Background Recent evidence suggested that the higher titers of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody from convalescent plasma donors contributed to the clinical improvement in coronavirus disease 2019 (COVID-19) patients. However, the titers of anti -SARS-CoV-2 antibodies varied in each individual, and the precise factors that might govern such variation have not been elucidated. Objectives To assess the factors associated with high titers of anti -SARS-CoV-2 antibody among COVID-19 convalescent plasma (CCP) donors. Methods A cross-sectional study was conducted in Saiful Anwar General Hospital, Malang, Indonesia. Information of interest including demographic characteristics, clinical symptoms, comorbidities, laboratory findings, and the titers of anti -SARS-CoV-2 antibody among COVID-19 CCP donors were collected. The correlation was assessed using multiple logistic regression. Results A total of 50 COVID-19 CCP donors with the titers of anti -SARS-CoV-2 antibody of more than 1:320 and 33 donors with the titers of less than 1:320 were analyzed. Our analysis revealed that CCP donors with history of cough, fever, dyspnea, and pneumonia significantly had higher titers of anti -SARS-CoV-2 antibody compared to asymptomatic donors. Moreover, CCP donors with elevated levels of eosinophils and immature granulocytes and low levels of albumins had higher levels of anti -SARS-CoV-2 antibody. The titer of antibody was not affected by comorbidities of donors. Conclusions CPP donors who had experience of symptomatic COVID-19 with high eosinophils level, high immature granulocytes and low albumin level have higher titers of anti -SARS-COV-2 antibody than those who experienced asymptomatic COVID-19. Our current findings may be used as the additional baseline criteria for selecting the donors of CCP for the management of COVID-19.
Multiple myelomas (MM) is the proliferation of malignant plasma cells in the bone marrow, characterized by the production of monoclonal immunoglobulins that are secreted in the blood and urine. However, in 1 - 5% of cases, the protein is undetectable and defined as non-secretory type of myeloma. A 36-year-old woman presented with complaints of weakness in both legs so she could not walk. She also felt pain in the head, back, and thighs since one year before. Physical examination showed anemic conjunctiva, gibus as high as T4, hypoesthesia as high as T6 segment. She had anemia (Hb 10.2 g/dL), decreased kidney function (eGFR: 30 mL/min/1.73m2), and multiple lytic lesions in the calvaria, ribs, superior-inferior pubic ramus, and left humeral os in the 1/3 proximal to 1/3 distal. Protein electrophoresis and Bence Jonce protein were negative. There was no hypercalcemia, and bone marrow aspiration showed myelodysplasia syndrome. A thoracolumbar MRI showed an extradural solid mass and the histopathology examination result was plasmacytoma. Non-secretory MM was defined into two groups, non-producers and multiple non-secretory myeloma patients who produce tumor proteins but cannot be excreted. This patients was categorized as non-producers non-secretory MM because she did not show a protein that can be measured in blood nor urine, but has significant plasma cells in tissue biopsy. The absence of paraprotein in the blood does not rule out multiple myeloma. Suspicion of multiple myeloma needs to be increased in patients who have symptoms of CRAB (calcium, renal impairment, anemia, bone lytic).
BackgroundConvalescent plasma therapy is expected to be a promising alternative to supportive therapy during the SARS-CoV-2 pandemic outbreak. Altered immune response in repetitive convalescent plasma donors has not been widely studied. This case series was reported to analyze the patterns of immune responses and the factors that might influence them in repetitive convalescent plasma donors and increase awareness of COVID-19 survivors to donate their convalescent plasma.Cases IllustrationThere were five repetitive donors who were eligible as convalescent plasma donor requirements. It was found two donors who showed increment of anti-SARS-CoV-2 IgG level after donation and two others who showed persistent anti-SARS-CoV-2 IgG level more than two months after recovered.DiscussionThere was a difference in immune response in survivors who have the probability of being exposed to same antigens with survivors who did not, where the group of survivors who are at risk of exposure to antigens after recovery could trigger anamnestic immune response that can increase antiSARS-CoV-2 IgG levels. The other factor that influence the prolongation of anti-SARS-CoV-2 IgG levels are the possibility of neutralizing antibodies in plasma upregulation.ConclusionImmunological phenomenon in SARS-CoV-2, both in survivors and convalescent plasma donors, have not been widely observed and studied. From the case series discussed above, it can be concluded that convalescent plasma donation does not yet have strong evidence of decreasing levels of specific antibodies against SARS-CoV-2 and plasmapheresis procedure is safe to be done without reducing the protective effect of donor antibody post-plasma donation.
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