For years, Stéphane Cliche was a healthy avid athlete, but he kept getting sinus and respiratory infections and doctors couldn't figure out why.
It wasn't until he was diagnosed with non-Hodgkin lymphoma in 2016 that it became clear his immune system didn't work properly.
Cliche got immunoglobulin — a cocktail of antibodies from donor blood plasma — as a standard treatment taken alongside chemotherapy, which often knocks down patients' immune systems.
Months after he stopped both the chemo and the immunoglobulin infusions, his health-care team did a followup blood test and found he had very few of his own antibodies — and would need to continue regular immunoglobulin injections to function as his immune system.
Now 51, the Ottawa college instructor credits those weekly doses with allowing him to live a normal, active life.
"If I would not be on the immunoglobulin, I probably could not work full time," Cliche said, noting that it would be dangerous for him to be exposed to students without immunity to fight off viruses and bacteria.
"I would start getting infections repetitively."
Cliche is just one of thousands of Canadians who rely on immunoglobulin made from plasma — the pale yellow liquid part of your blood that's left over after red blood cells are separated out. According to Canadian Blood Services, the demand for immunoglobulin is rising every year, but 70 per cent of Canada's supply comes from international sources — mostly the U.S.
Although there is no current shortage of immunoglobulin in Canada, the current political climate of protectionism in the U.S., coupled with the "dramatic" demand projected to increase about 10 per cent each year, could put the supply at risk, said Dr. Graham Sher, CEO of Canadian Blood Services.
"It is critically important that Canada become more domestically self-reliant in making immunoglobulins in this country," he said.
The need for more immunoglobulin production is driven by several factors, he said, including more cancer patients getting the antibody treatment while their immune systems are suppressed through chemotherapy, as well as a growing and aging population adding to the number of immune system-related diagnoses, including autoimmune disorders.
Meeting more of that demand means driving up donation rates to get the raw plasma needed, then manufacturing the end product of immunoglobulin drugs here in Canada, Sher said, creating "truly a domestic end-to-end supply chain."
Right now, about 30 per cent of the plasma for immunoglobulin production comes from donors in Canada, then is sent to manufacturing facilities in the U.S. and Europe. Those manufacturers return the finished product to Canada. Much of the rest of the immunoglobulin is made from plasma collected from American donors.
"Our long-term strategic goal is to achieve a minimum of 50 per cent domestic self-reliance — meaning of all the immunoglobulin used by Canadian patients, at least 50 per cent will be collected from Canadian donors and manufactured in Canada for Canadian patients," Sher said.
The goal isn't 100 per cent self-sufficiency to help protect against domestic supply chain disruptions, he said.
"You don't want to be 100 per cent all your eggs in one basket."
To achieve that 50 per cent self-reliance, Canadian Blood Services has partnered with Grifols, a Barcelona-based company that manufactures plasma-derived medications and currently makes most of Canada's immunoglobulin in its North Carolina plant.
The company is in the midst of a multi-phase construction project on a site in Montreal it bought back in 2020, Grifols said in an emailed statement to The Canadian Press.
The first phase, which is up and running, is a facility to produce albumin, a protein also found in plasma and used to boost blood volume in patients.
The company is now working on the immunoglobulin part of the plant, which is expected to be fully operational by the end of 2027, the statement said.
The agreement with Grifols also includes price protections to shield Canada from rising costs of immunoglobulin on the global market, Sher said.
But a critical part of increasing Canada's immunoglobulin supply is getting more plasma donations in the first place, he said.
"We really need more donors to show up because we tend to rely on a small number of donors, and we're dramatically increasing the amount of plasma collections that we need."
Although Canadian Blood Services is planning to integrate whole blood and plasma donations into the same centres, many of its blood donor clinics can't process plasma donations right now.
The agency has contracted Grifols to collect plasma in 17 centres across the country to fill that gap, Sher said.
"They can only open plasma centres in locations that we authorize," he said.
"All of the plasma that they collect from those centres is exclusively dedicated for Canadian patients. They can't manufacture the immunoglobulin and sell it offshore."
Donating plasma is similar to the experience of donating whole blood but takes longer — about an hour compared to 10 or 15 minutes. Both processes involve taking blood through an IV in your arm, but with plasma donation, a machine separates the blood components and returns your red and white blood cells to you through the IV.
People can donate whole blood about every three months, but can give plasma as often as once a week.
"We have a target where we would love plasma donors to give, you know, six to eight times per year," Sher said.
Anyone 17 years and older who is healthy, not recently pregnant and doesn't have certain medical conditions could be eligible to donate. Canadian Blood Services has a questionnaire that every prospective donor completes online. There are waiting periods after getting tattoos or piercings or travelling to some countries.
Picture Courtesy: THE CANADIAN PRESS/Handout - Canadian Blood Services
