THE Cebu Doctors’ University Hospital (CDUH) is calling on patients who recovered from the coronavirus disease 2019 (Covid-19) to donate their plasma antibodies.
The hospital has introduced a medical procedure that is believed to help severely affected Covid patients survive their ordeal.
A patient with severe Covid-19 who was admitted to the CDUH recovered after she was given the treatment called the hybrid therapeutic plasma and convalescent plasma exchange.
The procedure is the transfusion of plasma from recovered Covid-19 patients to sick Covid patients and the removal of plasma from either a donor or a patient by use of an apheresis machine.
“This is the bright side of what’s happening in the middle of a pandemic. Together with me is the team responsible for the first convalescent plasmapheresis exchange in the country,” Dr. Potenciano Larrazabal III, president and chairman of the board of Cebu Doctors Group of Hospitals, said during a press conference on Monday, June 22, 2020.
Plasma, according to redcrossblood.org, is the liquid portion of blood. About 55 percent of blood is plasma and the remaining 45 percent are red blood cells, white blood cells and platelets that are suspended in the plasma.
Larrazabal said the procedure will help critically-ill Covid patients and decongest hospitals as they are in the process of adding more beds and hiring more medical staff to address the rising cases in Cebu.
“On the brighter side, we can even help more patients to survive, most especially those with very critical stages like this patient who was presented at the ER (emergency room),” he said.
Gratitude
The CDUH discharged 68-year-old Ana Marie Clavano-Cruz who had a severe case of Covid and was treated by the hybrid convalescent plasmapheresis exchange 13 days after her admission.
Cruz was given a novel mode of convalescent plasma therapy (CPT), Larrazabal said.
He credited the Office of the Presidential Assistant for the Visayas (Opav) for identifying and referring recovered Covid-19 patients to the CDUH so they could become plasma donors.
He said that almost two weeks ago, a consultant had approached them and suggested that they try a new mode of treatment better than the ordinary plasma transfusion for Covid-19 patients.
However, they could not find any plasma donor.
“I am thankful to Opav and Secretary Michael Dino. So, we were able to get so many plasma donors with high antibodies,” Larrazabal said. After the screening, he said they identified three donors.
First, they removed the bad plasma from the patient and then replaced it with good plasma from the donor. This was the first time this type of treatment was done in the country, Larrazabal said.
He said the first patient to receive this novel treatment was already intubated when she agreed to undergo the procedure.
Pulmonologist Dr. Geraldine Lim said she had told relatives of the patient that the chance of survival was very low. “But after the treatment there was a significant improvement immediately,” she said.
Doctors saw improvement in the patient’s condition three days after she underwent the treatment.
The Covid-19 Inter-Agency Task Force for the Management of Emerging Infectious Diseases considers intubated patients to have 80 percent mortality rate.
Larrazabal said intubated patients who recover usually stay at the hospital for three weeks to one month.
President Rodrigo Duterte has been calling on recovered patients who have developed antibodies to donate their plasma to treat Covid-19 patients.
On Monday, Duterte also signed into laws three bills upgrading public hospitals in Talisay City in Cebu, Surigao City and Tagkawayan town in Quezon.
Republic Act (RA) 11473 upgrades the Talisay District Hospital into a medical center to be named as the Cebu South Medical Center.
Meanwhile, Secretary Dino has initiated a plasma donation campaign in cooperation with the cities of Cebu, Mandaue and Lapu-Lapu.
The Vicente Sotto Memorial Medical Center in Cebu City has agreed to be the depository of the donated plasma.
Larrazabal said they are recommending this treatment for moderate Covid-19 cases. Two more Covid-19 patients have agreed to undergo the procedure, he said.
Larrazabal said recovered patients who want to donate their plasma can proceed to the Cebu Doctors blood bank for screening.
He said they are willing to share the procedure, which can be replicated in other hospitals in Cebu, which have the plasmapheresis machine. The machine gets rid of unhealthy plasma and replaces it with healthy plasma from a donor.
“In this pandemic situation, team work ang kinahanglan (team work is needed). It’s a team work approach to this Covid-19 crisis we are facing,” Larrazabal said.
Risk
Dr. Edgar Tan, the patient’s cardiologist, said the risk of death for patients who require mechanical ventilation when they are admitted ranges from 85 to 90 percent.
“When this patient came in, she was in severe acute respiratory distress and the lungs wiped out,” he said.
Dr. Maria Isabel Mahinay, hematologist, said the patient was treated with the combination of the therapeutic plasma exchange (TPE) and CPT.
CPT transfers antibodies active against the virus into the bloodstream of the sick patient while TPE, or plasmapheresis, is the removal of plasma from either a donor or a patient by use of a pheresis machine. This enables removing only that which needs to be removed.
“In the convalescent plasma donor, only about 400-600 milliliter of his plasma is removed. This needs the donor to have at least two big enough veins in both arms,” she said.
Mahinay said a convalescent plasma donor should have the following:
* proof that he/she was once Covid positive throught RT-PCR results;
* needs to have recovered for at least 14 days with no signs and symptoms of Covid-19;
* must be 18 to 65 years of age;
* must weigh more than 50 kilos;
* he/she must undergo at least four hours of fasting before undergoing antibody testing; and
* he/she will need to pass all blood bank screening tests and interviews and the antibody titer testing.
Opav Assistant Secretary Jonji Gonzales said the mayors of the cities of Cebu, Mandaue and Lapu-Lapu agreed to the plasma drive over the weekend following reports of more symptomatic patients admitted in metro hospitals.
Gonzales said one of the private hospitals is working on protocol for convalescent plasma therapy.
As early as April, hospitals in Manila like the two hospitals of St Luke’s Medical Center treated seven Covid-19 patients with the convalescent plasma therapy.
The World Health Organization (WHO) said Covid-19 convalescent plasma can be made available on an experimental basis through local production provided that ethical and safety criteria are met for its preparation and use.
A 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 in compliance with established standards and requirements for plasma for transfusion, the WHO pointed out. (MVG with a report from JJL)