Plasma, The Most Critical Blood Component For COVID-19 Treatment

ZIMBABWE this week commenced its 21 days lockdown as a response to the growing cases of the COVID-19 in the country.

By Michael Gwarisa

Zimbabwe currently has nine confirmed COVID-19 cases but with increased testing, cases are likely to increase in the coming weeks. In his address prior to the commencement of the Lockdown, President Emerson Mnangagwa hinted that essential services and critical staff in various key sectors will be reporting for work even during the shutdown period.

The National Blood Service of Zimbabwe (NBSZ) is among those organisations whose services have been classified as essential during the lockdown. The NBSZ was cleared through the Ministry of Health and Child Care (MoHCC) to collect blood from their regular blood donors at both static and mobile clinics.

Even during a lockdown, blood is still essential and blood transfusions will still be necessary for emergency situations such as trauma, post-partum haemorrhage, severe infant anaemia, blood dyscrasias, and urgent surgeries requiring availability of blood.

There is need for increased stocks to support the COVID-19 f patients with severe sepsis or requiring extracorporeal membrane oxygenation support.

According to the World Health Organisation Interim Guidance on Maintaining a safe and adequate blood supply during the pandemic outbreak of coronavirus disease (COVID-19) of March 2020, experience suggests that empirical use of Convalescent Plasma (CP) may be a potentially useful treatment for COVID-19.

Detailed risk assessment must always be conducted to ensure that the blood service has sufficient capability to safely collect, process and store these specific blood components in a quality-assured manner.

“WHO has previously released interim guidance for the use of CP collected from patients recovered from Ebola Virus Disease.16 Additionally, the WHO Blood Regulators Network Position Paper on Use of Convalescent Plasma, Serum or Immune Globulin Concentrates as an Element in Response to an Emerging Virus (2017) provides helpful considerations,” said the Report.

WHO also noted that Respiratory viruses such as COVID-19 have never been reported to be transmitted through blood or blood components; therefore, any potential risk of transmission by transfusion of blood collected from asymptomatic individuals is theoretical.

“Any actions taken to mitigate risk are therefore precautionary. Options include donor education, self-deferral or deferral of at-risk donors, quarantine of blood components, retrieval of in-date products based on a report of post-donation illness in the donor, screening of donations using laboratory tests, and pathogen reduction.”

In accordance with the WHO guidelines, potential donors should be educated about the need to self-defer based on risk factors for COVID-19 or feeling unwell. Current donor screening measures excluding symptomatic individuals who are unwell or with signs and symptoms of fever and respiratory disease (such as cough or breathlessness) must be strictly complied with.

“Persons who donate should inform the blood centre immediately if they develop a respiratory illness within 28 days of donation. Persons who have fully recovered from confirmed COVID-19, those with possible direct exposure to COVID-19 from a confirmed case, and those who have travelled from areas with ongoing community transmission should refrain from blood donation for at least 28 days.

“This may take the form of self-deferral or mandatory deferral. In the event of widespread transmission, donor restrictions based on definitions of exposure risk and duration of deferral may need to be reduced to fit the local situations so as not to affect availability of blood for critical transfusion therapy,” said WHO.

Meanwhile, WHO noted that blood services across the globe should monitor blood donation numbers to mitigate against the risk of running out of stocks during the a pandemic.

“Reduction of donor numbers before, during and after a COVID-19 outbreak is a major risk for blood services. Blood services should consider the sufficiency risk early to enable preparedness and response.

“Blood donation numbers should be closely monitored so that measures can be taken quickly to pre-empt any decline in donor attendance or to consider importation of blood and components. This is particularly critical for components with short shelf life, such as platelets, where a constant supply is needed for patients dependent on platelet transfusions.”

WHO added that a proactive communication strategy is needed to address donor anxiety, which often stems from lack of awareness, misinformation or fear of becoming infected during blood donation.

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