Covid-19 crisis: Plasma transfusion is adjunct treatment; timing is key

India has set guidelines on when and on whom CPT can be used. It is for those who are moderately ill and whose oxygen requirements are increasing despite using steroids.
A young staffer at Dwarka’s Aakash Healthcare was suffering from Covid-19, and suddenly his condition worsened. His oxygen requirement increased and he turned breathless. The staffer received blood plasma transfusion from a colleague who had recovered.

Within a day the patient’s condition improved.

“In the morning he was gasping for breath, and by evening, he was sitting and having biscuits,” said Dr Aashish Chaudhary, managing director of Aakash Healthcare.

How quickly or how effectively transfused plasma works depends on the stage of the disease, or organ failure, he added. Convalescent Plasma Therapy (CPT) is not a sure-fire remedy. It is an experimental therapy used off label in Covid-19 and has been in use for decades (was used in SARS1 and MERS also).

Dr Behram Pardiwala, principal investigator of plasma trial at Wockhardt Hospital, said he was happy with the results.

“CPT can be used as an adjunct of other therapies like remdesivir and tocilizumab. It can be used as a sole therapy too. But I do not think it can replace conventional therapies,” he said.

India has set guidelines on when and on whom CPT can be used. It is for those who are moderately ill and whose oxygen requirements are increasing despite using steroids.

“We are not allowed to use it in serious cases. It would be foolish to do so because it is experimental treatment,” Pardiwala said.

Doctors say initial treatment for hospitalised patients is usually steroids when someone’s SpO2 (oxygen saturation) is not going above 96 per cent, the pulse rate is high, and C-Reactive Protein (CRP) is elevated. If steroids do not make much of a difference, the next line of therapy — tocilizumab or remdesivir — is considered.

Timing is the key for CPT.

Dr Sandeep Budhiraja, group medical director, Max Healthcare, said: “Earlier it was thought that plasma therapy should be administered when nothing seems to be working and the patient was on the ventilator. These ideas have changed and doctors are using the therapy early.”

It is difficult to say on which patients the therapy would work. “One should not be under the impression that anyone who uses plasma will be saved or things will deteriorate without plasma,” Budhiraja said. Most patients develop complications between 8th and 12th day of catching the infection, which is the critical period.

Max Hospital has enrolled itself for plasma therapy trials with the Drug Controller General of India and treated 50 patients with it. There has to be a follow-up period of 28 days after plasma is administered. The hospital will collate the data for some 200 patients it has given plasma therapy outside the trial to have a better understanding of its effectiveness.

However, no studies have shown a significant impact of plasma therapy in reducing mortality, primarily because the volume of data is low. Doctors are still learning on how to manage Covid-19.

Sandeep Dewan, director and head of the department, critical care medicine, Fortis Memorial Research Institute, summed it up: “As doctors, we are learning when it is right to give plasma therapy.”

Clinicians, however, do not agree that the growing use of CPT is only because of the commercial angle. While the cost of separating plasma from blood is Rs 10,000-11,000, the cost of treatment goes up to Rs 15,000-20,000 or so (adding storage and transportation costs).

Pardiwalla said the prices should come down. “I would like to see the costs coming down by 50 per cent if the logistics are managed well.”

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