Therapeutic plasma exchange for COVID‐19‐associated hyperviscosity

Abstract

Background Recent data suggests an association between blood hyperviscosity and both propensity for thrombosis and disease severity in patients with COVID‐19. This raises the possibility that increased viscosity may contribute to endothelial damage and multiorgan failure in COVID‐19, and that therapeutic plasma exchange (TPE) to decrease viscosity may improve patient outcomes. Here we sought to share our experience using TPE in the first 6 patients treated for COVID‐19‐associated hyperviscosity. Study Design and Methods Six critically ill COVID‐19 patients with plasma viscosity levels ranging from 2.6 to 4.2 centipoise (cP; normal range, 1.4‐1.8 cP) underwent daily TPE for 2‐3 treatments. Results TPE decreased plasma viscosity in all six patients (Pre‐TPE median 3.75 cP, range 2.6‐4.2 cP; Post‐TPE median 1.6 cP, range 1.5‐1.9 cP). TPE also decreased fibrinogen levels in all five patients for whom results were available (Pre‐TPE median 739 mg/dL, range 601‐1188 mg/dL; Post‐TPE median 359 mg/dL, range 235‐461 mg/dL); D‐dimer levels in all six patients (Pre‐TPE median 5921 ng/mL, range 1134‐60 000 ng/mL; Post‐TPE median 4893 ng/mL, range 620‐7518 ng/mL); and CRP levels in five of six patients (Pre‐TPE median 292 mg/L, range 136‐329 mg/L; Post‐TPE median 84 mg/L, range 31‐211 mg/L). While the two sickest patients died, significant improvement in clinical status was observed in four of six patients shortly after TPE. Conclusions This series demonstrates the utility of TPE to rapidly correct increased blood viscosity in patients with COVID‐19‐associated hyperviscosity. Large randomized trials are needed to determine whether TPE may improve clinical outcomes for patients with COVID‐19.

Combination therapy with plasma exchange and glucocorticoid may be effective for severe COVID‐19 infection: A retrospective observational study

“…Although dexamethasone and remdesivir have been reported to be useful in the treatment of COVID‐19 [4,7], it is still reported that even with multidisciplinary treatment, there is a high risk of the condition being fatal in men older than 65 years, and in patients with diabetes, hypertension, and heart disease [8]. So far, numerous reports on the efficacy of PE for severe COVID‐19 have been published, including case reports and case series [9–13].…”

Autoimmunity to the Lung Protective Phospholipid-Binding Protein Annexin A2 Predicts Mortality Among Hospitalized COVID-19 Patients

“…( 45 ) In addition, clinical trials directed at treating severe COVID-19 patients may need to include interventions used in other catastrophic autoimmune diseases especially if autoimmunity is found to have an important role in the pathophysiology of COVID-19. ( 46, 47 )…”

Are We Forgetting About IgA? A Re‐examination of Coronavirus Disease 2019 Convalescent Plasma

“…While early studies suggest that CP therapy may be safe, 15 the long‐term complications that may arise from this therapy, including thromboembolic events that commonly complicate COVID‐19, 28‐30 have been more difficult to ascertain. Like delayed type hemolytic transfusion reactions, 31‐36 these complications may not be apparent during or even shortly following transfusion and therefore may be more easily missed given the propensity of hospitalized patients with COVID‐19 to experience underlying thromboembolic complications 28‐30 . Thus, while intriguing, these observations are correlative in nature and therefore establishing the role of IgA in CP treatment efficacy is not possible with this study.…”