Active surveillance of serious adverse events following transfusion of COVID‐19 convalescent plasma

Abstract

Background The reported incidence of adverse reactions following Coronavirus disease 2019 (COVID‐19) convalescent plasma (CCP) transfusion has generally been lower than expected based on the incidence of transfusion reactions that have been observed in studies of conventional plasma transfusion. This raises the concern for under‐reporting of adverse events in studies of CCP that rely on passive surveillance strategies. Materials and Methods Our institution implemented a protocol to actively identify possible adverse reactions to CCP transfusion. In addition, we retrospectively reviewed the charts of inpatients who received CCP at Stanford Hospital between May 13, 2020 and January 31, 2021. We determined the incidence of adverse events following CCP transfusion. Results A total of 49 patients received CCP. Seven patients (14%) had an increased supplemental oxygen requirement within 4 h of transfusion completion, including one patient who was intubated during the transfusion. An additional 11 patients (total of 18, 37%) had increased oxygen requirements within 24 h of transfusion, including 3 patients who were intubated. Six patients (12%) fulfilled criteria for transfusion‐associated circulatory overload (TACO). Conclusion Using an active surveillance strategy, we commonly observed adverse events following the transfusion of CCP to hospitalized patients. It was not possible to definitively determine whether or not these adverse events are related to CCP transfusion. TACO was likely over‐diagnosed given overlap with the manifestations of COVID‐19. Nevertheless, these results suggest that the potential adverse effects of CCP transfusion may be underestimated by reports from passive surveillance studies.

High‐titer post‐vaccine COVID‐19 convalescent plasma for immunocompromised patients during the first omicron surge

“…Several clinical trials have shown the safety of CCP administration. 7,20,21 Most CCP studies have used pre-vaccination CCP and had mixed outcomes 20,22,23 ; patients with comorbidities who received CCP early in the illness course were thought to have the most benefit. 24 A number of studies have examined high-titer CCP in immunocompetent patients.…”

“…One patient had a febrile nonhemolytic transfusion reaction, and another had transfusion‐associated circulatory overload with transient supplemental oxygen requirement via nasal prongs. Several clinical trials have shown the safety of CCP administration 7,20,21 …”

COVID-19 convalescent plasma: current status, lessons from the past and future perspectives

“…These include the common transfusion reactions, including HLA-, HNA- and HPA-antibodies. Several reports indicate that the risk of such reactions are not increased compared to regular transfusion reactions [22] , [23] . If several units of convalescent plasma were pooled, this could improve efficacy of the product and it would lead to standardisation [24] .…”

Current advances in transfusion medicine 2021: A critical review of selected topics by the AABB Clinical Transfusion Medicine Committee

“…The most common adverse reactions are transfusion‐associated dyspnea and transfusion‐associated circulatory overload. Active surveillance can help mitigate under‐reporting of adverse reactions 9 …”