If we no longer submit the whole blood donation, the same does not apply to plasma, one of the four components of blood, along with red blood cells, platelets and white blood cells. The first campaign specifically dedicated to plasma donation, which began on October 17, should allow us to fill in our gaps. But the purpose of this sensitization operation orchestrated by the Etablissement Français du Sang (EFS) is at least as educational as it is strategic: by trying to increase the samples of this liquid with precious virtues, the EFS intends to strengthen its autonomy and the less depend on imports. .
Every year, thousands of polytrauma and immunocompromised patients, including patients with chronic inflammatory diseases, severe haemophiliacs or severe burns, require a plasma transfusion or injection of plasma-derived drugs. Two examples: plasma-derived drugs are used to palliate severe blood clotting disorders, particularly in Willebrand’s disease or haemophilia A (factor VIII or IX deficiency), and plasma transfusions are required for some rare conditions. such as thrombotic microangiopathies, especially in the acute phase. Without this translucent yellow liquid, which represents 55% of the blood volume, these sick or people in intensive care could not live normally.
If the French Blood Establishment (EFS), which is responsible for collections in France, is campaigning for the donation of plasma, this unprecedented initiative aims to attract new donors to bolster supplies. A five-year plasma plan is indeed in preparation. “ The goal is to reach 1.4 million liters of plasma collected, compared to the current 900,000, or even less since the Covid pandemic “says Dr Cathy Bliem, Director General of the Blood Transfusion Chain, Therapies and Development at EFS.
A supply under pressure
Rich in over 300 different proteins (albumin, immunoglobins, coagulation factors, etc.), plasma is an extremely valuable raw material. By dividing it, it is possible to create more products from the same batch. Therefore, 90% of the plasma collected from EFS is used for the production of derivative drugs, while the remaining 10% is used as therapeutic plasma. However, this remains insufficient to cover needs at the national level. ” The French Fractionation and Biotechnology Laboratory (LFB), which produces drugs derived from plasma, holds about 35% of the French market share, the remaining 65% is imported, mainly from the United States which takes 70% of the world’s plasma., explains our interlocutor. The challenge is therefore to strengthen our independence, especially in a context of strong tension on the stocks of immunoglobulins (Ig), also known as antibodies. “
In fact, in recent years, the demand for immunoglobulins has increased significantly, which has led the National Agency for the Safety of Medicines (ANSM) to establish, in 2021, ” a management that is fine enough not to waste resources “. There are two types of immunoglobulins: specific Ig, used to prevent the development of a disease, such as tetanus or hepatitis B in unvaccinated people – these antibodies are extracted from the plasma of donors vaccinated against one or another of these diseases -, and the general Igs, the majority, prescribed to patients with an immunodeficiency (lack or absence of antibodies), autoimmune pathology or neuropathy, for example. The second category is particularly threatened with shortages.
Up to 24 times a year
We therefore need to raise awareness, recruit and retain new donors. If whole blood donation provides approximately 600,000 liters of plasma, that amount has reached its ceiling (determined by the need for concentrated red blood cells). ” The apheresis collection which currently provides 300,000 liters is to increase significantly “, says Dr. Cathy Bliem. The apheresis technique takes blood from a donor, spins it to retain only the plasma and restore red blood cells, white blood cells, and platelets.
This method, which requires the donor to be available for about ninety minutes, has two advantages: it allows you to collect more plasma than from a bag from a whole blood donation (800 ml versus 250 ml) and more frequently. The apheresis donation can be done twice a month. ” Today the average is three donations a year, it should increase to five or six. “
A plan like a series of obstacles
Having ambitions is fine, but you still need to have the means to make them happen. EFS is struggling to recruit staff, both lab technicians and nurses and doctors. And for good reason: the latter do not enter the Ségur de la santé, which increases the difficulties of the establishment. ” Consequently, we favor whole blood donation and self-sufficiency of immediately available labile blood products, usually for emergency room, at the expense of plasma donation. “, Dr. Cathy Bliem acknowledges. Another handicap is the price of plasma. ” In France, the selling price of plasma as a raw material is 77 euros per liter of plasma from whole blood donation and 110 euros for apheresis, well below the European price. In the United States, the selling price of plasma is nearly double. As a result, this generates a chronic deficit of several million euros for the EFS. “
Finally, we must open new donation centers, currently 90 in number, extend reception hours, inform and communicate about this important donation, invest in transportable cars to reach the largest number of donors. ” The plasma plan will require strong state support “, Dr. Bliem points out. As for the protest against the fact that the plasma donation is remunerated across the Atlantic, he points out “if the French model were not negotiable, without American plasma, there would not be enough blood products, but ethics also means that the patients for whom these products are essential can benefit from them “.
We don’t necessarily know, but in France there is a fee of 7 euros, but rarely offered. Elsewhere in Europe, some countries grant fees of up to around € 25 for plasma donation, when this does not entitle to a paid day’s work and an absence authorization. These practices exist in particular in Germany, Austria, Italy and Spain.
