With plasma therapy making no difference to his health, Mumbai’s first patient to undergo the treatment, a 52-year-old man with COVID-19, may not be given further transfusions. His condition continues to be “very critical” and he remains on ventilator support.
“After an initial round of plasma transfusion showed no results, we have dropped the plan of transfusing more plasma into him. He has developed septicemia, and is suffering from cytokine storm. Plasma is not a magic therapy, it is still being experimented upon,” said chief operating officer Dr V Ravishankar of Lilavati hospital.
Cytokine storm is a term used to describe the body’s own immune system attacking it instead of fighting the virus, leading to multi-organ failure. Ravishankar said the patient had both septicemia and cytokine storm before he was given the plasma transfusion.
Dr Om Srivastava, leading the plasma therapy study under BMC, said recipient of plasma therapy is chosen only if she or he meets some parameters. “Cytokine storm is an ideal condition in which we give plasma to patient. We have to time it correctly,” he added.
The 52-year-old was first given plasma on April 25. “The effects of the antibodies can be seen in a few hours, but in this case we saw no improvement,” Ravishankar said.
Dr Jalil Parkar, pulmonologist, said the patient has been unresponsive to most treatment. He was also made to lie face down on his stomach to improve oxygenation in lungs. “Plasma therapy can show changes in 48 to 72 hours. We see if oxygen saturation is improving, if breathing is improving, if patient can be weaned off ventilator support. We have not seen dramatic changes in him,” he added.
On April 20, the patient reached Lilavati hospital several days after developing COVID-19 symptoms. By then he had developed acute respiratory distress syndrome. He was put on ventilator support and was chosen to receive plasma therapy on “compassionate” grounds, doctors said.
The therapy involves extracting plasma from recovered patients using a plasma pheresis machine and administering it to those critically ill. The antibodies in plasma help fight against the virus. In this case, while the patient has no other illness, doctors believe his health deteriorated because he reached the hospital late.
Parkar, his treating doctor, said plasma therapy is also not very easy or affordable and more units may not be transfused as patient is not benefiting from them.
Srivastava said the protocol to administer plasma therapy to patients in Mumbai is ready and has been approved by Indian Council of Medical Research (ICMR), the apex institute framing COVID-19 guidelines in India.
When other treatment methods fail, plasma therapy can be used for COVID-19 patients. The donated plasma will be stored in Nair hospital. “We are refining our protocol every day. Requirement may differ from patient to patient,” Srivastava said. So far, there have been six plasma donors in Mumbai.
On Monday, Joint Secretary (Health) Luv Agrawal said that there is no approved therapy for COVID-19 and that plasma was only an experimental therapy. “ICMR is studying the efficacy of this therapy,” he said, adding that plasma therapy can have life threatening complications if not used properly.
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