Two of seven critically ill COVID-19 patients in Arkansas who have received plasma containing antibodies to the virus in the hope that the blood product will help them improve have been able to get off the ventilators keeping them alive, a doctor involved in the program said today.
The so-called convalescent plasma was donated by people who’ve recovered from the viral disease as part of a program created collaboratively by the University of Arkansas for Medical Sciences and the Arkansas Department of Health. Dr. Tina Ipe, director of the division of transfusion medicine services at UAMS, said the improvement seen in the patients is not proof of the efficacy of the experimental therapy — it could be coincidental — but Ipe said the anecdotal data has made her “hopeful.”
Ipe and infectious disease specialist Dr. Atul Kothari, who works with both UAMS and ADH, guided the plasma donation program, embarking on a complicated process that required hospitals and blood collectors to work with the Food and Drug Administration, which has strict criteria for people donating plasma. The Arkansas Blood Institute in Little Rock collected the first convalescent plasma two weeks ago.
To donate plasma — the yellow liquid portion of blood that contains clotting factors and antibodies — for the treatment, donors are required to have had a positive COVID-19 test determined by a polymerase chain reaction process and be symptom-free. If they’ve been symptom-free for 14 days, to donate they must have a nasopharyngeal swab test to make sure they have no live virus. If they’re 28 days post-symptoms, no new test is required.
“We were very blessed that the health department was able to provide us a list of individuals they knew were positive for COVID-19 and who were also willing to donate convalescent plasma,” Ipe said. “So we worked with the list and helped coordinate donors.”
Because COVID-19 testing didn’t begin in Arkansas until the second week of March, some of the people who volunteered to donate were found to still have live virus. The first person to donate who passed the 28-day mark gave plasma today. To date, 10 Arkansans have donated plasma to the effort.
It takes an hour to donate plasma; donors are hooked up to a plasmapheresis machine that separates the plasma from the red blood cells and platelets. A total of 650 milliliters of plasma is collected.
The convalescent plasma is sent to a testing facility in Oklahoma to make sure it contains no blood-borne pathogens. The plasma is then returned to the blood collection centers, where it’s kept until distribution.
There are no good tests for antibodies at present, collaborator Dr. Jennifer Dillaha of the Arkansas Department of Health said, for the presence of COVID-19 antibodies, so their amount in the plasma can’t be measured. In the future, once antibodies are identified, researchers will consider how much antibody is needed — the titre — to be effective as therapy. The health department is keeping sample tubes of donated plasma for future testing.
Hospitals must have FDA approval to transfuse the convalescent plasma. COVID-19 patients eligible to receive the plasma are the sickest of the sick, with life-threatening illness. Informed consent is required. It is a therapy of last resort, given only after other therapies — such as the drugs Remdesivir, hydroxychloroquine or tocilizumab — have been used. There is no treatment for COVID-19 that is not technically experimental; the virus only began to infect humans in 2019.
In Arkansas, doctors are giving patients two units — a total of 500 ml, or about two cups — of convalescent plasma. That means each donor can provide enough plasma for one patient, Ipe said. Different states are using different amounts, depending on supply and demand, Ipe said.
In addition to the two patients that Ipe said have come off the ventilator, a third is showing significant respiratory improvement, Dillaha said. The seven patients are in four hospitals, she said.
Convalescent plasma has been shown, in some studies, to have possibly improved mortality rates in the respiratory illnesses SARS and MERS. “As a person who provides blood products, it is my hope [that the plasma is effective]. We worked hard to bring this to the state,” Ipe said. But, she added, “I tend to let data tell me whether it is appropriate or not.”
Coordinating the convalescent COVID-19 plasma donation has been “one of the bigger challenges that I have had,” Ipe said. “In most places, it is the hospital request for you to take care of their patients, but here the request was from the Arkansas Department of Health to take care of all Arkansans. So what we did was create a collaboration between all hospitals and all blood collectors. … I think this is very different. … That’s what makes this initiative one I’m really proud to be part of. It’s a vision that’s really shared. For all of us.”
Two other blood collecting facilities have signed on: Lifeshare in South Arkansas and Community Blood Center of the Ozarks, in Bentonville. Persons wishing to donate convalescent plasma may contact Ipe at firstname.lastname@example.org.