Does plasma therapy work?

“Covid changes your approach to life,” says Arjun Khanna (name changed), who recovered from the disease a few weeks ago. He says he can never forget the fear he felt after testing positive. Now he wants to do all he can to help in the fight against Covid-19. And one way he is doing it is by donating the plasma from his blood.

Khanna was one of the first donors to have his plasma harvested at SMS Hospital in Jaipur. It will be administered to one of the three patients eligible for plasma therapy at the hospital on May 2. The first patient is a doctor from the hospital, whose symptoms have taken a turn for the worse. He had been on ventilator support last week, and has since been shifted to an ICU but still has reports of breathlessness, falling oxygen saturation, lung lesions, while his tests for cytokine markers are positive. If successful, the plasma harvested from Khanna could save his life.

“To put it in lay terms, blood consists of plasma, red blood cells, white blood cells and platelets--plasma is the liquid part of your blood which carries cells. Only the plasma is used for treatment. It is still in the early stages and being given only to critical cases under close watch. In the next few weeks, we will start to get a better understanding,” says Dr Sanjiv Bhandari, principal of SMS Hospital, which received approval from the Indian Council of Medical Research (ICMR) to conduct plasma treatment on April 31. Blood plasma therapy harvests plasma from recovered Covid patients, two weeks after they test negative for the virus. A two-week gap is maintained to ensure the virus does not remain in the blood. Blood is then taken through the vein, the plasma separated through a machine and only the blood cells returned to the donor. It is a pain-free procedure. The plasma from the recovered person has IgG antibodies that would have built up against Covid-19, and could help a second patient’s immune system build antibodies against the virus. At present, this is only being done globally for severe patients, usually those on ventilator support, as the long-term impact and safety of the treatment is yet to be determined. On April 18, ICMR received approval from the DCGI (Drug Controller General of India) to start human trials of the therapy.

The most critical step in harvesting plasma is screening it for other viruses such as HIV or viral hepatitis. “An essential step for readying plasma is to screen it for other viruses. For this, one requires a First Nucleic Acid Test machine,” says Dr Asha Kishore, director of the Sree Chitra Tirunal Institute for Medical Sciences and Technology in Thiruvananthapuram. The hospital received approval from the Kerala government to begin plasma harvesting in March. However, before they could commence, the ICMR protocol changed in early April and limited plasma harvesting to only Covid hospitals. “We are not a Covid facility, but we have a plasma harvesting set-up and have Rs 25 lakh in CSR funds to cover at least 200 donors for free,” she adds. The hospital estimates the cost of harvesting, storing and distributing plasma to be around Rs 12,000-15,000. She says the Kerala government will most probably partner with private hospitals to provide plasma. But plans are still to be confirmed.

The plasma treatment at SMS Hospital is not the first in India. A 49-year-old critically ill patient on ventilator support successfully received plasma treatment at Max Hospital in Delhi and was released on April 26. However, the health ministry on April 28 announced that the plasma therapy was still in experimental stages and could trigger life-threatening complications. Any use of this treatment would be “illegal”, unless the medical facility has ICMR approval for it. While two patients at Mumbai’s Lilavati Hospital, who underwent the therapy on an experimental basis after ICMR approval, are doing well, another 53-year-old patient who received the treatment died on April 29.

“We don’t know entirely how a person will react to foreign plasma, and whether the antibodies in plasma would be effective. Most of our understanding is based on very limited research and small-scale studies. No treatment can be approved without fully understanding its impact on people across ages, gender, demographics and so on. At present, we only know it has had some success,” says Dr Kishore. Blood plasma therapy has received approval for emergency cases from the FDA (Food and Drug Administration) in the US. The therapy is rooted in a Chinese study of five patients on ventilator support. After receiving plasma, the study noted that symptoms improved and within 10 days, three of them were taken off the ventilator. “There is hope and potential. We will know more soon,” adds Dr Bhandari.

At its best, plasma could be useful in helping critical cases build up antibodies before the virus leads to inflammation or organ damage. At its worst, it could lead to other complications, such as allergic reactions, transfusion-related acute lung injury, transfusion-associated circulatory overload, or rare instances of infectious disease transmission if the plasma is not screened properly. India has the blood transfusion infrastructure and recovered patients needed to donate plasma--all it needs now is a green signal.

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