Coronavirus: Fresh guidelines for blood transfusion services and convalescent plasma

New Delhi, Jun 29: Blood can be collected from a person, who tested positive and recovered from COVID-19, only after 28 days of discharge from a treating facility or 28 days after home isolation ends, the National Blood Transfusion Council (NBTC) said in a fresh set of guidelines.

The second interim national guidance for blood transfusion amid the COVID-19 pandemic also stated that systems should be in place to enable re-entry of cured COVID-19 patients as donors for convalescent plasma for treatment of those affected by the novel coronavirus.

"The treatment of COVID-19 patients using the convalescent plasma is under clinical trial and currently no evidence of the efficacy of the convalescent plasma as a treatment modality for SARS-COV-2 is established," the NBTC said in the document.

For collection of convalescent plasma under clinical trial from cured COVID-19 patients, the donor selection criteria specifically for this purpose should be as per the protocol approved by Drug Controller General of India and Central Drugs Standard Control Organization (CDSCO). The use of convalescent plasma for routine treatment of COVID-19 patients is not recommended at present, it said.

The necessary guidelines for collection of convalescent plasma from recovered COVID-19 patients for the treatment of such cases will be issued as and when the efficacy of this form of treatment is established and approved by competent bodies, it said.

The document stressed on safe functioning of services. The NBTC had issued the first interim recommendations in March. To maintain safety, the NBTC in its guidelines urged blood banks and camp organisers to exclude donors who are in the risk category. Very mild, mild, pre-symptomatic, moderate and severe COVID-19 cases must be deferred for 28 days from donating blood after discharge from a treating facility or 28 days after the end of home isolation, stated the guidelines issued by the NBTC, which comes under the ambit of the Union health ministry.

The definition of end of discontinuation of home isolation should be as per the home isolation guidelines issued by the ministry from time to time, they said. Individuals with history of contact with confirmed or suspected COVID-19 cases, including those under quarantine, should be deferred from donating blood for 28 days from the last time they came in close contact with a COVID-risk person, the guidelines stated.

Individuals should be deferred from donating blood for 28 days after the date of departure from a country with COVID-19 transmission in the community and areas as notified by the Ministry of Health and Family Welfare from time to time, they said.

Social distancing being advocated for preventing an individual from contracting COVID-19 is also being interpreted to not congregate for blood donation opportunities, the NBTC document noted. If people do not turn up to donate at blood centres or camp locations, there is a likelihood of shortfall in blood supplies, which may be detrimental to those who are in urgent need of blood and blood components, like thalassemics, persons with severe anaemia, instances of severe blood loss, road traffic accidents, ante-partum and post-partum haemorrhage, patients needing urgent surgeries, the document said.

As per the advisory issued by the Ministry of Health and Family Welfare, it is advised that mass gatherings may be avoided or possibly be postponed until the disease spread is contained, the guidelines stated. It is, however, also mentioned that for such gatherings, states may take necessary action to guide blood camp organisers on precautions to be taken as per the existing guidelines.

"Therefore, keeping in view the essentiality of maintaining safe blood supplies, it is recommended that in-house blood donation as well as outdoor blood donation activities may be continued, while ensuring compliance with extant social distancing norms, mass gathering rules, infection control guidelines and biomedical waste disposal rules," the guidelines said.

This is to be ensured not only by the staff of blood centres, but also by camp organisers, potential blood donors and all other stakeholders, they said.

Social distancing measures which are advised from time to time by authorities should be followed at blood donation sites. These measures include physical distance, restriction on social norms of hand shaking and hugging, reduce overcrowding, managing blood donation couches such that one metre distance is maintained between two couches of blood donation, calling donors in a staggered manner, the guidelines stated.

Blood centre and camp organisers should educate staff and donors on these measures and provide facilities like running water, soap, hand sanitisers, personal protective equipment, colour coded dustbins. Hand hygiene and coughing etiquette must be maintained, they said. Safe disposal of used gloves, masks, caps and other soiled material should be ensured.Protocols for proper cleanliness of the equipment used during the blood donation should be maintained, the guidelines said.

Following procedures for cleaning and disinfecting and increasing frequency of these activities was also recommended. "In some circumstances, an outbreak may be geographically restricted to a small identified area like a village, block etc., and such areas may be declared as containment zones by the administrative authorities.

In such cases blood collection from voluntary blood donors of these areas may be temporarily ceased," the guidelines stated. It may be noted that while the health ministry continues to monitor the situation actively, these recommendations may be considered interim till revised in light of upcoming evidence for COVID-19 and revision in global guidance for the same.