WHAT AND HOW IS THE CONVALESENT PLASMA TREATMENT DONE?

Convalescent plasma therapy (TPK) is a passive immunization using donor donor plasma Covid-19 who has recovered and given to patients who are still sick Covid-19. This therapy is an alternative therapy that can be done more quickly when vaccines and antiviral drugs that effectively kill the SARS-COV-2 virus have not been found. Plasma from a recovered donor of covid-19 containing antibodies both immunoglobulin M (IgM) and immunoglobulin G (IgG) specific to SARS-COV-2. These antibodies are expected to be able to neutralize existing viruses in covid-19 patients who are still sick.

This passive antibody therapy is a well-known therapeutic technique. In the 1890s this therapy was used to treat infectious diseases before antibiotics were developed. This therapy is also used in several outbreaks that have occurred in the world such as SARS-CoV-1 in Hong Kong in 2003, H1N1 in 2009-2010, MERS CoV in 2012 and Ebola outbreak in 2014. Currently a number of countries such as Italy, China, Europe , Japan, Singapore, including Indonesia, have run the TPK.

To be able to run the TPK, of course there must be a donor who donates plasma and there are patients who need it. The main requirement to be a prospective convalescent plasma donor is that he must have been infected by SARS-COV-2 and has been declared cured both clinically and in the laboratory in the form of an RT-PCR swab examination. Why must be infected with SARS-COV-2 and recovered? Because the main target of donated plasma products is to contain specific SARS-COV-2 antibodies which are expected to neutralize the virus. Specific SARS-COV-2 antibodies can only be formed naturally by people who have been infected with SARS-COV-2 before. Other requirements such as body weight, age, blood pressure, hemoglobin level, negative screening results for Infectious Infection Through Blood Transfusion (IMLDT), and other requirements are exactly the same as donor requirements that are routinely carried out (in accordance with Permenkes 91 of 2015 concerning Blood Transfusion Service Standards ). These other requirements are needed to prevent transfusion reactions in patients both acute and slow and to maintain donor health.

The following is a concise list of convalescent plasma donor requirements:

·         The patient recovered from Covid-19 with a negative PCR swab

·         Complaint free at least 14 days after being declared cured

·         Male or female donors have never been pregnant and have never been transfused

·         Age 17-60 years

·         Body weight ≥55 kg

·         Blood pressure: systole 100-160 mmHg, diastole 60-100 mmHg

·         Pulse: 50-100 x / minute

·         Fill in the donor form according to the donor form from the Blood Transfusion Unit (UTD)

·         Laboratory outcome targets: complete blood hemoglobin ≥12.5 g / dl, covid-19 antibodies: titer> 1/320, negative alloantibody screening, IMLTD (HIV, Hepatitis B, Hepatitis C, syphilis) non reactive and SARS PCR swab COV-2 is negative.

These donor requirements can vary from one blood service center to another, depending on the guidelines of each country and the facilities available.

The procedure for donor plasma collection can be done in two ways, namely collection through a whole blood donor or whole blood and taking plasma by apheresis machine. The withdrawal of a whole blood donor is almost similar to a normal donor blood draw but the volume of blood to be taken can be more than 450 ml using a blood bag that is equipped with a leukoreduced (leukoreduced) filter. Whole blood will then be separated through a process of centrifugation to obtain a plasma product of around 200 ml (half the therapeutic dose). In taking plasma by apheresis machine, the machine will automatically separate the blood components so that only the pasma product is collected and the other blood components will be returned automatically to the donor's body. Plasma collection from one donor apheresis can reach a volume of 400 ml or more (one dose of therapy). The prepared plasma product can then be given to the patient on the same day after the pre-transfusion test (blood type and crossmatch examination). If the plasma product is given more than 24 hours, then the plasma can be stored in a blood freezer with a temperature of -30o C or lower for 1 year.

Regarding indications that patients who received TPK also varied in various co-19 care centers. Almost all scientific journals that have been published including recommendations from the Food and Drug Administration (FDA) of the United States say that TPK should be given to covid-19 patients who are experiencing a severe illness or immediate life-threatening condition.
In the majority of scientific journals, including the experience of TPK in Indonesia getting a fairly good therapeutic response from convalescent plasma administration, many patients experience improvement and recovery. Even though it seems good, it cannot be concluded at this time whether the success of the therapy is purely due to the TPK itself or due to other therapies that have been given or a combination of all the therapies that have been carried out. Further evaluation is still needed regarding the effectiveness and efficiency of the TPK in more cases and in-depth evaluation methods. In several recommendations it is mentioned that in the absence of certainty the type of therapy, the TPK can be taken into consideration in handling Covid-19.