Hospitalized COVID-19 Patients Treated With Convalescent Plasma in a Mid-size City in The Mid West

Abstract

BackgroundSARS-CoV-2 and its associated disease, COVID-19, has infected over seven million people world-wide, including two million people in the United States. While many people recover from the virus uneventfully, a subset of patients will require hospital admission, some with intensive care needs including intubation, and mechanical ventilation. To date there is no cure and no vaccine is available. Passive immunotherapy by the transfusion of convalescent plasma donated by COVID-19 recovered patients might be an effective option to combat the virus, especially if used early in the course of disease. Here we report our experience of using convalescent plasma at a tertiary care center in a mid-size, midwestern city that did not experience an overwhelming patient surge.MethodsHospitalized COVID-19 patients categorized as having Severe or Life-Threatening disease according to the Mayo Clinic Emergency Access Protocol were screened, consented, and treated with convalescent plasma collected from local donors recovered from COVID-19 infection. Clinical data and outcomes were collected retrospectively.Results31 patients were treated, 16 severe patients and 15 life-threatened patients. Overall mortality was 27% (4/31) but only patients with life-threatening disease died. 94% of transfused patients with severe disease avoided escalation to ICU care and mechanical ventilation. 67% of patients with life-threatening disease were able to be extubated. Most transfused patients had a rapid decrease in their respiratory support requirements on or about day 7 following convalescent plasma transfusion.ConclusionOur results demonstrate that convalescent plasma is associated with reducing ventilatory requirements in patients with both severe and life-threatening disease, but appears to be most beneficial when administered early in the course of disease when patients meet the criteria for severe illness.

Convalescent Plasma for the Prevention and Treatment of COVID-19: A Systematic Review and Quantitative Analysis

“…Studies demonstrated that CP could effectively improve the respiratory symptoms of severe patients and help them wean from oxygen support. However, patients in extremely critical or life-threatening conditions could not benefit from CP [63,122,124,294].…”

“…For disease severity, severe COVID-19 is a clinical situation in which the patient has dyspnea, tachypnea (respiratory rate≥30 breaths/minute), blood oxygen saturation≤93% on room air, partial pressure of arterial oxygen to fraction of inspired oxygen ratio <300 PaO 2 /FiO 2 <300, or lung infiltrates >50% within 24-48 hours on chest x-ray [63]. Life-threatening disease is defined as respiratory failure, septic shock, or multiple organ dysfunction or failure [63].…”

“…Therefore, transfusion of CP at the early stage of disease theoretically should be more effective [114,121,124]. CP appears to be of greater clinical benefit when administered early in the course of disease than delaying transfusion under the development of severe disease [63,108]; in principle, the course of disease does not exceed 3 weeks [67]. Studies have found that, regardless of COVID-19 severity at time of transfusion, patients that received CP earlier in their course of disease showed lower mortality, more rapid viral clearance, and shorter hospital stays [92,113].…”