Investigation of hesitancy to donate plasma among COVID-19 survivors in Goa: an online survey

Background: The ongoing COVID-19 pandemic led to surge in mortality. In the absence of definitive treatment, convalescent plasma therapy was accepted as a modality to treat COVID-19 patients. There exists hesitancy with regards to COVID-19 convalescent plasma donation. To find the deterrents to CCP donation.Methods: An online survey was conducted by snowball technique. The study participants were COVID-19 survivors. They were asked to express their willingness to donate CCP. The reasons for not donating CCP were recorded. The data was analyzed using R-program. The adjusted and unadjusted Odds ratios were calculated to find the predictors of willingness to donate CCP.Results: 110 study participants responded to the survey. 49.1% of the responders were willing to donate plasma. The top three deterrents of CCP donation were ill health (27.6%; 95% CI, 18.28%-39.27%), ineligibility (10.5%; 95% CI, 4.98%-20.21%), not recovered completely (6.58%; 95% CI, 2.45%-15.34%). The female gender, older age, being symptomatic, unaware of government incentives, tested by RAT, and unaware of CPT were associated with lower odds of donating CCP.Conclusions: Ill health, ineligibility, and perceived incomplete recovery were the major deterrents of CCP donation. Being female, older age, being symptomatic, unaware of government incentives, tested by RAT, and unaware of CPT were associated with lower willingness to donate CCP. There is a need to develop interventions to target these factors to improve CCP donation whenever it is indicated.

Case Report: Serial Cases: Prolongation of High Immunoglobulin G Level in Repetitive COVID-19 Convalescence Plasma Donor in Saiful Anwar Hospital Malang, Indonesia

BackgroundConvalescent plasma therapy is expected to be a promising alternative to supportive therapy during the SARS-CoV-2 pandemic outbreak. Altered immune response in repetitive convalescent plasma donors has not been widely studied. This case series was reported to analyze the patterns of immune responses and the factors that might influence them in repetitive convalescent plasma donors and increase awareness of COVID-19 survivors to donate their convalescent plasma.Cases IllustrationThere were five repetitive donors who were eligible as convalescent plasma donor requirements. It was found two donors who showed increment of anti-SARS-CoV-2 IgG level after donation and two others who showed persistent anti-SARS-CoV-2 IgG level more than two months after recovered.DiscussionThere was a difference in immune response in survivors who have the probability of being exposed to same antigens with survivors who did not, where the group of survivors who are at risk of exposure to antigens after recovery could trigger anamnestic immune response that can increase antiSARS-CoV-2 IgG levels. The other factor that influence the prolongation of anti-SARS-CoV-2 IgG levels are the possibility of neutralizing antibodies in plasma upregulation.ConclusionImmunological phenomenon in SARS-CoV-2, both in survivors and convalescent plasma donors, have not been widely observed and studied. From the case series discussed above, it can be concluded that convalescent plasma donation does not yet have strong evidence of decreasing levels of specific antibodies against SARS-CoV-2 and plasmapheresis procedure is safe to be done without reducing the protective effect of donor antibody post-plasma donation.

Plasma donation induces a protein expression profile shift in circulating human blood

Commercial plasma donation yields a change in protein concentration similar to that observed in therapeutic plasma exchange (TPE) in humans. The post-donation expression profile shows an increase in many proteins after even a single donation, and the effect is enhanced with additional donations. Unlike TPE, human plasma donation returns saline without albumin to the donor, thus eliminating supplemental albumin as a contributing factor. The observed fold change falls outside the variation expected by natural circadian expression changes.

Help Is in Your Blood—Incentive to “Double Altruism” Resolves the Plasma Donation Paradox

Blood donation is considered as one of the purest forms of altruism. Plasma donation, in contrast, despite being a similar process, is mostly a paid activity in which donors are compensated for their contribution to the production of therapeutic preparations. This creates a so-called “plasma paradox:” If remuneration is promised for a socially useful effort, volunteers with altruistic motives might be deterred. At the same time, regular plasma donors who pursue the monetary benefits of donation might drop out if remuneration stops. The same controversy can be caught in the messages of most plasma donation companies as well: They promise a monetary reward (MR), and at the same time, highlight the altruistic component of donation. In this study, we tested the assumption that emphasizing the social significance enhances the willingness to donate blood plasma more effectively than either MR or the combination of these two incentives. This had to be rejected since there was no significant difference between the three scenarios. Furthermore, we also hypothesized that individuals might be more motivated to donate plasma if there is a possibility of offering an MR toward other socially beneficial aims. We found an increased willingness to donate in scenarios enabling “double altruism”, that is, when donating plasma for therapeutic use and transferring their remuneration to nongovernmental organizations, is an option. We propose relying on double altruism to resolve the plasma paradox, and suggest that it could serve as a starting point for the development of more optimized means for donor recruitment.

Persistent symptoms and lab abnormalities in patients who recovered from COVID-19

With increasing numbers of patients recovering from COVID-19, there is increasing evidence for persistent symptoms and the need for follow-up studies. This retrospective study included patients without comorbidities, who recovered from COVID-19 and attended an outpatient clinic at a university hospital for follow-up care and potential convalescent plasma donation. Network analysis was applied to visualize symptom combinations and persistent symptoms. Comprehensive lab-testing was ascertained at each follow-up to analyze differences regarding patients with vs without persistent symptoms. 116 patients were included, age range was 18–69 years (median: 41) with follow-ups ranging from 22 to 102 days. The three most frequent persistent symptoms were Fatigue (54%), Dyspnea (29%) and Anosmia (25%). Lymphopenia was present in 13 of 112 (12%) cases. Five of 35 cases (14%) had Lymphopenia in the later follow-up range of 80–102 days. Serum IgA concentration was the only lab parameter with significant difference between patients with vs without persistent symptoms with reduced serum IgA concentrations in the patient cohort of persistent symptoms (p = 0.0219). Moreover, subgroup analyses showed that patients with lymphopenia experienced more frequently persistent symptoms. In conclusion, lymphopenia persisted in a noticeable percentage of recovered patients. Patients with persistent symptoms had significantly lower serum IgA levels. Furthermore, our data provides evidence that lymphopenia is associated with persistence of COVID-19 symptoms.