Researchers from the Shenzhen Third People’s Hospital, China have reported that five critically ill patients with COVID-19 and acute respiratory distress syndrome (ARDS) experienced clinical improvement following transfusion with plasma from donors who had recovered from the coronavirus infection.
The authors of the paper, which was published online [Shen C, et al. JAMA. 2020 Mar 27 Epub ahead of print], cautioned that these are preliminary data from a small, uncontrolled case series. They concluded that the limitations of their study preclude any definitive statement about the potential effectiveness of the treatment strategy and that their observations require evaluation in randomized clinical trials.
The plasma for transfusion was obtained from five individuals aged 18 to 60 years who had been diagnosed with laboratory-confirmed COVID-19 and then tested negative for the causative pathogen (SARS-CoV-2). All of the donors had been asymptomatic for a minimum of 10 days prior to blood donation and their plasma had demonstrable IgG and IgM anti-SARS-CoV-19 antibodies and neutralised the virus in vitro.
To be eligible for transfusion with the “convalescent” plasma, critically ill patients had to have laboratory confirmed COVID-19, severe pneumonia with rapid progression and continuously high viral load despite antiviral treatment, PAO2/FIO2 <300, and been on or currently being supported with mechanical ventilation. Blood type testing was done, and the critically ill patients received ABO-compatible convalescent plasma given as two consecutive transfusions (400 mL total) on the same day of plasma donation, which was done to preserve activity of the plasma.
The recipients, who were 35 to 65 years old, had been in the hospital for 10 to 22 days. None were smokers, and four had no preexisting medical conditions. All were on mechanical ventilation and had been treated with two or more antiviral agents and methylprednisolone. They all remained on antiviral treatment after the transfusion.
Within three days of transfusion, fever subsided in four patients. The Sequential Organ Failure Assessment score improved in all patients within seven days. Within 12 days, PA02/FI02 increased, viral loads became negative, and SARS-COV-2 specific ELISA and neutralizing antibody titers increased. ARDS resolved in 4 patients at 12 days, and 3 patients were able to come off mechanical ventilation within 2 weeks.
At last follow-up, 37 days after transfusion, three patients had been discharged from the hospital and the other two patients were in stable condition.
Interest in using convalescent plasma to treat patients with COVID-19 derives from reports of its use to treat other virus outbreaks, including SARS, pandemic 2009 influenza A (H1N1), and avian influenza A (H5N1).
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