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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