Treating Severe Cases with Convalescent Plasma

126 views 0 04/01/2020 05/22/2020

  1. According to the experience with other strains of coronavirus, antibodies from convalescent plasma would neutralize the virus. 3,4
  2. Patients who received convalescent plasma transfusion had a clinical improvement as assessed by decreased body temperature, increased PaO2/FiO2, radiologic improvement and lower inflammation blood markers. (Caution: Other treatments (steroid and antiviral treatment) were administered at the same time.) 1
  3. The administration of convalescent plasma would stop viral shedding and prolong the survival of patients with respiratory failure. 2
  4. Theoretically, the administration of plasma would be more effective in the early stages of the disease. 1,2
  5. This treatment is associated with few complications or adverse events in the literature. 2,4
  6. Currently:
  • FDA approved the use of convalescent plasma for the treatment of COVID-19 severe disease. 5
  • EFS and Inserm have started Coviplasm clinical trial.7
  • Health Canada and Canadian Blood Services are currently working on a clinical trial on the use of convalescent plasma. 6

 

This data comes from 4 studies.  Shen C. et al. conducted a case series of 5 critically ill patients with confirmed COVID-19 and ARDS admitted to Shenzhen Third People’s Hospital in Shenzhen in China between January 20, 2020 and March 25, 2020. The patient had to meet inclusion criteria: severe pneumonia with rapid progression and continuously high viral load despite antiviral treatment; PAO2/FIO2 <300; and mechanical ventilation. All patients were treated with convalescent plasma transfusion  between 10 and 22 days after admission and their clinical outcomes were studied before and after administration. Zeng Q.-L et al. conducted a retrospective observational study on 21 critically ill patients admitted to the The First Affiliated Hospital of Zhengzhou University and The Sixth People’s Hospital of Zhengzhou City. They compared clinical outcomes of patients who received convalescent plasma and those who did not. Cheng Y. et al. studied the clinical outcomes of 80 SARS patients treated with convalescent plasma between March 20 and May 26, 2003 at the Prince of Wales Hospital in Hong Kong, China. Mair-Jenkins J. et al conducted a systematic review of 32 studies on SARS coronavirus infection and severe influenza. They studied the reduction of mortality associated with the administration of convalescent plasma. 

 

Sources

  1. Shen C., Wang Z., Zhao F., et al (March 27, 2020). Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma. JAMA https://doi.org/10.1001/jama.2020.4783
  2. Zeng Q.-L., Yu Z.-J., Gou J.-J. et al. (April 29, 2020).Effect of Convalescent Plasma Therapy on Viral Shedding and Survival in Patients With Coronavirus Disease 2019. The Journal of Infectious Diseases. https://doi.org/10.1093/infdis/jiaa228
  3. Cheng Y., Wong R., Soo Y.O. et al (January, 2005). Use of convalescent plasma therapy in SARS patients in Hong Kong. Eur J Clin Microbiol Infect Dis. https://doi.org/10.1007/s10096-004-1271-9
  4. Mair-Jenkins J. , Saavedra-Campos M. , Baillie J. K.,  et al (January, 2015). The effectiveness of convalescent plasma and hyperimmune immunoglobulin for the treatment of severe acute respiratory infections of viral etiology: a systematic review and exploratory meta-analysis. J Infect Dis. 10.1093/infdis/jiu396
  5. Tanne J. H. (March 26, 2020).Covid-19: FDA approves use of convalescent plasma to treat critically ill patients. BMJ.https://doi.org/10.1136/bmj.m1256
  6. Canadian Blood Services (April 2, 2020). COVID-19 convalescent plasma for patients. Retrieved from: https://blood.ca/en/about-us/media/newsroom/covid-19-convalescent-plasma-for-patients
  7. EFS (April 4, 2020). Covid-19 : démarrage de l’essai clinique Coviplasm visant à tester l’efficacité de la transfusion de plasma de patients convalescents du Covid-19 dans le traitement de la maladie Retrieved from: https://www.efs.sante.fr/covid-19-demarrage-de-lessai-clinique-coviplasm-visant-tester-lefficacite-de-la-transfusion-de-0
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