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COVID-19 Management

Use of Convalescent Plasma in Critically Ill COVID-19 Patients: Results from a Preliminary Study

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BACKGROUND AND PURPOSE:

  • Convalescent plasma has been successfully used as a treatment method during other viral outbreaks, including MERS, SARS, H5N1 and H1N1
  • Shen et al. (JAMA, 2020) assessed whether convalescent plasma transfusion could be used for critically ill patients with COVID-19

METHODS:

  • Case series (January 20 to March 25, 2020)
  • Setting
    • Shenzhen Third People’s Hospital in Shenzhen, China
  • Participants
    • Critically ill patients with confirmed COVID-19
    • ARDS
      • Severe pneumonia with rapid progression and continuously high viral load despite antiviral treatment
      • Pao2/Fio2 <300
      • Mechanical ventilation
  • Donors
    • 5 Donors with confirmed infection, now recovered (asymptomatic ≥10 days) | Ages 18 to 60 years
    • Negative for SARS-CoV-2 and other respiratory viruses, as well as hepatitis B virus, hepatitis C virus, HIV, and syphilis
    • Plasma from the donors had high virus-specific IgG and IgM titers
  • Transfusion procedure
    • Patients received 2 consecutive transfusions of 200 to 250 mL of ABO-compatible convalescent plasma on the same day it was obtained
    • Patients remained on antivirals (including interferon and lopinavir/ritonavir) until SARS-CoV-2 viral loads were negative
  • Primary outcomes
    • Temperature | SOFA scores | Pao2/Fio2 | Viral load | Serum antibody titer | Routine blood biochemical index | Ventilatory and ECMO requirements pre and post plasma administration

RESULTS:

  • 5 critically ill patients were recruited to receive convalescent plasma
    • Age range: 36-65 years | 2 women
    • All had received antiviral agents and methylprednisolone
  • Following plasma transfusion
    • Body temperature: Normalized within 3 days in 4 of 5 patients
    • SOFA: Scores decreased (indicating improvement)
    • Pao2/Fio2: Increased
    • Viral loads: Decreased | Negative within 12 days
    • ARDS: Resolved in 4 patients by day 12
    • Ventilator support: 3 patients weened from ventilators
  • SARS-CoV-2–specific ELISA and neutralizing antibody titers increased following the transfusion
    • Neutralizing antibody titers are an important measure of the ability of antibodies to limit the viral infection
  • Patient condition at end of study period
    • Hospital discharge: 3 patients
    • Stable condition: 2 patients (at 37 days post transfusion)

CONCLUSION:

  • In this report, it appears that critically ill patients with COVID-19 benefited from convalescent plasma transfusion
  • Authors acknowledge this is a preliminary study
  • Study limitations include lack of controls and small ‘n’
  • Clinical trials are necessary

Learn More – Primary Sources:

Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma

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Related ObG Topics:

Aerosols and Surfaces: SARS-CoV-2 Stability
Washington State’s First COVID-19 Cases: Outcomes and Characteristics of 21 Critically Ill Patients
MMWR Reports on Initial US COVID-19 Experience: Demographics, Mortality and Outcomes 

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