Red blood cell exchange for SARS-CoV-2: A Gemini of therapeutic opportunities

Abstract

As of now, therapeutic strategies for the novel coronavirus (SARS-CoV-2) are limited and much focus has been placed on social distancing techniques to “flatten the curve”. Initial treatment efforts including ventilation and hydroxychloroquine garnered significant controversy and today, SARS-CoV-2 outbreaks are still occurring throughout the world. Needless to say, new therapeutic strategies are needed to combat this unprecedented pandemic. Nature Reviews Immunology recently published an article hypothesizing the pathogenesis of TAM (Tyro3, Axl, and Mer) receptor signaling in COVID-19. In it they expressed that hypercoagulation and immune hyper-reaction could occur secondary to decreased Protein S (PROS1). And hypoxia has been recently discovered to significantly decrease expression of PROS1. Regarding the cause of hypoxia in COVID-19; NIH funded research utilizing state-of-the-art topologies has recently demonstrated significant metabolomic, proteomic, and lipidomic structural aberrations in hemoglobin (Hb) secondary to infection with SARS-CoV-2. In this setting, Hb may be incapacitated and unable to respond to environmental variations, compromising RBCs and oxygen delivery to tissues. The use of red blood cell exchange would target hypoxia at its source; representing a Gemini of therapeutic opportunities.

Correlation of hematological parameters and cycle threshold in ambulatory patients with SARS‐CoV‐2 infection

“…The SARS‐CoV‐2 infection kinetic with respect to the lymphocytes indicates that it is possible that when there is a high viral load, CD4 + or CD8 + lymphocytes increase to release different cytokines such as IFN‐γ or IL‐10 to decrease inflammation or interfere with viral replication 30 . In turn, this would corroborate with the increase in red blood cells (RBC) in women, this increment is a compensatory mechanism to increase lung oxygen transport, since with lower Ct values (high viral load), this parameter increase (Figure 3B) 31 . Therefore, knowing the values of blood biometry gives us a guide about possible scenarios during viral infection.…”

Implication of COVID-19 on Erythrocytes Functionality: Red Blood Cell Biochemical Implications and Morpho-Functional Aspects

“…Others experience a seemingly well state, in which the lungs do not appear severely damaged despite insufficient blood oxygenation (silent hypoxia) [19]. These conditions have led several research groups to suppose a direct involvement of erythrocytes in Coronavirus infections [20][21][22]. Cosic et al, in 2020, through studies performed with the Resonant Recognition Model (RRM), proposed RBCs as an alternative point of access to the SARS-CoV-2 virus, which, by entering through the alveoli membrane in the lung, reaches the bloodstream [21].…”

A Fresh Breath of Oxygen: Red Blood Cell Exchange Transfusion in Sickle Cell and COVID‐19

“…In other case reports, there have been suggestions of conducting RBCX in patients with SCD and COVID‐19 after admission and before rapid respiratory deterioration to prevent intubation and ICU admission. 4 , 6 , 7 , 8 Our patient had to be intubated prior to undergoing a RBCX. Perhaps if we were able offer the patient RBCX prior to her acute onset of respiratory distress, we could have prevented the mechanical ventilation, ICU admission, and the extra dose of convalescent plasma, which are certainly costly in the hospital setting.…”