Prof Gurpal Singh of Panjab University, Chandigarh was infected by the COVID-19 in the month of April and had spent around one month in isolation for recovery.
After winning the battle against the deadly virus, Prof Gurpal Singh not only returned to his work but also donated plasma for the treatment of other COVID-19 (Coronavirus) patients. He is among the seven recovered patients who have come forward to donate plasma at the Post Graduate Institute of Medical Education and Research.
Amid galloping COVID-19 cases in Chandigarh, Prof Gurpal, 41, says, “The situation in the city is grim due to sudden surge in the number of positive cases. There are thousands of recovered patients, who should now come forward to donate plasma to save the lives of critical COVID-19 patients.”
About his decision to donate the plasma, he says, “I have struggled with the virus for one month and have fully recovered. As of now, we do not have any vaccination against this contagious virus so the light beam of hope is plasma therapy. The reason behind donating the plasma was to save the lives of others.”
“I understand people have some misconceptions about plasma donation. But, there are no side effects of donating the plasma,” he adds.
Sadly, most of the recovered COVID-19 patients have apprehensions and misgivings concerning the plasma donation and are not forthcoming.
In the convalescent plasma therapy (CPT), plasma from a COVID-19 recovered patient (which is rich in antibodies to fight the virus) is transfused into another COVID-19 patient to help boost the recipient’s immune response to the SARS-CoV-2 infection.
The concept of plasma therapy is not new and has been used for more than a century now in treatment of infectious diseases, with varying degrees of success.
The Indian Council of Medical Research (ICMR) had in the month of April begun a randomised controlled study to assess safety and efficiency of the therapy. While the results of the convalescent plasma therapy are yet to be made public, medical institutions in several states, including Delhi, Punjab, Haryana, Maharashtra among others have been prescribing plasma therapy to the Coronavirus patients.
The plasma therapy has raised hopes in treatment of critically-ill COVID-19 patients, however, the larger challenge remains in finding a plasma donor. Several plasma banks have been set up across the country but the response to a call to recovered patients for donating plasma has been lukewarm so far.
The Post Graduate Institute of Medical Education and Research here was also among one of the institutions selected by the ICMR for the national-level trial of the CPT. The clinical trial for CPT had concluded in July by the PGIMER but the institute had decided to go ahead with taking plasma donations with the consent of the donors.
Even as the PGIMER is now in the process of setting up a plasma bank, the biggest challenge lies in convincing a recovered patient to donate the plasma.
“When the CPT clinical trial had begun in May, we had made calls to around 120 recovered patients and among the eligible donors, only seven came forward for donating plasma and subsequently, we had collected 10 units of convalescent plasma for potential transfusion into patients with COVID-19.
Few patients had donated plasma for more than once,” tells Dr Ratti Ram Sharma, Head, Department of Transfusion Medicine (Blood Bank), PGIMER while talking to The Pioneer.
"Currently, the PGIMER is left with not even a single plasma unit. We are working out logistics to set up a plasma bank and have been making appeals to the recovered patients to donate plasma,” says Dr Sharma.
The Nehru Hospital Extension, PGIMER is a 200-bedded treatment facility for critical COVID patients. The patients admitted in NHE belong to Chandigarh, Punjab, Haryana, Himachal and Uttar Pradesh and so far, more than 540 have been discharged from the PGIMER after being recovered from the virus.
In the union territory of Chandigarh, the total positive cases have crossed 4500 while more than 2500 have recovered from COVID-19.
The eligibility criteria for donors preclude many recovered patients, says Dr Sharma adding that the donor should have had a prior diagnosis of COVID-19 with symptoms like fever and cough, and should have completely recovered with no symptoms for at least 28 days prior to donation. “We also came across recovered patients who wanted to donate plasma but were not eligible and did not have desired antibody level,” he adds.
Based on the ICMR guidelines, recovered patients above the age of 18 can donate their plasma. Further, it should exclude critically-ill patients, pregnant or breastfeeding women and patients with any known hypersensitivity to blood products.
Dr Pankaj Malhotra, Department of Internal Medicine at PGIMER tells, “The inclusion criterion is also determined by using a P/F ratio, which records the measure of inspired oxygen received by the patient.
The P/F ratio of patients should fall between 200 and 300. These patients are then eligible for receiving plasma therapy according to ICMR protocol.”
Elaborating about the clinical trial of CPT, he says, “As far as trials in PGIMER are concerned, the results have been positive and encouraging.
The PGIMER had enrolled nine patients, of whom five received plasma treatment and the remaining four were on the control arm.The patients who were administered plasma were discharged after successful treatment and have shown no side effects.”
The plasma treatment is already being used in infected patients in India, United States and other countries while the extent of its effectiveness and safety is still debated by health experts.
The World Health Organisation had recently stated that using plasma from the recovered to treat COVID-19 is still considered an experimental therapy and that the preliminary results showing it may work are still inconclusive. However, with no vaccine or specific drug available for COVID-19 till now, the concept of plasma therapy has gained popularity and the doctors are doing their bit to save the lives of critical patients through the procedure.
With no evidence yet to support that the plasma therapy is a promising intervention to treat critical COVID-19 patients, Dr Malhotra says, “The sample size for the ICMR study across the country on plasma therapy was 452 and the final results are still awaited. Having said that, we still believe that plasma therapy is a safe and effective treatment for COVID patients.”
Talking about the daunting task of finding plasma donors, Dr Malhotra shares, “We have reached out to many recovered persons but only a few have turned up till now. The recovered patients have some apprehensions about the plasma donation.
We are often asked will giving plasma weaken the recovered patients while many are reluctant to donate fearing a relapse. We want to assure that the plasma donation is a safe process and has no side effects on the donor.”
As per the protocol followed, the blood bank assesses the eligibility of donors and check their antibody levels before they can donate plasma.
Dr Malhotra adds, “To boost the plasma donation initiative, the PGIMER is setting up a plasma bank and we have also recommended starting antibody testing in the institute. To facilitate the donors, we have also made arrangements to send a vehicle to their place for conducting the screening procedure.”