Convalescent Plasma Therapy in Coronavirus Disease 2019: a Case Report and Suggestions to Overcome Obstacles

Abstract

Coronavirus disease 2019 (COVID-19) is rapidly spreading around the world, causing much morbidity and mortality everywhere. However, effective treatments or vaccines are still not available. Although convalescent plasma (CP) therapy can be useful in the treatment of COVID-19, it has not been widely used in Korea because of the concerns about adverse effects and the difficulty in matching patients to donors. The use of ABO-incompatible plasma is not contraindicated in treatment, but can be hesitated due to the lack of experience of physicians. Here, we describe a 68-year old man with COVID-19 who was treated ABO-incompatible plasma therapy; additionally, we comment on the acute side effects associated with ABO mismatch transfusion. To overcome the obstacles of donor-recipient connections (schedule and distance), we propose the storage of frozen plasma, modification of the current Blood Management Law, and the establishment of a CP bank. We suggest that experience gained in CP therapy will be useful for not only the treatment of COVID-19, but also for coping with new emerging infectious diseases.

Plasma convalescent therapy for COVID-19 patients: A literature review.

“…El plasma convaleciente disminuyó la carga viral y no se informaron efectos secundarios mayores (20,21) . Un reporte de caso (23) se señaló que dos pacientes que desarrollaron dificultad respiratoria cuatro días después de que la terapia con plasma convaleciente mostró una mejoría clínica.…”

Treatment of COVID-19 with convalescent plasma: lessons from past coronavirus outbreaks

“…A summary of the primary literature describing the use of convalescent plasma is found in Table 2 [ 15 , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] ]. Sixteen reports of convalescent plasma in COVID-19 ( n = 5353 treated), four in MERS-CoV ( n = 13 treated), and five in SARS-CoV ( n = 125 treated) were identified.…”

“…There were two randomized control trials [ 20 , 21 ], and there was a comparator group in seven COVID-19 studies, and in two SARS-CoV studies. Most of the identified studies reported a benefit of convalescent plasma therapy, manifested as clinical improvement, reduced mortality, longer survival time, earlier discharge, increased viral clearance or increased virus-specific IgG or IgM following treatment [ 15 , 20 , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] ]. Before COVID-19, the two largest studies were reported, retrospectively, from the same group in Hong Kong during the SARS-CoV outbreak of 2003 [ 24 , 25 ].…”

“…Other than two trials that were published after being terminated early [ 20 , 21 ], there is a lack of randomized control trials investigating convalescent plasma as a therapy for coronaviruses, though observational studies have reported some promising benefits [ 15 , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] ]. Therefore, the purpose of this review is to summarize the literature and identify areas for future focus regarding the use of convalescent plasma to treat coronaviruses (SARS-CoV, MERS-CoV and, in particular, SARS-CoV-2).…”

“… Patient 2: clinical improvement 70 h after infusion (fever, dyspnoea, lymphocyte counts), discharged 21 days after admission. No immediate COVID-19 Im, J.H., et al., 2020 [ 35 ] No None n = 1 Deteriorated after standard treatment, severe Day 9 of admission, 500 mL ABO non-compatible donor Hydroxychloroquine, antivirals Improvement in respiratory distress symptoms for 3 days after transfusion, improved Pa o 2 /Fi o 2 and CXR on day 3, followed by acute worsening requiring 12 days of ECMO, at which point patient was discharged home. Subacute worsening, eventual recovery COVID-19 Figlerowicz, M., et al., 2020 [ 34 ] No None n = 1 Age 6, severe, aplastic anaemia ~Day 35 of admission, 200ml IgG titre 1:700 IVIG, azithromycin, antivirals, steroids, blood and platelet transfusions, antifungals Nasopharyngeal SARS-CoV-2 RNA swab became negative for the 3 weeks following CP, after 5 weeks of positive swabs.…”