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Is Plasma donation beneficial in Covid-19 patients?

DIRECT ANSWER - YES (probably)

Yes, you read it right. Various researches have been done on this topic throughout the world. But due to less number of covid recovered people donating plasma, there is less surity of the beneficial effects of convalescent plasma donation to a coivd patient.

Convalescent Plasma refers to plasma taken from patient recovering from a disease (convalescent patient). 
Plasma is the part of blood that remains after separting the red blood cells. It contains water, proteins (including anti-bodies), minerals and vitamins. The anti bodies present in the Plasma has been used as a weapon against various disease in the past- SARS1 IN 2003 and MERS IN 2012.

Anti bodies are of 5 various types. Out of these there 2 main types which play an important role in Plasma Donation, these are IgG and IgM. IgM anti bodies play role in short term defences of body and IgG antibodies play role in long lasting defences of the body. It is the titre of IgM and IgG that is determined in the plasma donated by the convalescent patient.


The complete process of plasma donation, its side effects, criteria are all explained here-

CRITERIA FOR DONATING CONVALESCENT PLASMA

  • confirmation of covid infection
  • 14 days after recovery
  • if done before 28 days after full recovery, confirmation of resolution using 2 times RT-PCR with interval of 24 hours
  • standard criteria as per whole blood trasfusion such as age, weight, frequency etc.
  • HIV, HbSAg, HCV, SYPHILIS negative.
  • prefer male donors over pregnant female or females having past pregnancy to avoid TRALI.
  • volume collected atleast 200-600ml


It was noted in one research that patients having more symptoms or those in whom symptoms lasted longer such as fever lasting more that 3 days or similar; had a higher IgG anti body titre in their blood as compared to those having less number or less severity of symptoms. 

Following points were kept in mind about plasma receiver subjects- 
  • plasma was transfused upto 3 weeks after hospital admission
  • better effect if given within 14 days 
  • atleast 200ml unit of plasma were given to each
  • 1 unit of plasma for Post exposure prophylaxis 
  • 1-2 units of plasma for treatment. Transfusion of plasma from at least 2 donors may be therapeuically beneficial for attaining effective immune protection.
  • lasting of these anti bodies is unknown


The following EFFECTS were seen in various studies in patients after recieving Convalscent Plasma-
  • temprature normalised within 3 days.
  • FiO2 increased within 12 days
  • increased oxygen saturation within 3 days
  • viral load decreased
  • patient became negative within 12 days after trasnfusion.
  • ARDS resolved at 12 days
  • radiological improvement wihtin 7 days.
  • few patients weaned from mechnical ventilation within 12 days of transfusion.
  • the study subjects recieving Convalscent plasma in a Hong Kong study recorded higher 22 day discharge rate.


SIDE EFFECTS

The side effects of plasma donation remains same for a covid or non-covid patient.
There were no different or special side effects noted in the Plasma Donation of Covid patients.


FREQUENCY

The frequency of donating plasma is once per 28 days, upto 1 times a year.

Certain points have to be kept in mind that inspite of all the above mentioned benefits seen in patients receiving Convalscent Plasma, there are points which do not favour the definitive benefit of plasma donation.

These include-
  • There were less study subjects in almost all the researches
  • There has been differences in the dosages of convalescent plasma given to the patients.
  • Many patients were given other treatments such as ivermectin, steroids and other drugs along with concalescent plasma. Hence marking the benefit of Plasma alone  in doubtful.
  • The time of giving Convalscent Plasma was highly variable in different study patterns across the research studies.

In August 2020 FDA (food and drug administration) approved the use of Convalescent Plasma in a COVID patient as emergency use drug.


But recently ICMR (indian council of medical research) funded PLACID trial found that Convalescent plasma was not found to reduce mortality or disease progression to severe disease. The study revealed no differences in 28 day mortality and disease progression in 464 moderately ill hospitalized patients.




In conclusion it can be said that there is less number of conclusive data on the sole capacity of Convalscent plasma.


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SOURCES-
  1. https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/donate-covid-19-plasma
  2. Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma by Chenguang Shen, Zhaoqin Wang and others
  3. Effectiveness of convalescent plasma therapy in severe COVID-19 patients By:Duan, K (Duan, Kai) and others 
  4. Convalescent Plasma to Treat COVID-19Possibilities and Challenges by John D. Roback, MD, PhD1; Jeannette Guarner, MD2
  5. Characteristics and serological patterns of COVID‐19 convalescent plasma donors: optimal donors and timing of donation by Ling Li,Xunliang Tong and others
  6. Anti-SARS-CoV-2 virus antibody levels in convalescent plasma of six donors who have recovered from COVID-19 by Libo Zhang, Rongrong Pang and others
  7. Anti-SARS-CoV-2 virus antibody levels in convalescent plasma of six donors who have recovered from COVID-19 by Libo Zhang, Rongrong Pang and others
  8. Anti-SARS-CoV-2 virus antibody levels in convalescent plasma of six donors who have recovered from COVID-19 by Libo Zhang and others
  9. Use of convalescent plasma therapy in SARS patients in Hong Kong by Y Cheng, R Wong, and others
  10. High-Dose Intravenous Immunoglobulin as a Therapeutic Option for Deteriorating Patients With Coronavirus Disease 2019 by Wei Cao, Xiaosheng Liu and others
  11. Points to consider in the preparation and transfusion of COVID‐19 convalescent plasma by Jay Epstein and others 
  12. https://www.fda.gov/news-events/press-announcements/fda-issues-emergency-use-authorization-convalescent-plasma-potential-promising-covid-19-treatment
  13. Points to consider in the preparation and transfusion of COVID‐19 convalescent plasma by Jay Epstein, Thierry Burnouf

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