Why Women With Pregnancy History Are Eliminated From Plasma Donation Eligibility List ?

You might have heard of plasma therapy as a possible treatment for the coronavirus. However, the plasma donation criteria followed by India has what is called the ‘blanket bar’ on women with pregnancy history. An interesting thing here is that there is no such bar on women from donating blood. And we all know that plasma is one of the components of the blood. However, women can only donate blood after pregnancy only after a specific time period. It is also fascinating to know that there is no such ‘blanket bar’ norm followed by any other developed countries.

Who Can Donate Plasma?

The most important thing is that the doctors have kept the complete safety of donors in mind. Hence, there are strict guidelines that doctors are told to adhere too. Some of the policies are mentioned below:

  • Only after 14 days of recovery can a person donate his/her plasma
  • People above the age of 60 to 65 years are not eligible to donate their plasma
  • The donor should not suffer from hypertension or uncontrollable diabetes
  • People having any chronic heart, lung, liver or kidney disease also cannot donate their plasma
  • The weight of the donor should be above 50 kilograms
  • Haemoglobin level of the donor should be more than 8
  • Women with pregnancy history are also excluded from the eligibility list
  • The antibody level of the donor should be good

Why Can’t A Woman With A Pregnancy History Donate Plasma?

The science behind the blanket bar is that when a woman gets pregnant, the baby she carries has the genetic material of both the father and the mother. Thus, women develop antibodies against the genetic material of the father, which is known as Human Leukocyte Antigen. This Human Leukocyte Antigen or simply HLA can lead to complications related to transfusion.

The probable difficulty is known as Transfusion Related Acute Lung Injury or TRALI. Now, the coronavirus patients already have weak lungs; therefore, plasma containing HLA antibodies can cause them more damage than recovery.

According to a study published the British Journal stated that plasma from women who have been pregnant for more than once had shown disease in about 20% of the people who received their plasma.

There are more than 2500 distinct HLA molecules. Everyone has a particular HLA type that ought to be recognised before stem cell, plasma or organ donation. HLA type of both the receiver and the donor should match. More the number of molecules the receiver and the donor share the more are the chances of the HLA type to match. In case the HLA type is not matched, and the plasma is donated.

The receiver’s body will think of it as a foreign element, and it will attack them.

A study conducted in the United States of America in 2010 was to find any correlation between plasma from women and TRALI. The study found strong relations between both of them.

Hence, the risk of TRALI is more in patients suffering from Covid 19 who already have damaged lungs. Thus, people with weak or damaged lungs are more likely to suffer from TRALI.

Why Is Green Signal Given To Women With A Pregnancy History In Developed Nations?

In developed countries like the United States of America, women with pregnancy history are allowed to donate their plasma. However, the condition is that they must have undergone an HLA antibody detection test.

Now the question arises why HLA antibody detection test is not possible in developing nations. The simple answer to this possible question is that because of the apparent differences between a developing country and a developed nation. The medical infrastructure is obviously better in the developed nations as compared to developing nations.

In addition, tests such as the Nucleic Acid Amplification Test or NAAT are costly. These tests are done to detect any virus in the blood. These tests are quite expensive, and they are only available in metropolitan cities. The medical infrastructure of the developing nation does not support a costly test like NAAT. Moreover, it is not possible to conduct such tests on almost every woman in a populated country like India.

The Exceptional Case

Although women who have been pregnant before are not eligible to donate their plasma, there is, however, an exception to this case. The time from which the fetus starts developing in the mother’s womb indicates that the body of the mother has developed antibodies. We all know by now that HLA antibodies will increase the risk of TRALI in covid-19 patients. Women who have experienced stillbirths or premature abortion are not eligible to donate plasma.

Now the exceptional case is that if the pregnancy had been terminated before the first eight weeks of her pregnancy, she becomes eligible to donate her plasma. The reason behind this exceptional case is that during the initial eight weeks, the fetus does not develop; hence the body of the female did not produce HLA antigen. HLA antigen is the main reason behind the blanket bar on women; thus, any woman without the presence of HLA antigen in her body automatically becomes eligible to donate her plasma.

Although plasma therapy for treating covid-19 hasn’t been entirely successful yet, many patients got cured with the treatment. Removing women with pregnancy history from the eligibility list will probably slow down the recovery rate through plasma therapy.

A significant number of covid 19 patients are women. If every woman could donate her plasma, there would have been more plasma at the hospitals for the patients to cure. For instance, in Bangalore, as many as 56 women registered to donate their plasma with the state plasma bank. Yet, merely 12 out of 56 women were eligible to donate their plasma.