Plasma exchange followed by convalescent plasma transfusion in COVID-19 patients

Abstract

Background Coronavirus disease 2019 (COVID-19) is an emerged pandemic disease with no specific treatment. One of the potential treatments in newly found infectious disease is plasma exchange (PE) with convalescent plasma transfusion (CPT). This case series aimed to evaluate the primary PE and CPT in five Iranian COVID-19 patients. Methods Five patients with confirmed COVID-19 who had acute respiratory distress syndrome and were supported by mechanical ventilation were treated with two consecutive PE containing fresh frozen plasma (FFP) of healthy donors and 0.9 % saline solution containing 5 % human albumin. Thereafter, CPT was performed just like PE, except that the FFP in this step was substituted with convalescent ABO-matched plasma. Clinical and laboratory factors were evaluated before and after treatments. Results Three to Four patients showed lower body temperature and improved oxygen saturation as well as reduced laboratory factors such as c-reactive protein, lactate dehydrogenase, creatine phosphokinase (total and myocardial isoform), aspartate aminotransferase, blood urea nitrogen, bilirubin (total and direct), D-dimer, interleukin-6, and CD4+/CD8 + T cells ratio initially after PE and continued to improve so that they were discharged. One patient due to secondary hemophagocytic lymphohistiocytosis and extensive lung fungal infection was expired. Discussion Overall, the PE followed by CPT was beneficial in reducing acute inflammation led to a considerable improvement in patients’ clinical features. It seems that PE along with CPT could provide clearance of pro-inflammatory mediators as well as the positive effects of CPT. Controlled studies are required to confirm the effect of PE/CPT compared with other therapeutic approaches.

What Is the Role of Therapeutic Plasma Exchange as an Adjunctive Treatment in Severe COVID-19: A Systematic Review

“…After excluding some of the articles for numerous reasons, the final 18 papers were included in the systematic review. The most common types of studies were case-series studies ( n = 14) [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ], then case-control studies ( n = 2) [ 17 , 35 ] and a propensity score matched study [ 36 ]. Only one randomized controlled trial was included in the analysis [ 37 ].…”

“…Out of 384 patients, 220 received TPE. The number of patients in the studies varied from 3 to 90 with a median of 8 patients (IQR 5–18) [ 17 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ]. The mean or the median age of participants in seven studies was below 65 years [ 8 , 10 , 11 , 12 , 13 , 14 , 15 ], whereas in the remaining four studies, it was above 65 years [ 5 , 6 , 7 , 9 ].…”

“…The mean or the median age of participants in seven studies was below 65 years [ 8 , 10 , 11 , 12 , 13 , 14 , 15 ], whereas in the remaining four studies, it was above 65 years [ 5 , 6 , 7 , 9 ]. Information regarding gender was available in all of the studies [ 17 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ], of which the majority of patients were male. Only three studies had a similar gender ratio of about 40%–60% [ 22 , 30 , 33 ].…”

“…Information regarding gender was available in all of the studies [ 17 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ], of which the majority of patients were male. Only three studies had a similar gender ratio of about 40%–60% [ 22 , 30 , 33 ]. The most common reason to qualify a patient for TPE was acute respiratory distress syndrome (ARDS) ( n = 8 [ 21 , 22 , 23 , 24 , 32 , 33 , 35 , 37 ]).…”

“…Only three studies had a similar gender ratio of about 40%–60% [ 22 , 30 , 33 ]. The most common reason to qualify a patient for TPE was acute respiratory distress syndrome (ARDS) ( n = 8 [ 21 , 22 , 23 , 24 , 32 , 33 , 35 , 37 ]). Another frequent inclusion criterion was cytokine release syndrome (CRS) [ 23 , 25 , 36 , 37 ].…”