Covid-19 patients, prescribed convalescent plasma therapy, have been facing difficulties in plasma procurement as blood banks in Mumbai have been insisting on replacement donors or extra deposits in cases where a replacement donor is not available immediately.
On Tuesday, the state government issued a circular to all blood banks directing them to refrain from making replacement donor mandatory. It also asked blood banks not to charge beyond Rs 5,500 for a single unit of plasma. Though treatment of coronavirus patients through convalescent plasma therapy has dipped following questions over its efficacy, a few doctors have continued to prescribe it.
As per the State Blood Transfusion Council (SBTC) norms, blood banks can neither insist on a replacement donor — one who donates his blood or plasma to replenish a blood bank’s stock in exchange for a unit sold by the bank — as a pre-condition to sell plasma nor can they take extra deposit beyond the government-mandated rate.
At Nallasopara, Uday Pujari, however, says he had lost an entire day scouting for a plasma donor for his 72-year-old father Vasu, who was admitted at Galaxy hospital for Covid-19 treatment in mid-October. Just three days after Vasu was admitted to the hospital, doctors had informed his family that medicines were not working on the septuagenarian and convalescent plasma therapy — the use of antibody-rich blood plasma from a recently recovered patient to boost another’s immunity system — could be an option.
On October 20, the first dose was administered to Vasu. The next day, doctors asked his son to arrange for a second dose.
“Manas blood bank had A-negative plasma, but they said until we get a replacement donor, they can’t sell a single unit,” Pujari said. He reached out to all his friends and social workers and by 9 pm on October 21 a donor was found. Plasma was extracted around 2 am.
“We immediately went to the hospital with the plasma. It was transfused but on October 23 morning my father passed away… We faced a delay of one day in getting plasma. Doctors said my father was already critical and it was too late by then,” he said.
When contacted, Manas blood bank technician Shrutika said, “There is a plasma shortage. We do not have any option but to ask for a replacement donor. Otherwise, how will we run our blood bank?”
In Thane, Bloodline blood bank allegedly has been charging Rs 5,750 for a single plasma unit and an additional deposit of Rs 5,500 if a patient has no replacement donor. Chetan Lade, whose relative Anjali Sapre was admitted at Malad’s Sanjeevani hospital for Covid-19 treatment, said when the hospital issued a prescription for B-positive blood group plasma, he had reached out to Bloodline bank.
“They (Bloodline bank) asked me for an additional deposit of Rs 5,500 and said it was refundable if I get a donor in two days. They gave me two receipts for it,” Lade said. He arranged for a plasma donor in two days and got a refund on the deposit. “They took the receipt back after I got donor,” he said. While Sapre received plasma on time, she succumbed to coronavirus infection.
In another case, Vishwanath Ghanekar had to buy A-positive plasma twice on October 26 and 27. He went to the Bloodline bank both the times. “The bank provided a receipt of Rs 5,750 but took cash of Rs 7,500 both times from us. When I inquired, they said they also have to pay some other bank for processing plasma but refused to give a receipt for Rs 7,500,” Ghanekar said.
Ghanekar’s relative remains admitted at a private hospital in Thane for Covid-19 treatment. He said he did not object both times because purchasing plasma was more important. “The bank staff refused to take payment through debit card or online banking,” he added.
Saying they would look into the matter, an in-charge at the blood bank said they had put up a notice informing people not to pay more than the government-prescribed rates.
As per a notification issued by the Maharashtra government on September 25, plasma units cannot be sold beyond Rs 5,500. “We only charge Rs 5,750 for a single plasma unit. The additional charge of Rs 250 is for the CLIA test done on the sample. We do not make replacement donors compulsory. If a patient is willing, we take a replacement donor,” the in-charge, requesting to not be identified, said.
Convincing donors is also a challenge. Bloodline bank officials said they called 5,000 patients who had recovered from Covid-19 but only 10 agreed to donate plasma. State Blood Transfusion Council (SBTC) in-charge Dr Arun Thorat, too, accepted that blood banks were unable to get plasma donors leading to an acute shortage.
State Additional Director of Health Services, Dr Archana Patil, however, said the government can initiate action if patients register complaints. “But no one has stepped forward to file a complaint,” she said.
Rohit Upadhyay, also a social worker, said complaining against blood banks at such stressful times is not a priority for a patient’s family. “Plasma is always an urgent demand. Patients have no time to waste. Almost all blood banks insist on finding a replacement donor first and patients do not know the norms to challenge it,” he said. Upadhyay added in some cases blood banks ask for 5-6 normal blood donors if the family cannot arrange for a plasma donor.
Questions have been raised over the efficacy of plasma therapy in the Covid-19 treatment after the Indian Council of Medical Research’s (ICMR) PLACID trial noted that the procedure was not effective in preventing mortality or progression of the disease into a severe illness.
While its use has dipped, some doctors continue to prescribe it hoping that if administered early, the plasma may generate a faster immune response. Former CM Devendra Fadnavis, who is undergoing Covid-19 treatment at St George’s Hospital in Mumbai, was also administered plasma. A hospital official said he was not asked to get a replacement donor.
📣 The Indian Express is now on Telegram. Click here to join our channel (@indianexpress) and stay updated with the latest headlines