"In the Know with Dr. Oh" Podcast
What is convalescent plasma? What is the rarest blood type? How much blood is used during a trauma or surgery? Get the answers to your most pressing blood banking questions and listen to In the Know with Dr. Oh!
Hoxworth Blood Center, an internationally recognized leader in transfusion medicine, takes you inside the world of blood banking! Hoxworth's Chief Medical Officer, Dr. David Oh, covers all aspects of blood donation and transfusion medicine. Tune in and learn about new advancements in the field of blood banking, get answers to our most frequently-asked questions, and uncover the truths behind the most common rumors, myths and fabrications about blood donation.
Have a burning question for Dr. Oh? Contact us at firstname.lastname@example.org.
Podcast Episode Transcripts
Alecia Lipton (00:27):
This is Alecia Lipton, and you're listening to in the know with Dr. Oh presented by Hoxworth Blood Center, University of Cincinnati. Our series of podcast will feature Dr. David Oh, our Chief Medical Officer, covering all aspects of blood donation and transfusion medicine. Most importantly, we will discuss how all this impacts you, the listener. Today's episode of In the Know with Dr. Oh focuses on convalescent plasma. First and foremost, Dr. Oh, what is convalescent plasma?
Dr. Oh (00:59):
Plasma is the plasma that we collect from a person who has been infected with COVID-19 and recovered. So COVID-19 convalescent plasma essentially contains the antibodies that can neutralize the virus from people who have recovered
Alecia Lipton (01:15):
Well, we're in blood banking and we've collected red blood cells, whole blood, platelets and plasma. But with the COVID 19 pandemic of 2020, we saw a new aspect come into blood banking, where we had to start collecting convalescent plasma. When did we start doing that?
Dr. Oh (01:35):
So it's actually not a new therapy. It was used over a hundred years ago in the flu epidemic of 1918. We started collecting COVID 19 convalescent plasma in April of this year,
Alecia Lipton (01:46):
When we first started working with the convalescent plasma in April of this year, we were doing that as part of an FDA study. Could you tell us a little bit about that?
Dr. Oh (01:57):
FDA has been very helpful in helping us to collect convalescent plasma and distribute it for people who need it. They provided a guidance, uh, which we pretty much use as a rule, a book to, or a playbook to help us in terms of collecting and distributing the product. We asked that donors who are interested in donating convalescent, plasma, contact us, and we evaluate their symptoms. And if they have any test results, that's very helpful in terms of us allowing them to go ahead and donate complex supplies.
Alecia Lipton (02:29):
And it looks like in about August the FDA then released some of the barriers so that it was easier for physicians to order convalescent plasma.
Dr. Oh (02:40):
In the pandemic we collected convalescent plasma. And the only way that patients could actually receive pelvis plasma was through three different mechanisms and they all had to be FDA approved protocols. So one was what we call an EIND and that's for individual patients. So a physician would see a patient that they wanted to treat and would actually have to contact FDA for permission to use the convalescent plasma. FDA was great in terms of being able to turn around those requests very rapidly, typically within a day. And, but you can imagine that the paperwork involved in that was pretty cumbersome. And that was a difficult process for both FDA and for individual doctors who were requesting. So the Mayo Clinic had a study, which had a lot of interest. It actually became an EAP or an extended access protocol, so that many hospitals across the country could use it and allow more patients to be able to get a convalescent plasma.
The Mayo clinic EAP was reviewed and approved by FDA, and actually FDA started recommending that physicians who requested plasma under an EIND start using the Mayo EAP because it was an easier process for them to get the convalescent plasma. Um, the other mechanism, the third mechanism was actually for individual hospitals or hospital groups to construct their own clinical trial. So this was an option that required a lot of work on behalf of the hospitals, but a couple of different hospitals in the Cincinnati area (Christ system and TriHealth system) developed their own protocols. And these had to be approved by FDA as well. And once those individual protocols were approved, then they could start enrolling patients to get convalescent plasma under the specific requirements of that specific protocol.
Alecia Lipton (04:25):
It sounds as if Hoxworth really worked hand in hand with the area hospitals and the FDA at the forefront of the COVID-19 and convalescent plasma usage.
Dr. Oh (04:34):
That's one of the great things about Hoxworth Blood Center. We have a very close relationship with our hospitals and we're able to work out some of these types of details. We are the only blood collector and supplier in this primary area. So all of the different hospitals in Cincinnati and the surrounding tri-state area, essentially get all of their blood from Hoxworth Blood Center. So we can help them directly with any special requests that they have or special processes such as this, we work closely with Christ Hospital and TriHealth in terms of helping them with their protocols and making sure that the convalescent plasma portion of those made sense. And we also worked with the UC health system with multiple studies that they were working on as well.
Alecia Lipton (05:17):
So you mentioned that Hoxworth Blood Center supplies blood to over 30 hospitals in the tri-state region. So does that mean no matter which hospital you're in at this point in time, if you are diagnosed with COVID-19, you have the ability to get convalescent plasma?
Dr. Oh (05:33):
Yeah, essentially we have been providing convalescent plasma to all the hospitals that we provide typical blood products to. And so that's essentially all of the hospitals in the area that includes the Mercy system, TriHealth, UC Health, Children's Hospital, Christ. So essentially if you or a loved one are receiving convalescent plasma in the Cincinnati area, you've gotten it from Hoxworth Blood Center.
Alecia Lipton (05:59):
When somebody has recovered from COVID-19 and they're considering, you know, I can go donate. Now, I've been symptom-free for 14 days. Does everybody have those antibodies or are there some people who might not have antibodies?
Dr. Oh (06:11):
There are people who, when we test do not seem to have antibodies, we perform antibody testing, which was not actually available in April for us to use. So initially we were accepting donors who had a test positive for COVID-19 at the time of diagnosis. It's hard to remember, but it was very difficult to get testing back then. So we were very fortunate when we had donors who had this type of test results. If we didn't have a test result because of a lack of testing availability, we actually held those convalescent plasma units that we collected until we were able to, to bring on, uh, an antibody test of our own. When we do do that testing the vast majority of people who report that they have had a COVID-19 infection, uh, do have, uh, antibodies that we are able to detect. And we actually want that level to be high enough for us to be able to have a lot of antibodies when we transfuse those to people who are actively infected
Alecia Lipton (07:07):
When somebody is contemplating, whether or not they should donate convalescent plasma, of course, we want them to pre-register for that on our website. And that is hoxworth.org/covid-19. So again, that's hoxworth.org backslash COVID dash 19. And why is it that we need people to register ahead of time? Why can't they just walk in the door and say, hi, I'm here to donate convalescent plasma?
Dr. Oh (07:35):
With all of our blood donations, even our standard blood products, we really would like for our donors to make appointments ahead of time, we have a limited amount of staff and equipment. So we really need to make sure when a donor arrives that we have availability for them so that their wait time is actually minimized for COVID-19. There's an extra level of qualification that has to happen because we don't want to be collecting people who won't have high levels of antibody. So oftentimes we really want to have documentation if it's at all available that the person was actively diagnosed with COVID-19.
Alecia Lipton (08:10):
You talked about having documentation that there was a positive diagnosis of COVID-19. Uh, what is it that you're looking for? Is it a doctor's note? Test results? What would the donor need to collect?
Dr. Oh (08:22):
We would prefer to have an actual lab result. If they have had a, for instance, nasal pharyngeal swab, that was positive. That's actually probably the best thing we could have. We also will accept, uh, doctors attestation that a person was infected, you know, early on. It was very difficult to get this documentation, but now it's actually pretty easy. I think for, for people to get that and testing has become much more available. So that testing is usually available.
Alecia Lipton (08:48):
I think one thing that's important for our listeners to know is that when you come and donate blood at blood center, we do a variety of, um, I believe 19 different tests on every unit of blood that's collected, but we do not currently test for COVID-19 or antibodies.
Dr. Oh (09:06):
That's correct. So for the general population, who's donating blood, we do not test for COVID-19. This is something that I think a few blood centers are doing, but really in terms of, you know, our function and our mission that COVID-19... Having people donate just to get results for COVID-19 was something that we did not feel like we should be, um, trying to do. The testing is not foolproof as well. So we really want people to have had a clinical symptoms and infection. If, if that's been, uh, documented for them before we would try to collect them for convalescent plasma.
Alecia Lipton (09:41):
And then the actual donation process, what is it like when you're coming in to do a convalescent plasma donation?
Dr. Oh (09:49):
Typically we have two major ways that people donate blood. One is whole blood and that's I think what most people traditionally think about when they think of blood donation. So oftentimes these are in a mobile setting, a donor will have a blood collected into a bag that actually has multiple empty bags connected to it. And it's a pretty rapid collection process. We collect about 500 milliliters of blood. Oftentimes you'll see that blood rocking on a scale that mixes the blood as it, as it weighs it, that is not the way we collect convalescent plasma, the other major mechanism, or a way that people donate is through automated devices. And so this is the way we currently collect platelets and we can collect plasma as well as we do that. A convalescent plasma, a donor will qualify just as they do for a whole blood donation, and then they will donate so that the blood goes into a device and we use disposable kits for every single donor that comes through. So, so the blood is kept separated from the actual machinery. The automated device will spin that blood at high speeds and allow us to actually layer out and collect the specific portion that we're interested in. Platelet donors will actually have platelets collected at the interface between the plasma and the red cells and for convalescent plasma donors, we're actually going to skim at the plasma level. So it's a very efficient way for us to collect that plasma and then return all of the other blood components back to the donor.
Alecia Lipton (11:18):
So it's very efficient. Also, as the donor, you're getting back some fluids as well. So, um, you leave feeling great. You're hydrated. How long does the process typically take? Is it the same with whole blood or is it as long as a platelet donation?
Dr. Oh (11:32):
It's kind of in between those two? So it's about an hour for most people, I would say whole blood is actually about 10 minutes in terms of the actual from needle to end of collection. But of course, with all of these donation types, there is an interview process, a questionnaire that needs to be answered and a recovery time in the, uh, after donating and what we call our canteen. So people can have some juice and cookies before they head out the door.
Alecia Lipton (11:57):
Yeah, that's the best part of the day, the juice and cookies. You did bring up something very important there, and that was the personal interview prior to donation and also filling out the donor questionnaire. So I think it's important that listeners know that when you're donating convalescent plasma, you're still going through that questionnaire process and there are still criteria that you need to meet. And that would be things such as travel medication and lifestyle restrictions, correct?
Dr. Oh (12:26):
That's definitely true. So unfortunately, sometimes we'll have donors who come in and are very excited to donate, whether it's convalescent, plasma or other blood products. And then through the interview process, we are unable to collect blood from them because they're ineligible for one reason or another. It's hard to understand sometimes why we would defer somebody for specific types of travel or for specific risk factors for a transfusion transmitted diseases, or even for donor safety reasons. But these questions are actually fairly uniform throughout all blood collectors. We use essentially what we call AABB, which is an organization over blood banks, donor history questionnaire, which has been approved by FDA. So you'll have a similar experience wherever you donate in terms of the types of questions that we ask. And the reasons for that are really regulatory in nature.
Alecia Lipton (13:17):
No. When people come to donate blood, they can't donate blood every day. Um, there are safety mechanisms put in place so that safe for you, the donor. So for whole blood, you can donate every 56 days. Platelets, you can donate every two weeks. What is the rule for convalescent plasma donors? How often can they donate?
Dr. Oh (13:36):
Yeah, this is a new product for us. So we've had work in terms of what we feel is appropriate for donation intervals. And you will see actually see some differences between different blood centers that are collecting convalescent plasma. At Hoxworth, we have decided to collect every seven days, a new convalescent plasma donor for up to four donations. So essentially for a month, we collect once a week, at most. After that fourth donation, we ask the donors to come back every 14 days. This is a change from earlier where we were asking people to come back every 28 days. But when we've looked at the antibody levels of our donors, we see that they do decrease over time. And that the best opportunity for us to collect plasma is early on in infection or as early as possible. Uh, for the first several months, at least. Many people will actually continue to have a good antibody levels over an extended period of time. But many people will have a more dramatic drop. And then we really would not want to use their plasma because the antibody levels are not as high as they could be.
Alecia Lipton (14:40):
Thank you for listening to in the note with Dr. Oh brought to you by Hoxworth Blood Center, University of Cincinnati for additional information, visit us online at www.hoxworth.org!
Alecia Lipton (00:29):
You are listening to In the Know with Dr. Oh, and today's episode focuses on convalescent plasma. If you have recovered from COVID-19 and you've been symptom-free for at least 14 days, we encourage you to go online and register to make a convalescent plasma donation. And you can do that www.hoxworth.org/covid-19. So I was looking at the figures this morning, Dr. Oh, and it looks like Hoxworth, since April, has distributed over 2,622 units of convalescent plasma, and we've collected just over 3,052 units from prospective donors. Can you give us an idea of current usage? Where are we at with our usage and in this area, especially as the diagnosis of COVID-19 is creeping up?
Dr. Oh (01:35):
Today is, uh, early December. So we are experiencing a third spike and not just here locally, but nationally, there have been more COVID-19 infections recently than there ever have been, uh, previously, uh, in the pandemic. So initially when we started collecting in April, uh, we were just distributing a few units per day to the hospitals. Um, that reached kind of an early baseline in September, where we were distributing about eight units per day to our hospitals. Over the past few weeks, we had multiple days where we were distributing over 60 units to the hospitals per day. So as a result of that, we asked our hospitals to start transfusing one unit of convalescent plasma per patient, uh, rather than oftentimes they would give two units. And so to make sure that our supply lasted longer, this is consistent with the way that convalescent plasma is transfused throughout the country. So it's either one or two units per patient, typically, per course. Um, so I think that was a very reasonable. And so recently we have had, I would say, uh, a 400% increase in terms of the amount of convalescent plasma that's been distributed, and it keeps going up as, um, more and more people become infected with COVID-19.
Alecia Lipton (03:00):
I've seen many Different graphs shared through the media about what the anticipated growth is for COVID-19 positive cases. And it looks like that's going to continue through January. Are you seeing the same thing, do you think we're going to need to continue to have more and more convalescent plasma donors?
Dr. Oh (03:19):
You know, there aren't a ton of different medications that physicians have in their armament against COVID-19 infection. So we've been very happy that we've been able to help with convalescent plasma. As you mentioned earlier, in August of this year, a convalescent plasma received an EUA status, which is an emergency use authorization, so that it was found over tens of thousands of transfusions, um, throughout the pandemic to that point, that safety profile was really good for this. So there was very little risk for people to receive convalescent plasma efficacy was reasonable to expect as well. So it makes sense as a model that antibiotics would help in terms of neutralizing virus and, and help with course. And there have been many, many anecdotal reports of, uh, really rapid improvement after convalescent plasma. So with the likely efficacy of the product, as well as a very high safety level, uh, it became one of those drugs that, uh, clinicians could start ordering without having to have their patients participate in the FDA approved trial because they had established, um, and gained so much experience with the use through the EAP study and other mechanisms
Alecia Lipton (04:36):
That's great that they product is much more widely available now for patients in need. You mentioned that the current protocol is to administer one unit of the convalescent plasma per patient. Is it recommended that that be done earlier in their illness or do they do that when they're more critically ill?
Dr. Oh (04:54):
I think most of us believe that when a patient receives convalescent plasma earlier in their course, it's more beneficial. So we definitely don't want to give convalescent plasma if somebody is very mild in terms of symptoms and, and likely won't require hospitalization or, you know, uh, more intensive treatment, which many people have fairly mild symptoms where I think it probably works best and has most efficacy is early in hospitalization as a person becomes closer to having to require ventilation or to be put on a ventilator if we can give convalescent plasma in that time period, I think that there are probably cases where the patient does not go on to become ventilator dependent, which I think is a bad sign for them, a marker for them as they go forward. So if we use it judiciously, uh, and I've heard, you know, many reports of, of this being the way that it's been used and, and with good results. So it's probably early in hospitalization before the person gets on a ventilator.
Alecia Lipton (05:58):
For listeners out there, you have a positive Diagnosis of COVID-19 and you have recovered and you have been symptom-free for at least 14 days, we do encourage you to go online and register to be a convalescent plasma donor. You can do that at www.hoxworth.org/covid-19. With Hoxworth, we're always talking about how we need donors. We need to have blood on the shelf before the need arises. And that's also very true with convalescent plasma. So we can't let people say, Oh, well, I'll donate when someone in my family needs convalescent plasma, can you explain the rationale for having the product on the shelf before it's needed?
Dr. Oh (06:39):
It seems fairly simple to just collect plasma and then have it available. But we do have to do a lot of preparation for the products, as well as testing that's performed on every single donation that occurs. We don't recommend a directed donation of convalescent plasma at this time. The safety of convalescent plasma has been shown through tens of thousands of, of transfusions to this point. So we would not really want people to, to try to direct their plasma. It, it ends up adding a lot of complication to the process that really is not necessary.
Alecia Lipton (07:11):
And you also have to be able to match up those blood types, correct?
Dr. Oh (07:15):
That's correct. You may have heard for red cells, that O is the universal donor. For plasma, AB is actually the universal donor, and there's only about 4% of the population is blood type AB I think in desperate times when AB is not available, clinician may make the decision to use A plasma, but it's a, it's usually something we try to avoid as much as possible. So if we, especially when we get AB donors to donate their plasma, that's usually the most, uh, the most efficient.
Alecia Lipton (07:47):
And recently it's been hard to turn on the news without hearing about COVID-19 convalescent plasma, different treatments that are being used to treat those with the COVID-19 virus. Is the convalescent plasma therapy similar to what President Trump received during his stay in the hospital?
Dr. Oh (08:05):
Yeah, my understanding is that president Trump did receive some antibodies treatments, uh, that were developed and available for him in limited amounts. So other people have not been easily able to get those therapies, uh, that he was, but the mechanism is generally the same with convalescent plasma and, and some of the treatments that he received and that the antibody should neutralize the COVID-19 virus, and so work in a similar manner.
Alecia Lipton (08:32):
When we've talked before about this type of therapy, you explained to me that it's a concept called passive immunity. And can you explain how that works and how the infected person then develops antibodies?
Dr. Oh (08:46):
Typically for a person let's say, who has never been exposed to COVID-19, let's say somebody gets infected with that after an exposure. So that would develop antibodies as part of their immune response. And that's the way our body tends to deal with micro-organisms that we encounter. Uh, and so, um, you, you actively develop antibodies to fight off this infection. It's actually the same thing after getting a vaccination. Uh, and the reason we get vaccinated is so that we form antibodies against, um, the virus or bacteria that we're concerned about. So that is a natural, active immune response. If you take plasma from somebody who has actually developed those antibodies and give them to somebody who has not previously been exposed to the virus or bacteria that you're worried about, you give those antibodies to that recipient in a passive manner, because it's just transfused. So your body actually hasn't developed those antibodies on their own, but those antibodies are present in the plasma that's transfused, and that can help to neutralize the virus until your own body then is able to mount a response. And then you become actively immunized as well after exposure to the virus itself.
Alecia Lipton (10:01):
One of our goals of the In the Know with Dr. Oh Podcast series is to let our listeners know about transfusion medicine, convalescent plasma, blood donation, and how it will impact them as the listener. Right now, we're hearing a lot about social distancing, especially with the third spike in COVID-19. Is it safe to come in and donate right now?
Dr. Oh (10:25):
That's a great question. Um, you know, early in the pandemic, in the state of Ohio, uh, I know that there were a lot of travel restrictions that were placed. And at that time, we made a point and, um, the governor supported this to, to make a distinction about blood donation in that we still do require and need people to come out and donate blood as kind of a medical necessity. So, we take precautions at our collections sites. We social distance as much as possible. Of course you can't keep six, six feet away and and be able to, uh, collect blood from somebody. But we have all of our staff and, and people who come into those facilities wear masks at all times. And we try to keep exposures, you know, as low as possible. So, uh, we do encourage people to come out, uh, during this time period, I can't say it's, you know, absolutely. You know, the safest thing you can do that the safest thing people can do is just stay home and not leave their house, but it is reasonable for people to come out with a specific intent to donate blood, to help others. It is a medical necessity for us, and it is something that I think we are still encouraging people to do.
Alecia Lipton (11:41):
We encourage people to make wise decisions in their daily business. We have to go to the grocery store, we have to go to work. We have to go to the gas station and just doing social distancing, we can still accomplish those tasks. And it's the same with blood donation. It is a medical necessity. And as long as you're practicing good hygiene and social distancing, then coming to donate blood and or convalescent plasma should be safe for you.
Dr. Oh (12:08):
Yeah. You know, Alecia, even with the pandemic going on right now and all the precautions that we're taking surgeries are still happening and people still need blood. People have cancer. They, they go on chemotherapy. There's still the need for other blood products like red cells, platelets and plasma that's not convalescent plasma for patients who are, who are having the blood blood requirements. Blood transfusion is actually the number one procedure that's performed at hospitals. So this has continued at a rate pre COVID 19. And so in addition to having to collect all the convalescent plasma that we are, and having to social distance and having less, uh, ability to collect on mobiles, because we're social distancing, we still have the same blood needs from the hospitals as before. So, it's very challenging for us in this time to provide not only the convalescent plasma, but also the other blood products that people need.
Alecia Lipton (13:05):
Is there anything that would prevent somebody from donating convalescent plasma other than our typical guidelines for travel and medication and lifestyle?
Dr. Oh (13:16):
That's a great question. So if somebody qualifies with all the questions that we ask, we actually do a lot of testing after the donation as well. So one of the things that we do do is we test for a lot of infectious disease markers. Occasionally a donor will have a positive infectious disease marker. That actually does not mean that they have, uh, the infectious disease that we're testing for! We use very sensitive tests. Unfortunately, sometimes we have donors who are not actually infected who have what we call false positives to that process. And then we notify them that unfortunately they're unable to donate blood going forward. Uh, sometimes we will recommend that they see their physicians if the results are worrisome, but many of these tests, unfortunately we know, are very, very sensitive and we'll sometimes have people that test falsely positive right now.
We're actually having a lot of, uh, false, positive syphilis tests, uh, nationwide, which it sounds really scary, but all of these tests are required to be performed as a process in, in releasing blood for transfusion. And then we want to be as safe as possible so that there are no transfusion transmissions as much as possible through, uh, through blood transfusion. Uh, and so, um, actually people who are having false positives for syphilis testing, uh, we encourage to come back in eight, eight weeks and we actually send them a letter. Part of the testing processes also to prevent a rare transfusion reaction called TRALI, which is actually a pulmonary reaction where the recipient will have trouble breathing after a transfusion of some blood products, especially those that contain a lot of plasma. These reactions are very rare, but they have been associated with donors who have actually been pregnant.
And, uh, actually donors who have actually been pregnant multiple times are at higher association with recipients who receive plasma from them. So we've started screening blood donors for antibodies to what we call HLA. And these are not a problem for them at all in terms of life and, and clinical significance for the donor themselves. But because of this association, with this rare, uh, transfusion reaction, we have not been using blood or plasma or platelets that has been collected from donors who have these antibodies. That can be quite high percentage of women, donors who have had pregnancies, especially if they've had multiple children. Uh, and so up to even 20 to 30% of, of women who have had three or more children. So it's not, unfortunately it's not uncommon for somebody to come out, try to donate blood with us and especially plasma or platelets, and then be told, Oh, unfortunately you can't continue to donate those products in the future
Alecia Lipton (16:03):
Because you can't donate one product. That doesn't mean that you can't donate at all. Correct?
Dr. Oh (16:08):
That's correct. So, uh, if we detect these antibodies and so essentially we ask a question on our questionnaire, if you ever been pregnant, and if they answer that, yes, then we will perform an additional test. If, for people who have never been pregnant or who are males, um, they typically do not have these antibodies. So they are not actually screened for this. We would actually ask those donors who have an anti HLA antibodies to donate, uh, red cells for us and whole blood. So those red cells can be used without significant increase in risk for recipients
Alecia Lipton (16:40):
Patients in the hospital don't get a holiday from illness. There's still cancer. There's still surgeries. There's still traumas and people still need those blood and platelet transfusions. So it's important that we continue to have people come in and donate blood. If you're interested in donating blood, you can call Hoxworth at (513) 451-0910 or visit www.hoxworth.org to schedule your blood or platelet donation. Again, if you have recovered from COVID-19 and you're interested in making a convalescent plasma donation, you do need to pre-register online and you do that www.hoxworth.org/covid-19.