BACKGROUND AND PURPOSE:

• Duan et al. (PNAS, 2020) assessed the effectiveness of convalescent plasma in treating severe COVID-19 cases

METHODS:

• Prospective study (January 23, 2020, to February 19, 2020)
  • 3 hospital in Wuhan, China
  • There was no control arm | Historic control group of randomly selected, matched individuals were used for comparison | Match based on hospital, age, gender, and severity
• Participants
  • Patients with severe, confirmed COVID
• Intervention
  • One dose of 200 mL of convalescent plasma
  • Maximal supportive care and antiviral agents
• Study design
  • Convalescent plasma came from recently recovered donors with the neutralizing antibody titers above 1:640
  • Patients were monitored for clinical symptoms and laboratory parameters within 3 days after transfusion
  • Primary endpoint: Safety
  • Secondary endpoints: Changes in clinical course

RESULTS:

• Ten patients received convalescent plasma
  • Underlying chronic disease: 4 patients (cardiovascular and/or cerebrovascular diseases and essential hypertension)
  • Median age: 52.5 years (IQR 45.0 to 59.5 years)
  • Median time from onset of illness to transfusion was 16.5 days
• Levels of neutralizing antibody were high after transfusion
  • Rapid increase up to 1:640 in 5 cases
  • High level (1:640) maintained in four cases

Clinical Course

• Clinical symptoms were significantly improved within 1 to 3 days following transfusion
  • Within 3 days oxyhemoglobin saturation increased
  • Lymphocyte counts increased
    • Pre-transfusion: 0.65 × 109/L
    • Post transfusion: 0.76 × 109/L
  • C-reactive protein decreased
    • Pre-transfusion: 55.98 mg/L
    • Post-transfusion: 18.13 mg/L
  • Chest CT findings: Within 7 days radiological examinations showed varying degrees of absorption of lung lesions
• Viral load
  • Undetectable within 6 after transfusion in 7 patients with previous viremia
• Side effects: None documented

Historic Control Group

• 10 matched controls (did not receive transfusion) were selected
• Baseline characteristics: No significant differences when compared to group receiving transfusion
• Outcomes: The transfusion group did significantly better than the control (P < 0.001)
  • Transfusion group: 3 cases discharged | 7 cases much improved status and ready for discharge
  • Historic control group: 3 deaths | 6 stabilized | 1 improved

CONCLUSION:

• The results of this study provide more evidence for the effectiveness of convalescent plasma therapy for patients with severe COVID-19
  • There were no major side effects
  • Symptoms improved in all patients
  • Viral load decreased
• The authors emphasize that despite encouraging findings, larger controlled trials are needed to fully determine the safety and effectiveness

Learn More – Primary Sources:

Effectiveness of convalescent plasma therapy in severe COVID-19 patients

Related ObG Topics:

ARDS, Critical Care and COVID-19: ‘Surviving Sepsis Campaign’ Guidelines and Key Points

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

Washington State’s First COVID-19 Cases: Outcomes and Characteristics of 21 Critically Ill Patients

NEJM Correspondence: Clinical Course of COVID-19 in Children