“No idea is so outlandish that it should not be considered with a searching but at the same time a steady eye.”

Few areas of blood management have been simultaneously so widely revered yet broadly questioned as the process of autologous platelet gel (APG). An equal balance of skepticism tempers the degree of enthusiasm where a believer’s passion is only surpassed by a critic’s admonitions. APG is described as the process of harvesting ones own cells (platelets), concentrating them, exposing them to an agonist, activating them to release their intrinsic substances, and applying them to an area of the body in need of healing. It’s growth over the past decade can best be described as geographically variant where certain locations have seen explosive growth while others have seen little to no acceptance. It is clearly a technology in search of a science, which suffers from the conventional wisdom of a lack of evidence-base. Its origins can be traced to the techniques of intra-operative plasmapheresis. Although the process of plasmapheresis has been in clinical use for over 50 years, its application as a perioperative clinical tool was not appreciated until the mid 1970s. Initial research focused on the separation of autologous whole blood into fractions that could be administered throughout the surgical procedure. In cardiac surgery this technique became popular in the late 1980s, but controversy surrounding its reproducible efficacy led to its decline in the late 1990s (1–5). Although a number of studies promoted the benefits of plasmapheresis as a blood conservation measure, an equal number failed to show a reduction in allogeneic blood product utilization. During the past two decades, however, this technique has reemerged not based upon its original potential to improve hemostasis, but instead related to the contribution of the platelet and its biological affect on wound healing (6). A secondary benefit of this process, and one that has promoted its popularity, is the derivation of the product from an autologous source. It is harvested from the same individual to whom it will be applied. The growth of APG has occurred most rapidly during the past decade both in the United States and across Europe and is beginning to expand in Asia. What makes APG so attractive is the ease of which the platelets can be harvested using point-of-care devices that are used both in clinics and physician offices as well as throughout operating theaters. The technique for making APG begins with a modified plasmapheresis procedure that yields a platelet-rich plasma (PRP) fraction either by a centrifugation procedure or through the process of ultrafiltration (the former being the most used Abstract: Autologous platelet-gel (APG) is the process of harvesting ones own cells (platelets), concentrating them most often through centrifugation, exposing them to an agonist which induces activation which releases intrinsic substances, and applying them to a target area to accelerate wound healing. APG is attractive because it concentrates a large number of biologically active substances, which are primarily proteins that participate in complex series of mechanisms involved in inflammation and wound healing. It has been used in numerous applications including sports medicine, dermatology, and surgery. However, there are few prospective randomized trials that have compared it in a rigorous manner to other techniques or to placebo. The following report is a review of APG, which includes a description of its perceived benefit, identification of the various modalities where it has been used, and criticisms concerning its use.