{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T13:07:38Z","timestamp":1789391258462,"version":"build-2803163510"},"reference-count":127,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Platelet-rich plasma (PRP) has been extensively used in clinical practice to treat musculoskeletal (MSK) and spinal maladies. PRP applications and preparation methods focus on variables such as delivery technique, formulation, and device performance. Few PRP preparation methods consider the variability in the biological status of the individual patient following a comprehensive homeostatic tissue repair response. In recent years, more information has become available for addressing the efficacy of PRP devices and preparation methods. Furthermore, the impact of the PRP dose and bioformulation on different pathoanatomical tissues and patient outcomes has been more widely discussed. This review aims to examine different variables in the optimization of PRP preparation methods, focusing on several platelet indices that influence hematopoiesis, subsequent to homeostasis and neuronal regulation, and how this relates to the release of platelets with variable densities, the mean platelet volume (MPV), platelet distribution width (PDW), and ultimately platelet concentration. Methods: A literature review was conducted using the PubMed, Medline, and Cochrane databases. Results: The literature indicates that the overall physiological platelet dynamics, from bone marrow megakaryocytes to peripheral blood release, differ continuously between health and disease. This study demonstrates that variations in platelet density, as indicated by mean platelet volume (MPV), and platelet count are associated with deviations in the total platelet distribution width. Conclusions: Incorporating platelet indices (PIs) into platelet-rich plasma (PRP) preparation protocols and methodologies is recommended to optimize the recovery of denser, more reactive, and regenerative platelets inherent in peripheral blood, which are integral to the patient\u2019s homeostatic tissue repair mechanisms. Pre-procedural assessment of the patient\u2019s platelet biological status allows for the preservation of an optimal platelet profile within PRP preparations, potentially enhancing clinical efficacy.<\/jats:p>","DOI":"10.3390\/jcm15187126","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T12:09:51Z","timestamp":1789387791000},"page":"7126","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Are Platelet Volume, Density, and the Homeostatic Blueprint the Missing Link in Platelet-Rich Plasma Therapies? An Evidence-Based Narrative Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3128-9380","authenticated-orcid":false,"given":"Peter A.","family":"Everts","sequence":"first","affiliation":[{"name":"Medical School (GBCS), The University of Queensland, Brisbane, QLD 4006, Australia"},{"name":"Medical School, Max Planck University Center (UniMAX), Indaiatuba 13343-060, SP, Brazil"},{"name":"Regenerative Medicine, Orthoregen International Course, Indaiatuba 13334-170, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7260-6191","authenticated-orcid":false,"given":"Luga","family":"Podesta","sequence":"additional","affiliation":[{"name":"Bluetail Medical Group and Podesta Orthopedic Sports Medicine, Naples, FL 34109, USA"},{"name":"College of Osteopathic Medicine, Orlando, FL 34787, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9578-026X","authenticated-orcid":false,"given":"Jane","family":"Fitzpatrick","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Dentistry and Surgery, University of Melbourne, Parkville, VIC 3010, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4098-1272","authenticated-orcid":false,"given":"Leonardo P.","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Levitetz Department of Orthopedic Surgery, Cleveland Clinic Foundation, Weston, FL 33331, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 F\u00e1bio","family":"Lana","sequence":"additional","affiliation":[{"name":"Medical School, Max Planck University Center (UniMAX), Indaiatuba 13343-060, SP, Brazil"},{"name":"Regenerative Medicine, Orthoregen International Course, Indaiatuba 13334-170, SP, Brazil"},{"name":"Clinical Research, Anna Vit\u00f3ria Lana Institute (IAVL), Indaiatuba 13334-170, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1836-6831","authenticated-orcid":false,"given":"Andr\u00e9","family":"van Zundert","sequence":"additional","affiliation":[{"name":"Medical School (GBCS), The University of Queensland, Brisbane, QLD 4006, Australia"},{"name":"Mayne Academy of Critical Care at The University of Queensland, Brisbane, QLD 4006, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9992-6927","authenticated-orcid":false,"given":"Mikel","family":"S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Arthroscopic Surgery Unit and Advanced Biological Therapy Unit, Hospital Vithas Vitoria, 01008 Vitoria-Gasteiz, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0494-0804","authenticated-orcid":false,"given":"Diego","family":"Delgado","sequence":"additional","affiliation":[{"name":"Arthroscopic Surgery Unit and Advanced Biological Therapy Unit, Hospital Vithas Vitoria, 01008 Vitoria-Gasteiz, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5138-9795","authenticated-orcid":false,"given":"Christine Brown","family":"Mahoney","sequence":"additional","affiliation":[{"name":"Bio-Statistics College of Business, Minnesota State University, Mankato, MN 56001, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glenn","family":"Flanagan","sequence":"additional","affiliation":[{"name":"Naples Regenerative Institute, Naples, FL 34103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Alexander","sequence":"additional","affiliation":[{"name":"Regenevita Biocellular Aesthetic and Reconstructive Surgery, Wound Healing, Hamilton, MT 59840, USA"},{"name":"Department of Surgery and Maxillofacial Surgery, University of Washington, Seattle, WA 988104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4610-8909","authenticated-orcid":false,"given":"Paul","family":"Harrison","sequence":"additional","affiliation":[{"name":"Department of Inflammation and Aging, School of Infection, Inflammation and Immunology, College of Medicine and Health, University of Birmingham, Birmingham B15 2TT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Everts, P., Onishi, K., Jayaram, P., Lana, J.F., and Mautner, K. 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