PESHAWAR: Hayatabad Medical Complex, the pioneer of passive immunisation therapy for treatment of Covid-19 patients in Khyber Pakhtunkhwa, has stopped supply of plasma to other hospitals following their failure to provide it with feedback in accordance with the laid down protocols, according to sources.

HMC, which started passive immunisation trial two months ago, has collected 100 donations from recovered patients of Covid-19 and has transfused the same to 80 patients. It wants other hospitals to start their own programme.

Sources said that HMC offered to impart, training, guidance and technical support to the hospitals after signing a Memorandum of Understanding with them.

Prof Shehzad Akbar Khan, the medical director of HMC, invited to a meeting the representatives of Lady Reading Hospital (LRH), Khyber Teaching Hospital (KTH) and private sector North West General Hospital (NWGH) on Thursday to sign a MoU with them for convalescent plasma trial in the province.

HMC supplied about six bags of plasma to each of these hospitals but it did not receive any feedback regarding its use, prompting its administration to stop more supply to other hospitals and scale up their capacity to start the programme on their own premises.

Hospitals fail to provide feedback to it according to protocols

Sources said that the unregulated supply and transfusion would create ethical issue as HMC was the sole approved hospital in the province for the purpose. It started immunisation under an agreement with National Institute of Blood Diseases (NIBD), Karachi. The hospital is pursuing experimental use of convalescent plasma in treating critically-ill Covid-19 patients.

They said that the trial approved by Drug Regulatory Authority of Pakistan (DRAP) and respective Ethical Boards required adherence to prescribed protocols under monitoring and control but it didn’t get any feedback from the hospitals that were sent the plasma.

HMC has made the hospitals binding to fill certain proformas before transfusion to the patients and sent the same to it but the recipients didn’t follow it, said sources.

The medical director informed the representatives of other hospitals that HMC was committed to helping all patients and hospitals of the province, but it wanted that certain basic formalities must be met before placing requests for convalescent plasma.

Sources said that hospitals were required to fill in the request forms by its heads and treating physicians with patients’ names and the reason that convalescent plasma could benefit them for issuance of plasma with the undertaking to abide by all the prerequisites and provisions of the desired clinical feedback.

He also informed the hospitals that it was clinical trial entitled “Experimental Use of Covid-19 Convalescent Plasma for the Purpose of Passive Immunisation in Current Covid-19 Pandemic in Pakistan in 2020” and the physicians were required to abide by the rules of the study.

It included other conditions like purpose of the trial and physician’s responsibility about confidentiality of the study, patients’ whereabouts and volunteer enrolment form. An informed consent should also be obtained from patient or immediate relative/guardian of the patient.

The confirmation of Covid-19 infection by RT-PCR is must along with symptoms and other medical conditions mentioned in the instructions for request form for obtaining plasma from HMC. It has made it obligatory upon the physicians for timely feedback to HMC. However, the hospitals have not given any feedback so far.

“People are visiting HMC, asking and forcing the administration for plasma of their patients in other hospitals. The situation has also been brought into the government’s attention but to no avail,” said sources.

LRH has plasmapheresis and a hematologist and can start plasma immunisation. It has sent technician to the first meeting held in health department regarding plasma immunisation. The technician didn’t understand what was going on there.

KTH has two machine and five hematologists but both have been given to ICU.

Abbottabad has four hematologists but no machine.

HMC has dedicated plasmapheresis set up under a special team led by head of pathology department Prof Shahtaj. Prof Mohammad Usman is clinical focal person for the relevant limb of this activity.

“HMC wants to act as focal point for plasma immunisation and enable other hospitals to start the programme because it cannot issue more plasma and spoil its trial,” sources said. They said that it would enable all the hospitals to supply plasma for different blood groups to one another and would come with outcome of a study covering larger population.

Published in Dawn, June 11th, 2020