Does ornamental plasma really work? Prof. Anna Piekarska: I did not notice any spectacular effects

Plasma of convalescents is one of the main pillars of the fight against the coronavirus pandemic in Poland. It has long been portrayed in the media as a miracle last-resort drug, and requests for plasma donation are proliferating on the Internet for those in a critical or critical condition. Meanwhile, the latest publication in the prestigious New England Journal of Medicine proves that preparations based on it do not work. So is it a really effective and safe drug for COVID-19?

Doubts have already been sown. Last week, Minister Niedzielski organized a meeting with prominent Polish contagious agents, during which they discussed, inter alia, possible revision of the COVID-19 treatment guidelines. Experts, according to PAP, agreed that the loud publication of the results of the Argentinean doctors’ research is not a breakthrough.

1. – The patient actually requires an antiviral drug for the first few days after infection – explains Prof. Anna Piekarska
2. Prof. Piekarska: – I would like to point out one important thing, no viral disease, none of the known to us, and we know a lot of them, we do not treat convalescents with plasma
3. Safe plasma is prepared only in the blood donation and haemotherapy center
4. You can find more about the coronavirus epidemic on the TvoiLokony home page

Coronavirus: does plasma therapy for convalescents make sense?

Recall that randomized Argentinean clinical trials show that in severe coronavirus pneumonia, plasma does not play a significant therapeutic role compared to placebo.

1. Learn more: Plasma doesn’t help people with COVID-19

— These new studies come as no surprise to us infectious agents – claims prof. dr hab. med. Anna Piekarska, head of the Department of Infectious Diseases and Hepatology at the Medical University of Lodz and head of the Department of Infectious Diseases and Hepatology at WSSz. them. dr Wł. Bieganski in Lodz. – The same for my colleagues from the Polish Society of Epidemiologists and Doctors of Infectious Diseases, who set the standards and guidelines for the therapy of SARS-CoV-2 infections.

Treatment of convalescents with plasma has been entered into Polish standards, but … You should pay attention to the table that divides the disease into four stages. According to her, the preparation is given in stage two, when the virus multiplies.

– If it makes sense to give the patient plasma, it is very early – says prof. Piekarska. – Therefore, when I hear on TV that people who are dying get them, either in a very serious condition or on a respirator, it is obvious to me that it has no right to work.

Specialists emphasize that plasma should be administered when the virus is still in the patient’s body, and this period is very short. After that, treatment is based on dealing with the consequences of the infection.

– This is a virus that works on the principle that it causes a storm of events and disappears – explains Prof. Piekarska. “And while he is there, that is, literally for the first few days after infection, the patient actually needs antiviral medication.

However, the plasma of convalescents is often not suitable for administration to the patient, for example because there are no antibodies or their level is too low.

– Undoubtedly, plasma is a drug much weaker than the antiviral drug we currently have at our disposal, remdesivir – adds Prof. Piekarska. – It does not change the fact that if there is any place for plasma in COVID-19 therapy, then in the first five, maximum seven days from the appearance of symptoms.

Unfortunately, most patients reach the hospital after this period, i.e. in the second week of illness.

Many doctors discussing on internet forums also raise the issue of media advertising of plasma as a panacea for COVID-19. There are suggestions that the strong promotion of it serves to obtain the raw material for the production of immunoglobulin.

– I believe that immunoglobulin may be important as a preparation used in post-exposure prophylaxis – says prof. Piekarska. – So, for example, we know that a doctor or a nurse had contact with a patient suffering from COVID, they are still healthy, but in order not to get sick, we give them immunoglobulin. Then I see the sense of administering this preparation.

In fact, there are very few patients who got plasma in the first days of infection, according to doctors.

– I do not expect an unusual therapeutic effect – says prof. Piekarska. – I would like to point out one important thing: no viral disease, none of the known to us, and we know a lot of them, we do not treat convalescents with plasma. This fact alone proves that the method is ineffective. Of course, this was a solution that was born in response to the need for a drug when a new disease emerged.

A measure that seemed brilliant at the beginning may lose its attractiveness after some time. After all, plasma is a biological preparation with all the consequences of this fact.

Plasma carries some dangers

Plasma rarely causes side effects at the time of administration. However, experts say that nowadays the use of blood products is quite limited. This is why? For example, due to the long-term effects of transfusion shocks. In addition, the plasma of convalescents, which currently receive COVID-19 patients, is the so-called plasma without grace.

The withdrawal period in blood donation consists in the fact that blood products from individual donors are tested immediately after collection for: HIV, HCV (hepatitis C virus) and HBV (hepatitis B virus). Thereafter, donors should report to a blood donation point after 3 months for a repeat test. They are performed twice because they give negative results when the donor is hatching. Plasma is important for a year, in some cases even 2 years, so under normal conditions a withdrawal period is applied in order not to transmit viral infections.

– I am afraid, although it is a distant concern, that if we start administering plasma on a mass scale without a grace period, infectious agents will have their hands full again in a year or two – says prof. Piekarska. – Because there will be a wave of viral infections spread again, the blood-borne infections with which we have just finished fighting. Before the pandemic, we were already happy that we were on the right track to contain them …

Although a similar scenario may never come true, it must be borne in mind, especially if young people receive plasma. If a senior develops any of the infections listed above, he will probably not live to see the consequences. Cirrhosis of the liver may appear after 10 years, and HIV does not appear immediately.

— You should not scare these infections, but it should be noted that plasma is not a neutral preparation – adds prof. Piekarska.

The decision to administer plasma to a patient with COVID-19 must be made consciously

– We do not know many things yet, although we are wiser every day – says prof. Piekarska. – Recommendations and our approach are evolving because we have to keep up with the changes.

Since March, the Polish Society of Epidemiologists and Doctors of Infectious Diseases has issued 3 editions of the recommendation, the first in March, the second in June, and the third in September.

– We are working hard to give doctors clear therapeutic guidelines that are, unfortunately, often ignored … and here is the problem – adds the professor.

The administration of plasma, as well as any blood product, requires appropriate indications and must be the result of a conscious decision of physicians. It must not be undertaken ad hoc.

– I supervise the treatment of COVID-19 infections throughout my hospital, in seven departments. Every time colleagues from the ward who entered covid treatment want to administer plasma, they consult me. It is always a joint, well-thought-out decision, made after all the pros and cons have been discussed.

And just because the decision has been made doesn’t mean that plasma will be automatically given. Often it is not there when it is needed. Sometimes they are ordered on Monday, and the transport does not come until Friday, when it does not matter anymore. It also happens that there is no appropriate group for the patient or the quality of the preparation is bad. Group selection is crucial in the case of plasma because it is done without cross-matching.

– Now the situation is that some doctors are looking for different methods of treatment, often completely ineffective, which are recommended by pseudo-specialists, necessarily wanting to treat the patient at home – says Prof. Piekarska. – Hence, ineffective preparations are often used, which delay hospitalization. As a result, the sick person is in a worse position than if he had received nothing.

However, in the light of the requests for plasma donation that are increasingly appearing in social media, we must remember that it is not possible to prepare it professionally outside the blood donation station. If it doesn’t come from there, it means it’s extremely dangerous.

– When the idea of ​​plasma therapy for convalescents arose, I applied to the bioethics committee for consent – says prof. Piekarska. – In Poland, it has still not been established whether the patient should give special consent to the administration of plasma or not. I have such consent. I treated with plasma, but I did not notice any spectacular effects.

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