Updated: October 12, 2020 1:10:34 am
Patients are on a desperate chase for convalescent plasma, an experimental therapy for Covid-19, as demand grows but very few recovered patients are willing to donate.
Data from Food and Drug Administration (FDA) until September 30 shows that blood banks have sold 9,194 plasma units across Maharashtra and 1,216 units remain in stock. Across the state, 108 blood banks have the license to collect plasma through aphaeresis machines.
On October 8, Paromita Sen went on a calling spree to every acquaintance to scout for a recovered Covid-19 patient who matches her mother Ranjana Sen’s blood group and is willing to donate. Ranjana, aged 70 and a diabetic, was breathless and on oxygen support two days after testing positive at Vedant hospital in Thane.
By the night of October 9, with help of FDA, she had purchased one unit from Navi Mumbai’s Bloodline bank. Several social workers came together to find an eligible donor with B positive blood group for a second unit of plasma. “The stress is overwhelming,” Paromita said.
No proof of efficacy
Convalescent plasma therapy still remains under discussion for its efficacy. It is yet to be proved that the therapy prevents mortality among Covid-19 patients. But with limited treatment options, doctors are increasingly relying on it. The stigma around being infected with Covid-19 has kept donors at bay, and lack of prompt availability of plasma remains a major hurdle in its timely and effective use to tackle the virus.
Plasma therapy is extraction of antibodies from a recovered Covid-19 patient and injection into another patient to fasten latter’s immune response against coronavirus.
While this therapy is part of ongoing research and there is little evidence about its efficiency, the Drug Controller General of India allows its off-label use for Covid-19 treatment.
Maharashtra has 12.55 lakh recovered Covid-19 patients, but it has managed to tap less than 1 per cent of them for plasma donation. Lack of plasma in blood banks and insistence of hospitals to get a donor have put the burden to secure plasma on the kin of the patients.
“Every day, I get 10 to 15 calls for plasma. We desperately reach out to people on WhatsApp to donate. It takes days to find a donor,” said social worker Darshan Popat, part of #SOSSaviours, a group of Mumbai residents who help Covid-19 patients.
On September 24, the Maharashtra government had capped plasma charges at Rs 5,500 per 200 ml unit. Dr Arun Thorat, in charge of State Blood Transfusion Council, said the price cap was introduced to curb profiteering. A 200 ml unit of plasma was sold at Rs 11,000 before it was capped. “Hospitals cannot insist on replacement donor in exchange of plasma or refuse plasma from other blood banks,” Thorat said.
But the shortage has forced hospitals to do so. In Nanavati hospital, Nirmala Singh was administered first plasma dose through the hospital’s blood bank. But for the second dose in September, her son Niraj Singh was asked to look for a donor. “I asked if I could get plasma from another bank, but they insisted on finding a donor,” he said. Nirmala continues to remain in the ICU.
“Our large pool of recovered patients and employees have selflessly donated plasma since the past few months. In extremely rare instances, when the donor cannot be arranged by the hospital, we encourage patient’s family in locating a plasma donor from outside. For the safety of the patient and to ensure standard clinical quality control protocols are followed, we prefer to perform the plasma transfusion at our facility.” said a spokesperson from Nanavati hospital.
Last week, Hiranandani hospital officials asked the family of T M Thomas to get donors in replacement of the plasma they transfused. “I managed to get three donors,” said Stalgy Thomas, his daughter.
Hansmukh Gandhi was also administered plasma at Hiranandani hospital and his son Amit Gandhi was asked to arrange for replacement donors. “But they did not make it compulsory,” Gandhi said.
Hospital CEO Dr Sujit Chatterjee said: “We do not have a policy as such of not accepting outside plasma donation but we request and encourage families of patients to get their own donors to ensure that patient gets good quality plasma. But in cases where families are unable to get donors for some reason, we procure plasma from sources available outside.”
He added that plasma therapy has scientific evidence and helps fight the infection better.
Thane FDA Drug inspector Virendra Ravi said hospitals cannot insist on replacement donors or live donors if they have plasma available in their bank.
“The problem hospitals are facing is in convincing recovered patients to return 28 days after discharge to donate plasma. Very few are willing to donate even if they benefited from someone else’s plasma. In Thane division, we have recorded only 1,100 donors,” he added.
In Mumbai, 31 blood banks licensed to extract plasma have 591 units left in all, FDA data until September 30 shows.
Bandra resident Lateef Shaikh has experienced the shortage thrice. “It’s a task to look for donor on short notice,” he said. On August 28, his father-in-law was admitted in Saifee hospital with Covid-19. It took a day to find a donor. But he could not be saved despite the therapy.
On September 8, Shaikh’s 76-year-old father also tested positive and suffered a cytokine storm. Holy Family hospital, where he was admitted, did not have plasma.
“I called several blood banks, KEM and Sion hospitals, none had plasma,” he said. Shaikh finally purchased two units from Nalasopara-based Sathiya blood bank.
His father survived but his friend’s mother was diagnosed with Covid-19 on September 29 and required plasma. She was admitted to Neptune hospital, Mira Road.
“The price capping notification had been released by then, and every blood bank we called refused citing they are facing loss at selling plasma for Rs 5,500. Even during the pandemic, blood banks are looking for profit,” Shaikh said.
His friend’s mother was a heart patient. While plasma was eventually arranged through Sathiya blood bank, she passed away.
Sandhya Fernandes, also a social worker, said hospitals only list requirement of plasma but do not hand hold patient’s family in procuring it.
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