Explained: What is Plasma Enrichment Treatment for COVID-19?

Explained: What is Plasma Enrichment Treatment for COVID-19?

Blood plasma therapy is being touted as a way to help critical COVID-19 patients. Does it work?

(Photo: iStockphoto)

All over the world, researchers and healthcare professionals are scrambling to find a way to slow down the novel coronavirus.

From social distancing to flatten the curve and help our medical systems cope, to the race for a vaccine - we’re trying it all.

On Wednesday, 15 April, the Institute of Liver and Biliary Sciences (ILBS), a Delhi government hospital plunged in too, using a plasma enrichment technique to treat severe COVID-19 patients on a trial basis said officials.

A five-member committee headed by ILBS Director Dr S K Sarin proposed measures to deal with increasing cases - one of which was to use this therapy to severally-ill coronavirus patients.

Delhi’s Max Healthcare too has taken approval from ICMR to conduct these trials, making them the first private hospital to do so. They used the therapy to treat two COVID-19 patients who were in the ICU, and they are on the road to a recovery says the doctor.

Max Hospital’s medical Director, Dr Sandeep Budhiraja, says,

Dr Sandeep Budhiraja“For plasma treatment, an approval needs to be given as clinical trial. At present, both ICMR and DCGI have worked out protocols and advertised for hospitals to submit proposals for conducting trials. Even as we were awaiting approval, the family of the two critically ill patients requested that we use this therapy on compassionate grounds”

How can this new form of treatment help patients? How does it work exactly and what do officials world over think of it? FIT explains.

Also Read: Explained: ‘Pool Testing’ for COVID-19 in India

What is Plasma Treatment?

Convalescent plasma treatment is an experimental procedure for coronavirus patients.

In this, antibodies from the blood of patients who have recovered from coronavirus are used to treat severely infected COVID-19 patients.

Human bodies are evolved to protect themselves against disease by producing antibodies.

• First, a virus or pathogen attacks us.
• In defence, our immune systems gear up to fight by producing antibodies.
• If we can produce enough antibodies, the virus is defeated and all is well - we can be cured of the disease.

Blood plasma is a yellowish, clear liquid.

The experiment of plasma treatment is in determining just how effective it is in treating COVID-19 patients. That is, doctors are trying to see if one recovered person’s immunity can help save another infected person via transferring the healthy blood plasma to the sick person.

Once a patient becomes infected with the respiratory COVID-19 disease, often complications arise - especially if the patient is above the age of 65 and has existing co-morbidities like diabetes or hypertension that make recovery harder. Doctors are trying to ascertain if the plasma treatment can limit these complications.

If all goes well, the antibody-rich healthy blood will help treat sick patients.

Also Read: Why Does Maharashtra Have the Highest COVID-19 Numbers in India?

How Does it Work?

The concept of plasma treatment is not new. In fact, versions of this have existed to treat the Spanish Flu of 1918 to another coronavirus’ like SARS in 2003 and MERS in 2012, according to a study in the The Lancet. Advancements in treatment and technologies have made this method safer and more effective with time, signalling hope for the current pandemic.

Firstly, what is plasma? The oft-forgotten component of our blood, besides red and white blood cells and platelets, blood plasma is actually the largest part of our blood and makes up 55 per cent of it. Plasma carries water, salt, enzymes and most importantly proteins and antibodies, according to Standford Children’s Health Association.

Donating blood plasma is much like donating blood, and the recipients and donors need to have the same blood type.

• The treatment begins when the donor is propped up to a connector.
• Their blood is drawn and separated for its antibodies.
• This serum is then given to a severe patient. It’s important to remember that the more serious, the lower the immunity and antibody production and so this treatment works to boost recovery.

Dr Sandeep Budhiraja“While we take 400 ml of plasma from one donor, one patient is given just 200 ml so this can be used for two patients. This is administered as a companionate, life-saving treatment but it is very early days to say the outcome of this as there are many factors involved in the outcome.”

This treatment provides a form of immunization - although unlike a vaccine that is permanent, this lasts only as long as the antibodies are in the sick person’s bloodstream which is less than a week. It works to boost the system in that time.

One major issue? In a new disease like COVID-19, much is still unknown and many of the patients who succumb have other underlying conditions like diabetes which makes it difficult to find enough antibodies for this treatment.

Another worry was that it is hard to separate the blood or even find enough antibodies. Luckily, as of 17 April, India has 1766 recoveries according to the Union Health Ministry and enough supply of healthy antibodies - at least for the clinical stage.

Also Read: COVID-19 Reinfections and the Efficiency of ‘Immunity Passports'

How Effective is This?

One of the benefits of this therapy is that it is tried and tested - and with new technology, chances are it will be more effective. It is also considered to be a low-risk treatment.

The downside lies in the unknown: COVID-19 is a new disease and the pool to test this on is not that large.

“COVID-19 is a new infection for humankind and we don’t know how long the antibodies will last, but we are hopeful they will be helpful,” says Dr Budhiraja.

But the evidence looks promising; a study published in The Lancet on 27 February 2020 found “no adverse effects of this treatment,” and recommending testing this method out with the COVID-19 virus.

Then, a study from China published in the journal Proceedings of the National Academy of Sciences of the United States of America looked at the results from 10 severe adult cases undergoing plasma treatment. Seven patients recovered without any side-effects, leading the study to conclude it was a “promising rescue option for severe COVID-19” although it depended on “varying degrees of absorption.”

Furthermore, recently three Indian-Americans who were critically infected with COVID-19 are slowly recovering post their blood plasma transfusion treatment reported The Hindu.

The good news? This treatment seems to offer a form of respite to suffering patients especially as we wait for a more permanent solution.

What Do the ICMR and Other Officials Think?

Early in April, the Indian Council of Medical Research (ICMR) sought participation in a randomised controlled study to assess the safety and efficacy of convalescent plasma to limit complications associated with coronavirus, reported PTI. ICMR also asked to participate in a study on therapeutic plasma exchange in improving the clinical status of COVID-19 patients.

Reportedly, ICMR had allowed Kerala to be the first state to try out this treatment method.

The US’s Food and Drug Administration also approved this method to reduce the severity and potentially the length of the COVID-19 disease.

The Union Health Ministry approved the use of this method for the Delhi government to save the lives of infected patients.

During an official COVID-19 review meeting in Delhi with Chief Minister Arvind Kejriwal, Delhi’s Lt Governor Anil Baijal said that all authorized officials must adhere to the protocols set by the Ministry of Health and Family Welfare during the treatment.

Individuals asking to help out in these trying times can make a huge difference. People who recovered from the illness can immediately pay it forward and donate blood plasma once this treatment is clinically proven.

Also Read: Child Abuse, Pornography on the Rise in India’s COVID-19 Lockdown?