valve seat 119 in the central passageway 118. However, as long as the high speed centrifugation continues, all of the liquid can be maintained against the foam. The centrifugal forces also force the hydrogel beads 19 radially outward against the outer screens 188 of the basket subassembly, out of contact with elements of the rake 190. Centrifugation is continued until a majority of the erythrocytes are completely trapped in the foam. Because any erythrocytes can weaken the gel product formed when the product is applied, the removal of a maximum proportion of the erythrocytes can be selected. The speed of centrifugation tends to separate erythrocytes from platelets, leaving a substantial portion of the platelets in the plasma while entrapping a majority of the erythrocytes in the foam.
FIG. 34 is a cross-sectional view of the separation and concentration assembly of FIG. 33. After the spinning is slowed or stopped, the platelet-plasma fraction 204 flows to the bottom of the upper bucket 8 and down through the central passageway 118 into the basket subassembly 18 where it comes into contact with the desiccating hydrogel beads 19. These beads concentrate the plasma by absorbing water from the liquid. The separation and concentrating assemblies are then rotated at a slow speed by the motor 218, stirring the beads by moving them through the stationary spines 196 of the rake 190. Agitating the beads insures maximum contact of the beads surfaces with the plasma and reduces gel polarization that arises when the plasma thickens adjacent the bead surfaces. This desiccating phase is continued until the desired proportion of the water has been removed and the desired concentration of the plasma has been achieved.
FIG. 35 is a cross-sectional view of the separation and concentration assembly of FIG. 34 at the beginning of high speed centrifugation separation of the platelet-plasma concentrate from the hydrogel beads. At this stage, removal and selected or maximum recovery of the platelet rich plasma concentrate 206 from the beads 19 is obtained. The separation and concentration assemblies are rapidly rotated by the motor 218 around the stationary tube 74, creating centrifugal forces that force the platelet rich plasma concentrate and the beads 19 against the screen elements 188 of the basket 18. The screen elements prevent escape of the beads 19 as the continuing centrifugal force causes the platelet enriched plasma concentrate to flow from the beads and through the screen. This high speed centrifugation is continued until a selected or maximum recovery of the platelet rich plasma is obtained.
The absorption of water by the hydrogel beads is accompanied by an increase in bead diameter, increasing the bead volume. If the increased bead volume causes the ends of the rake 190 to drag on beads packed on the screen surface, the rake can break along the break-away notches 200 (FIG. 19), and the rake fragments become mixed with the beads.
FIG. 36 is a cross-sectional view of the separation and concentration assembly of FIG. 35 after the high speed centrifugation has ended and the platelet-plasma concentrate has flowed into the platelet-plasma concentrate sump 162. The cap 66 has been removed, exposing Luer fitting 70 at the upper end of the tube 60. An applicator syringe (not shown) can be secured to the Luer fitting 70. The platelet-rich plasma concentrate is removed from the sump 162 by retracting the barrel of the applicator syringe, drawing platelet rich plasma concentrate up through the tubes 74 and 60 and into the syringe. Breathing tube 108 permits air to flow into the system to replace the volume of liquid removed by the syringe, thus preventing the creation of a partial vacuum in the system that would impede liquid removal.
Regarding the concentration factor, for maximum wound-healing, the platelet level can be maximized and high concentrate ion factors can be created. For homeostasis, plasma concentrations of about 3 to about 4 fold over anti-coagulated plasma levels are most effective. Concentrations below about 3 fold have an insufficient fibrinogen concentration. Concentrations higher than about 4 fold have excessive levels of total protein (principally albumin) which interferes with the fibrin gel structure. To obtain a preparation that maximizes haemostatic effectiveness while also providing improved (albeit perhaps less than maximal) wound-healing potential, a concentration range of about 3 to about 4 fold over anti-coagulated plasma levels may be selected. For applications where sealant activity is not desired, high concentrations may be selected.
Regarding erythrocyte levels, normal human hematocrits vary from about 37 percent or lower to about 52 percent for whole blood, measured after a very high speed spin. To achieve concentrations of about 3 fold or higher, some erythrocyte removal may be selected. However, the tensile strength of concentrated plasma gels diminish as the level of erythrocyte contamination increases. The concentration of erythrocytes in the final concentrate should be less than about 3 to about 5 percent to provide effective haemostatic properties. The separation and concentration device can be used to remove as much of the erythrocytes as is technically practical with the system, although trace contamination is acceptable. For applications where sealant activities are not desired, higher levels of erythrocytes can be maintained.
Regarding volume, both the depth filter and the beads reduce the liquid volumes being processed. Because of this volume loss, from about 14 to about 17 percent volume yields of effective haemostatic wound-healing product is generally obtained from average patient blood with the separation and concentration device. To make an effective product, the depth filter volume is selected to retain about 50 percent of the anti-coagulated blood (blood containing anticoagulant) and product about a 50 percent yield of PRP. The amount of the beads, in water absorption units, is selected to retain water equaling about 67 percent of the PRP volume.
Regarding accuracy, the amount of the depth filter and beads in each system is carefully selected to yield an optimum product. However, because of the wide range of hematocrit levels in patient populations, an approximate balance of components can be determined and selected.
If too much blood is added to the device, there is a greater chance that the product will have a substantial erythrocyte contamination, and the final product will be less concentrated than selected because the volume exceeds the practical capacity of the depth filter. Because the volume retained by the depth filter is about half the total volume of blood to be processed, if the volume of blood introduced into the device is too small, a substantially lower volume of PRP may be delivered to the beads. For example, if the blood volume is low by about 25 percent, this will result in about 50 percent of the desired volume being delivered to the beads. If the volume of PRP contacting the beads is low by 33 percent or more, no product will be recovered because the beads may absorb as much as about 67 percent or more of the targeted PRP volume. If the volume contacting the beads is short by about 17 percent, this may yield half of the desired volume of final product with twice the desired concentration (and hence of little value as a hemostat). In other words, a small error in the volume of blood introduced into the device is amplified into a large error in final product volume and concentration factor.
If it is selected to tolerate inaccuracy of introduced blood volume, the device can incorporate an overflow chamber as described in provisional patent application Ser. No. 60/654,718 filed Feb. 17, 2005 and U.S. patent application Ser. No. 11/342,761, filed on Jan. 30, 2006, the contents of which are hereby incorporated by reference.
c) slowing or discontinuing the spinning to permit the platelet enriched plasma to flow to the bottom of the inner cylinder.
balancing distribution of the blood in the separation zones with the plates during rotation of the inner cylinder, thereby reducing vibration and erythrocyte displacement from the depth filter.
3. The method of claim 1 wherein a rotational speed of the inner cylinder is accelerated to centrifugal speeds at a rate that allows balanced distribution of blood in separation zones, and after the centrifuging is complete, the rotation speed of the inner cylinder is decelerated to below centrifugal speeds at a rate that allows balanced distribution of the blood sample in the separation zones, thereby reducing vibration and erythrocyte displacement from the depth filter.
4. The method of claim 1 further comprising concentrating the platelet enriched plasma by contacting the platelet enriched plasma with desiccating beads in a concentration chamber while the beads are agitated with a rake to form a platelet rich plasma concentrate.
5. The method of claim 4 wherein the concentration chamber includes an outer screened cylinder for the desiccating beads, and the platelet rich plasma concentrate is separated from the beads by rotating the concentrating chamber about its central axis at a speed that separates platelet rich plasma concentrate from the beads.
6. The method of claim 1 further comprising retaining at least about 85 volume percent of a hematocrit value of the blood and less than a major portion of the platelet enriched plasma remaining after the erythrocyte separation.
7. The method of claim 1 further comprising retaining at least about 97 volume percent of a hematocrit value of the blood and less than a major portion of the platelet enriched plasma remaining after the erythrocyte separation.
8. The method of claim 1 further comprising retaining at least about 99 volume percent of a hematocrit value of the blood sample and less than a major portion of the platelet enriched plasma remaining after the erythrocyte separation.
9. The method of claim 1 further comprising retaining at least about 100 volume percent of a hematocrit value of the blood and less than a major portion of the platelet enriched plasma remaining after the erythrocyte separation.
10. The method of claim 9 further comprising retaining less than a significant portion of the enriched plasma remaining after the erythrocyte separation.
c) slowing or discontinuing the spinning to permit the platelet enriched plasma to flow to a bottom of the inner cylinder.
balancing distribution of the blood during the spinning of the inner cylinder in a plurality of separation zones thereby reducing vibration and erythrocyte displacement from the depth filter, wherein the separation zones are defined by plates radially extending from the inner wall.
wherein slowing or discontinuing the spinning includes decelerating the inner cylinder at a rate that allows balanced distribution of the blood sample in the separation zones.
concentrating the platelet rich plasma by contacting the platelet rich plasma with desiccating beads in a concentration chamber while the beads are agitated with a rake to form a platelet rich plasma concentrate.
15. The method of claim 14 wherein the concentration chamber includes an outer screened cylinder to contain the desiccating beads, and the platelet rich plasma concentrate is separated from the beads by rotating the concentrating chamber about its central axis at a speed that separates platelet rich plasma concentrate from the beads.
retaining at least about 85 volume percent of a hematocrit value of the blood and less than a major portion of the erythrocyte free platelet enriched plasma remaining after the erythrocyte separation.
retaining at least about 97 volume percent of a hematocrit value of the blood and less than a major portion of the platelet enriched plasma remaining after the erythrocyte separation.
retaining less than a significant portion of the platelet enriched plasma remaining after the erythrocyte separation.
decelerating or discontinuing the spinning of the system to permit the platelet enriched plasma to collect in the system.
balancing distribution of the blood during the spinning of the system in a plurality of separation zones thereby reducing vibration and erythrocyte displacement from the depth filter, wherein the separation zones are defined by plates radially extending from the inner wall.
concentrating the platelet enriched plasma by contacting the platelet enriched plasma with desiccating beads in a rotating concentration chamber while the beads are agitated with a rake to form a platelet rich plasma concentrate.
22. The method of claim 21, wherein the concentration chamber includes an outer screened cylinder to contain the desiccating beads, and the platelet rich plasma concentrate is separated from the beads by rotating the concentrating chamber about its central axis at a speed that separates platelet rich plasma concentrate from the beads.
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