Tubes with Citrate for Platelet-Rich Plasma (PRP)

Platelet-Rich Plasma (PRP) therapy has become one of the most popular regenerative treatments in medical aesthetics, orthopedics, dentistry, and dermatology. Its growing popularity stems from its natural approach to healing and rejuvenation using the patient’s own blood. However, one crucial yet often overlooked component of PRP preparation is the type of tube used for blood collection—particularly citrate tubes. These specialized tubes play a vital role in maintaining the integrity and effectiveness of PRP.

In this article, we will explore what citrate tubes are, why they are important in PRP preparation, how they work, and the benefits they offer for producing high-quality platelet concentrates.

What Are Tubes with Citrate?

Tubes with citrate, often referred to as sodium citrate tubes, are specialized vacuum blood collection tubes that contain a citrate-based anticoagulant. The most common form used in PRP preparation is 3.8% sodium citrate or ACD-A (Acid Citrate Dextrose Solution A).

Citrate acts by binding to calcium ions in the blood, which prevents the activation of the coagulation cascade. In simpler terms, it keeps the blood from clotting while maintaining platelet stability and functionality. This makes citrate tubes ideal for applications where viable platelets are needed, such as in PRP therapy.

Why Citrate Is Important in PRP Preparation

When preparing PRP, the primary goal is to isolate and concentrate platelets from the patient’s blood without activating them prematurely. Platelets contain growth factors and bioactive molecules that play a critical role in tissue repair, collagen production, and cell regeneration.

Here’s why citrate is important:

1. Prevents Premature Clotting:
   Citrate prevents coagulation during centrifugation, allowing easy separation of plasma layers.

2. Maintains Platelet Viability:
   By chelating calcium, citrate preserves platelet integrity and function until PRP is ready for injection.

3. Ensures Accurate Separation:
   The absence of clots allows the centrifuge to properly separate red blood cells (RBCs), white blood cells (WBCs), and platelets, ensuring high-quality PRP yield.

4. Enhances Safety and Sterility:
   Citrate tubes are sterile, single-use containers that maintain sample purity and minimize contamination risk.

How Citrate Tubes Work in PRP Preparation

The PRP preparation process using citrate tubes generally involves the following steps:

1. Blood Collection:
   A small amount of the patient’s venous blood (typically 10–20 mL per tube) is drawn into citrate-containing tubes. These tubes are labeled according to their anticoagulant type and volume.

2. Centrifugation:
   The tubes are then placed in a centrifuge and spun at a specific speed and duration, depending on the PRP system used. Centrifugation separates the blood into three main layers:

   • Bottom layer: Red blood cells (RBCs)

   • Middle layer: Buffy coat (platelets and white cells)

   • Top layer: Platelet-poor plasma (PPP)

3. Platelet Concentration:
   The platelet-rich layer is extracted carefully and can undergo a second spin (double-spin method) to further concentrate the platelets.

4. Activation and Application:
   After preparation, the PRP can be activated (with calcium chloride or thrombin) and injected into the target area, whether for hair restoration, joint repair, or skin rejuvenation.

Throughout this process, the citrate in the tube ensures the blood remains unclotted and that the platelets are kept in their resting state until use.

Types of Citrate Tubes Used for PRP

Citrate tubes used in PRP can vary based on the specific composition and manufacturer. The two most common types are:

1. Sodium Citrate Tubes (3.8% or 0.109 M):
   These tubes are widely used in laboratories and medical settings for coagulation studies and PRP preparation. They provide consistent anticoagulant action.

2. ACD-A (Acid Citrate Dextrose Solution A) Tubes:
   These are more advanced PRP tubes that not only prevent clotting but also nourish platelets, maintaining their viability for longer durations. The dextrose component acts as an energy source for platelets.

Some PRP systems also use gel-separator citrate tubes, which have a special gel layer to facilitate the clean separation of plasma from red blood cells after centrifugation.

Benefits of Using Citrate Tubes for PRP

Using citrate tubes for PRP offers multiple advantages that ensure both quality and safety in treatment outcomes.

1. Enhanced Platelet Yield:
   Citrate’s gentle anticoagulation preserves the platelets’ structure and function, resulting in a higher yield of viable, active platelets.

2. Improved Patient Safety:
   Since citrate is non-toxic and biocompatible, it poses minimal risk to patients, unlike other anticoagulants such as heparin.

3. Consistency in Results:
   Standardized citrate tubes help ensure uniform results across multiple PRP preparations, which is crucial for clinical consistency.

4. Prolonged Shelf Life of PRP:
   Citrate maintains platelet stability for a longer period, allowing PRP to remain viable for up to several hours after preparation.

5. Compatibility with Multiple PRP Systems:
   Citrate tubes can be used with most manual and automated PRP centrifuge systems, making them a versatile choice for clinics and laboratories.

Citrate Tubes vs. Heparin or EDTA Tubes

While other anticoagulants like EDTA or heparin are also available, they are not ideal for PRP preparation.

EDTA tubes can cause platelet fragmentation, while heparin may interfere with platelet activation. Thus, citrate remains the gold standard for PRP collection and processing.

Applications of Citrate-Based PRP

PRP prepared with citrate tubes is widely used across various medical fields:

• Aesthetic Medicine: For facial rejuvenation, acne scars, and skin tightening.

• Trichology: For stimulating hair growth and treating hair thinning.

• Orthopedics: To accelerate healing of tendons, ligaments, and joints.

• Dentistry: For bone grafts and implant healing.

• Sports Medicine: For faster recovery from muscle and ligament injuries.

In all these applications, the quality of PRP—and therefore the effectiveness of the treatment—depends heavily on the correct use of citrate tubes.

Best Practices When Using Citrate Tubes

To ensure optimal results, medical professionals should follow these best practices:

• Always use sterile, single-use citrate tubes.

• Avoid shaking the tubes vigorously; gentle inversion is sufficient to mix the anticoagulant.

• Follow the manufacturer’s recommended centrifugation speed and time.

• Use PRP immediately after preparation for best biological activity.

• Store the tubes at room temperature, away from direct sunlight.

Conclusion

Tubes with citrate for Platelet-Rich Plasma (PRP) preparation are not just a small technical detail—they are a key factor in determining PRP quality, efficacy, and safety. Citrate ensures that platelets remain viable, functional, and ready to unleash their healing potential when applied to the patient.

As PRP therapy continues to gain momentum in medical aesthetics, sports medicine, and regenerative treatments, choosing the right citrate tube system is essential for achieving consistent, reliable, and clinically superior results. Whether you are a medical practitioner or a clinic specializing in regenerative therapies, understanding the importance of citrate-based PRP tubes will help you deliver the best possible outcomes for your patients.