Assessing the impetus and impediments to donate coronavirus disease-2019 convalescent plasma: A survey study from a tertiary care Indian blood center

BACKGROUND: Amidst the raging coronavirus disease-2019 (COVID-19 pandemic), COVID-19 convalescent plasma (CCP) therapy emerged as an important experimental therapy. The majority of the research studies have focused on determining the safety and efficacy of CCP in the management of COVID-19 and little attention has been paid to the source of CCP, i.e., the CCP donor recruitment. The main challenge at our blood center was maintaining high spirits and continuous motivation among the volunteers to keep donating CCP. With this background, our primary aim was to observe the impetus and impediments of potential CCP donors among the SARS-CoV-2 recovered individuals. MATERIALS AND METHODS: All the potential CCP donors who met the inclusion criteria were telerecruited, i.e., contacted telephonically by trained personnel of the blood center. Donors were informed about CCP and its harvest procedure. Subsequently, donors were presented with 10 statements to assess the potential impetus (motivators) and impediments (barriers) toward donating CCP. In addition, SARS-CoV-2 IgG antibody titers were performed using chemiluminescence assay in donors who passed the predonation screening. RESULTS: Based on their medical records, a total of 96 potential CCP donors were contacted telephonically for inclusion in the study. Among these 68.75% (n = 66/96) individuals expressed their willingness to donate CCP. "Altruism from adversity " was the most common motivational factor among voluntary donors (47.8%), whereas kinship was the strongest motivational factor among replacement donors (40%). Logistical reasons such as their distance from the blood center (33.3%) were the most common reason for not donating CCP. About 21.2% (n = 18/66) of the donors were deferred due to absent or low levels of anti-SARS-CoV-2 IgG antibodies. CONCLUSIONS: Motivation factors such as "altruism from adversity " are more common in CCP donation. At the same time, most of the impediments to CCP donation were similar to those of the routine apheresis procedure. Knowledge of these motivators and barriers should form the cornerstone of plasma therapy-based donation program in any future pandemic.

A Comparative Study of Hematological Parametersin COVID-19 Positive Cases, Influenza like Illness Patients, and Healthy Subjects

Introduction: Since its origin in December 2019, Novel Corona virusinfection has behaved in an unprecedented manner. Viral infectionsare characterized by atypical and reactive lymphocytosis as is seen ininfectious mononucleosis and dengue viral infection respectively.Previous studies on influenza like illnesses have demonstrated the roleof Neutrophil-to-lymphocyte as a preferable diagnostic tool to screeninfluenza virus-infected patients. In addition to these, volume conductivity and scatter has revealed significant findings in volumescatter and conductivity of monocytes and neutrophils in the past ininfluenza and influenza like illnesses.Aims &Objectives: To study the hematological parameters ofCOVID-19 positive cases and to compare the hematological parameters in COVID-19 positive cases, patients with influenza andinfluenza like illness.Materials &Methods: 169 Covid positive cases, 113 influenza andinfluenza like illnesses and 140 healthy controls were included in thestudy. All samples were processed on DXH 800 and all parameterswere recorded.Result: There was significant difference between Covid 19 and influenza and influenza like illness in terms of age, percentage ofneutrophils, percentage of lymphocyte, percentage of monocyte, percentage of eosinophil and basophil. Significant difference was alsofound between mean neutrophilic and mean monocytic volume, and inall the scatter parameters of neutrophils. Neutrophil-to-lymphocyteratio (NLR) and platelet-to-lymphocyte ratio (PLR) also showed significant difference in both the conditions. Multivariate analysis wasperformed and a joint probability was calculated which showed a cutoffin differentiating Covid 19 from influenza and influenza like illnesses.Conclusions: Covid 19 and Influenza can cause different changes inperipheral blood parameters and the diagnostic formula developed inthis study will enable the clinicians to differentiate Covid 19 frominfluenza during the early stages.

COVID-19 vaccination: The impact on the selection criteria of the convalescent plasma donors.

Clinical management protocols for COVID-19 are evolving rapidly as more information about the epidemiology and pathophysiological changes in COVID-19 become available. However, no definite treatment of COVID-19 has been found till date. The COVID-19 convalescent plasma (CCP) therapy has emerged as an important investigational therapy in the management of COVID-19 patients. Additionally, the regulatory agencies, in particular, the Indian blood transfusion council must release some interim recommendations for the blood centres on the CCP blood donor eligibility criteria after COVID-19 vaccination. More clinical trials are needed to know the efficacy of the CCP harvested from COVID-19 recovered individuals who have been vaccinated against those COVID-19 recovered individuals who are not vaccinated to understand the vaccine impact on the IgG titres of anti-SARS-CoV-2 antibodies.

COVID-19 vaccination in the Indian blood donors: Adjudging the impact on the deferral period.

The only efficacious way to provide people with herd immunity against the novel corona virus [nCoV] is to administer an appropriate vaccine and help check the current pandemic. With the genetic sequence data of the nCoV already available since January 10, 2020, leading pharmaceutical companies, world over, in turn, have started working on the clinical trials to produce vaccines against this nCoV. In fact, many vaccines under the Phase III trial have claimed to demonstrate their efficacy to be as high as 95% against the nCoV. In January, the central drugs standard control organization, India had granted the emergency-use authorization [EUA] to two vaccines namely, Covishield (live vaccine, Oxford-AstraZeneca, United Kingdom being manufactured by the Serum Institute of India, Pune) and Covaxin (inactivated vaccine, Bharat Biotech, India). Although, most of the countries offer no deferral period for the donors who have been administered an inactivated vaccine against this nCoV. However, the national blood transfusion council of India has recently recommended a donor deferral period of 28 days from the last dose of vaccination. This could essentially lead to a massive loss of eligible blood donors and jeopardize the already disrupted blood supply management due to the COVID-19 outbreak. The authors, herein, propose a thorough redefining of this deferral period post-vaccination amongst the Indian blood donors.

To study the hematological parameters in covid-19 positive cases in different clinical categories

Aims & Objectives: Since it's origin in December 2019 Novel Corona virus infection has behaved in an unprecedented manner. A number of studies had been done so far to find out peculiar characteristics about this disease. However, few studies have shown varied hematological manifestations of this which have been found to have prognostic implications. In this study we aim to assess the hematological parameters of COVID-19 positive cases and in their different clinical categories (mild, moderate and severe). Patients/Materials & Methods: It is an observational study done in Himalayan Institute of medical sciences, Dehradun. (1) Number of cases included were 118 over 3 months duration (July, August, September-2020). (2) The relevant clinical details of all the COVID-19 positive patients such as name, age, UHID were recorded. (3) EDTA sample was run on DXH800 (Beckmencoulter automated analyzer) and all parameters were recorded including the VCS. Inclusion criterion: Patients diagnosed with COVID-19 on Rapid antigentestor RTPCR of all age groups. Exclusioncriterion:Patients with missing hematological parameters. Results: In our study, total number of cases included were 118, out of which 84 (71.18%) were males and 34 (28.81%) were females. Patients above 60 years were 35 (29.6%). The patients were categorized into mild, moderate and severe on the basis of clinical findings and those findings were co-related with the VCS parameters. The significant findings include decreased absolutely mphocytecount in 43.2% cases and absolute eosinopenia in 83.05% of cases, absolute neutrophil count was increased in 44.9% cases and platelet count was reduced in 30.5% of the cases. Discussion & Conclusion: In major number of cases absolute lymphocyte count, absolute eosinophil count and neutrophil to lymphocyte ratio was found significant;so it is advised to categorize patients on the basis of clinical findings and related VCS parameters for early COVID-19 testing.

Determining the usage and efficacy of COVID-19 convalescent plasma harvested at our blood centre

Aims & Objectives: COVID-19 convalescent plasma (CCP) has gathered momentum as a potential therapeutic option for patients hospitalized with the novel coronavirus [nCoV] especially as an ''offlabel'' therapy approved by the Indian Council of Medical Research (ICMR). Our principal aim was to evaluate the usage and efficacy of CCP harvested at our blood centre. Patients/Materials & Methods: Donors: All the donors were selected based on the guidelines given by ICMR. The CCP was harvested by apheresis equipment [MCS Haemonetics, U.K. Ltd]. The product was aliquoted in two parts of 200 mL each and frozen below -30 °C. Prior to issue it was thawed at 37 °C in accordance to our department SOP. Patients: All the RT-PCR COVID-19 positive patients during one and a half months [1st Sept'220 to 17th Oct'20] were included. This pilot study was approved by the institutional ethics committee and an informed consent was received from the patients prior to CCP administration. Results: In total ten voluntary donors [M: F = 9:1] consented for the CCP donation. Their average age in years was 35 ± 7.6 (25 to 48). The average length of first CCP harvest from the date of recovery [in days] was 41 ± 16.3 (26 to 75). The average signal/cutoff value by Chemiluminescence for the anti-IgG neutralizing antibody [Nabs] against spike protein was 34 ± 10.5 (16.4 to 47.3) and the mean total serum protein level [in g/dL] was 7.2 ± 0.53 (6.5 to 8.4). The infection results and antibody screening were negative. Interestingly, among the eligible donors, around five were unwilling to donate CCP. All the donor-patient pairs were ABO compatible. The recipient details are reported (Table 1). Discussion & Conclusion: CCP therapy can grant the recipient, immunity in the form of Nabs against the nCoV. Yet, one of the major limitations in this study was the small data sub-set to comment on the actual efficacy of the CCP in the recipients. To sum up, the recovery rates were much better when the CCP was given early [i.e. within five days of diagnosis]. Motivation for donating CCP needs to be stressed right at the time of recovery and discharge of such patients.

Indian blood donor selection guidelines: Review in the context of the ongoing COVID-19 pandemic.

The National Blood Transfusion Services under the aegis of the ministry of health and family welfare, India has recently issued guidelines regarding the blood donor selection criteria and the processing of blood. Care has been taken to make the blood transfusions safer. However, COVID-19 has disrupted the organization of the voluntary blood donation drives, whole blood donations [WBD] and restricted the donors' movement to the blood transfusion centres all across the world. While sickness and the need for transfusions are very much in place, the gap of demand against blood collection has widened. Additionally, with the monsoon season at hand, and the categorical challenges of a dengue outbreak, the subsequent need for blood components especially the platelet concentrates is going to rise. Some of the criteria laid for deferring a blood donor from his or her WBD need a categorical revision, considering these unprecedented times. We, therefore, critically analyzed the blood donor selection criteria and hereby, suggest an updating regarding the pre-donation haemoglobin, sexually transmitted diseases, lactation, pregnancy and many such subheadings. We also suggest collecting smaller blood volumes in the blood bags for the optimal benefit of the recipients both for now and also as a measure of pandemic preparedness for future use.

The blood supply management amid the COVID-19 outbreak.

Due to the government's early intervention such as mass lockdown and curtailment strategies towards mass gatherings, amid the COVID-19 outbreak, the organization of the voluntary blood donation camps have been suspended. It's most significant impact on the blood community has been a dramatic decrease in the number of blood donors. Therefore, our blood stock has almost dried up and put our inventory in a state of jeopardy. Additionally, all the elective surgeries and non-urgent clinical interventions have also been deferred during this time. This has led to a drop in the blood collection, demand as well as the issue at our blood center. With this backdrop, we intended to assess the effect of this mass lockdown on our blood supply management, particularly in two phases [phase-I prior to the outbreak] and phase-II [during the outbreak]. Transitioning back to the normal conditions would most likely depend on the extent and the time duration of this pandemic and associated behavioural change, which is foreseen to remain in effect well beyond the original estimates.