- Plasma therapy has shown positive results in Delhi, Noida, among others
- The plasma therapy has been used to treat diseases like Hepatitis B
- One can donate 500 ml of plasma which can be given to 2 COVID-19 patients
New Delhi: On Monday (June 29), Chief Ministers of Delhi, Maharashtra and Haryana made big announcements with regard to plasma therapy. Delhi Chief Minister Arvind Kejriwal announced setting up of a plasma bank to facilitate availability of life-saving plasma. Chief Minister of Maharashtra Uddhav Thackeray inaugurated ‘Project PLATINA’ claimed to be the world’s largest convalescent plasma therapy (CPT) trial cum treatment of severe COVID-19 patients. After receiving approval from the Indian Council of Medical Research (ICMR), Haryana Health Minister Anil Vij announced that the state will start plasma therapy as a treatment. Plasma therapy has been gaining ground as a possible treatment for critically-ill COVID-19 patients.
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On June 17, Delhi Health Minister Satyendar Jain tested positive for Coronavirus. Over the next two days, his condition deteriorated and he had to be shifted from Rajiv Gandhi Super Speciality Hospital (RGSSH) in Delhi’s Dilshad Garden to a private facility, Max Hospital in Saket. Here he was administered plasma therapy after which his condition improved – the fever subsided and oxygen levels improved. Plasma Therapy involves transfusion of antibodies from someone who has recovered from COVID-19 (convalescent coronavirus patient) into a critical patient. The therapy is based on the principle that the blood of a recovered patient is rich in antibodies needed to combat COVID-19, as these Y shaped proteins produced by a human body is used by the immune system to identify and neutralise foreign objects such as bacteria and viruses. These antibodies are expected to help critical patients recover.
The effectiveness of plasma therapy has also got a stamp of approval from the Food and Drug Administration (FDA) of United States. Countries like China, South Korea are using this technique to save lives of people suffering from COVID-19. In a series of tweets, the ICMR backed the center and said that FDA has also viewed plasma therapy as an experimental therapy and there is no robust evidence to support it for routine therapy.
Currently, there are no approved, definitive therapies for #COVID19. Convalescent plasma is one of the several emerging therapies. However, there is no robust evidence to support it for routine therapy. @US_FDA has also viewed it as an experimental therapy (IND). 1/4
— ICMR (@ICMRDELHI) April 28, 2020
Delhi has also been trying the convalescent plasma therapy (CPT) to treat critically ill patients of COVID-19 for quite some time now and so far, the results have been encouraging. A 49-year-old COVID-19 patient admitted in Delhi’s Max Hospital in April was the first to receive the treatment and recover from it. Since then plasma therapy has been given to 84 COVID-19 patients and has been successful in 80 cases.
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States like Delhi, Maharashtra had already got the approval from the centre to start a clinical trial of plasma enrichment technique on COVID-19 patients who are critically ill.
But there are concerns as well. On April 28, at the regular news briefing, Lav Agarwal, Joint Secretary, Ministry of Health, called the treatment ‘life-threatening’ and said,
There is no concrete evidence to support plasma therapy as coronavirus treatment. The therapy is still in an experimental stage and the ICMR is conducting a national study on it. It can even be life-threatening if not carefully done.
Back then Mr Agarwal very categorically stated that plasma therapy should be used only for research or trial purposes and should not be considered as an approved therapy for the treatment of COVID-19.
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Plasma therapy has indeed raised hopes of the people, but what are the dos and don’ts? NDTV spoke to a group of medical experts – Dr Ravindra Mehta, Chief of Pulmonary and Critical Care Medicine at Apollo Hospitals in Bengaluru; Anurag Mehrotra, Chief Cardiologist at Siddh Hospital in Moradabad, Uttar Pradesh; Dr Sandeep Budhiraja, Group Medical Director, Max Healthcare; Dr Suresh Kumar, Medical Director at LNJP; Dr Guido Vanham, Virologist; Dr Ravi Godse, Attending Physician, UPMC, Pennsylvania; Dr Pramod Gandhi, Endocrinologist; Dr Vivek Nangia, Director, Pulmonology, Fortis Hospital Vasant Kunj.
How Does Plasma Therapy Work?
Blood plasma, a yellowish liquid is a component of blood and consists of protein, minerals and anitbodies. If someone has recovered from COVID-19 there are chances that the person’s body has developed antibodies that helped him/her to fight the virus. The same antibodies, if infused into a critical patient may provide passive immunity and help in the recovery process.
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What Is The Procedure Of Convalescent Plasma Therapy?
The procedure of donating plasma and transfusing it into someone’s body is similar to blood transfusion. Plasma from a patient who has recovered from coronavirus infection is taken out and infused Intravenously (IV).
Explaining the procedure, Dr Ravindra Mehta, Chief of Pulmonary and Critical Care Medicine at Apollo Hospitals in Bengaluru, says,
First blood is drawn to check the level of antibodies. Once it’s clear that an individual can donate plasma, we take blood, then we separate plasma from the blood and give that to a compatible person, not to everyone. The point to be noted is, only plasma is taken from the blood and at the end, blood is sent back to the body. The plasma can either be immediately given to the prospective patient or stored for a year.
Among many donors is 36-year-old Tabrez Khan who donated his plasma at the Institute of Liver and Biliary Sciences (ILBS) in South Delhi. Talking to NDTV about the process, Mr Khan says,
It was very easy. In total, it took two hours in the hospital, which includes blood testing, reports analysis, the process of extracting blood and then removing the plasma from it and infusing the remaining blood again in the body. The hospital also made all arrangements.
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Who Can Donate Plasma?
Patients who have passed through the cycle of coronavirus, who have recovered from COVID-19, can donate plasma because only they have developed the immunity against this virus, says Dr Anurag Mehrotra, Chief Cardiologist at Siddh Hospital in Moradabad, Uttar Pradesh.
This means that a healthy individual or anyone who has not had COVID-19 cannot donate plasma. According to Dr Ravindra Mehta, Plasma can be donated after 14 days of recovering from the disease.
Dr Sandeep Budhiraja, Group Medical Director, Max Healthcare who did the first plasma therapy in India for a COVID patient back in April informs that 500ml of plasma is taken from an individual which can be used for two patients. Also, not all COVID-19 recovered patients can donate plasma. Dr Budhiraja adds,
There are certain restrictions like people less than 18 years of age, individuals over 60 years and people who have contracted any other infection in the recent past cannot donate plasma.
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Will Donating Plasma Make Me Weak And Prone To COVID-19?
No, donating plasma won’t make the donor weak as only plasma from the blood is taken out and not the blood. Also, there is no evidence to suggest that donating plasma can make one prone to contracting the Novel Coronavirus again.
Fatima Hashmi, a plasma donor and a nurse at Max Super Speciality Hospital, Patparganj encourages people to donate plasma and says,
I’m a nurse and I know how pathetic the Coronavirus condition is right now. Having seen the situation, I decided to donate plasma because what’s better than saving someone’s life? Donating plasma is like donating blood; in fact, easier, as only plasma is extracted. I didn’t feel any weakness or wasn’t exposed to any other virus. Now, I’m back to work also.
23-year-old Smruti Thakkar who is said to be the first recovered patient in Ahmedabad has donated her plasma. Sharing her experience with NDTV, Smruti says,
The doctors who guided me on plasma therapy sounded very positive and confident and gave me the courage to go ahead and donate my plasma. It is 100 per cent safe procedure and not at all painful. It took me 99 minutes. There was no blood loss. During the procedure, I didn’t feel any drowsiness; I was given juices and vitamins.
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At What Stage Of COVID-19 Is Plasma Therapy Recommended?
Dr Sandeep Budhiraja reiterates that plasma therapy is not a defined treatment to COVID-19; it’s still being used in some hospitals as an experiment and on compassionate grounds. However, this doesn’t mean that anyone can opt for the said treatment. Explaining the same, Dr Budhiraja says,
There is no point in administering plasma to mild cases of COVID-19 or at an early stage of infection. The convalescent plasma therapy is not much effective when a patient is on a ventilator. The best stage to give plasma is ‘moderate severity’ – when the patient’s requirement of oxygen increases.
Dr Suresh Kumar, Medical Director at LNJP (Lok Nayak) Hospital in Delhi says that plasma therapy benefits people more who are under 65 years of age; have only SARI (severe acute respiratory infections); acute respiratory failure because of COVID; oxygen saturation is less than 90.
If we give plasma before cytokine storm, before multi-organ failure stage then the chances of survival are high, says Dr Kumar.
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Is Plasma Therapy The Only Way To Treat COVID-19?
In the absence of a vaccine against COVID-19, plasma therapy is being looked upon as a potential treatment. But this has not been approved by ICMR yet; it’s being tried as an experimental therapy. Though the treatment has given positive results, Dr Randeep Guleria, Director, All India Institute of Medical Sciences (AIIMS) has asked to not look at the treatment as ‘magic bullets’. Speaking to the news agency ANI, he said,
Plasma therapy is not the only treatment strategy and it is not that it will be effective in all patients because there are a number of other things happening in people affected with coronavirus. Also, patients willing to give blood after 14 days of recovery must contain a good amount of antibodies.
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Dr Guleria adds,
We need to look at it with a research type of treatment modality rather than something which can be done for all patients suffering from COVID-19.
Is There Any Evidence To Support The Use Of Plasma Therapy?
Plasma therapy is not a new concept; in fact, in the past, it has proven to be helpful in the treatment of other diseases like Hepatitis B. Sharing his opinion on plasma therapy and how successful it can be, Dr Guido Vanham, Virologist said,
Plasma therapy has been successfully used in Hepatitis B and unsuccessful in case of HIV and Hepatitis C. There is data from China that about 30 per cent of people who have recovered do not develop neutralising anti-bodies that can block the virus. If that is the case then the therapy will not be universally successful, but you can expect 60-70 per cent success.
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Hoping that plasma therapy is going to be affective, Dr Ravi Godse, Attending Physician, UPMC, Pennsylvania, said,
In US, FDA has approved it and trials have just started. We hope that plasma is going to be effective. Whether we know it is going to be effective or not, the time to start collecting plasma is right now. We are hoping that the peak doesn’t come to India but in case it comes to India, we should start collecting the plasma and be ready.
Why Is ICMR Not Approving Plasma Therapy As A Treatment For COVID-19?
Anup Agarwal, Consultant at ICMR said that currently, we do not know how effective convalescent Plasma is and added,
This is the reason ICMR is doing a randomised clinical study. We do not know whether or not it will be effective in critically ill patients of COVID -19. It will take 3-6 months to put out the findings of the research.
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ICMR Director General Dr Balram Bhargava said in an opinion piece written for The Hindu newspaper,
Scientific research in medicine is the only means to overcome novel and complex diseases such as COVID-19 and that too thrives on the same spirit of debate and criticism. So is the case with the convalescent plasma therapy that is being currently studied by the Indian Council of Medical Research, through open label, randomised controlled trial to evaluate it for both safety and efficacy. In theory, the antibodies of the recovered person may help that patient’s immune system fight the virus. While showing great promise, it is a line of treatment that is yet to be validated for efficacy and safety and cannot be deployed widely without caution. The current evidence to conclude anything about the true benefits of this therapy is very thin.
Dr Bhargava also noted that plasma therapy involves risks that make it even more important to study it thoroughly before suggesting it as a treatment.
Are There Any Risks Involved In Plasma Therapy?
Blood transfusion related infections can be transmitted so before plasma transfusion, we need to do other tests like HIV. These are routine tests and are done for all transfusions, says Dr Pramod Gandhi, Endocrinologist.
Further talking about the risks involved and ICMR’s take, Dr Vivek Nangia, Director, Pulmonology, Fortis Hospital Vasant Kunj says,
Plasma therapy has been tried during different pandemics and gave only modest results. In the case of Ebola and MERS, the therapy failed completely. To conduct this therapy, it’s important to know if there are enough antibodies available in the body of COVID-19 recovered patients. But the antibodies test we have is qualitative and not quantitative.
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Dr Kumar from LNJP says plasma therapy should not be given to patients with a liver problem, renal failure, alcoholics and cancer patients.
As of now, in the treatment of COVID-19 patients, plasma therapy has shown positive results. ICMR categorises CPT as ‘experimental’. Doctors can ask patients to take part in CPT trial and patients can be added to it only with the approval of hospital ethics committees. However, lately, the reports have shown that COVID-19 patients are struggling to find plasma. For instance, it took Shweta Singh, a resident of Delhi, three days to arrange plasma for 58-year-old father. Now, with the government’s involvement in the CPT trial, the search will become easier.
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