Lessons learned from early compassionate use of convalescent plasma on critically ill patients with Covid-19

Abstract

Background: The management of critically ill patients with coronavirus disease 2019 (COVID-19), caused by a new human virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is challenging. Recently, there have been several reports with inconsistent results after treatment with convalescent plasma (CP) on critically ill patients with COVID-19, which was produced with a neutralizing antibody titer and tested in a P3 or P4 laboratory. However, due to the limitation of the conditions on mass production of plasma, most producers hardly had the capability to isolate the neutralizing antibody. Here, we report the clinical courses of three critically ill patients with COVID-19 receiving CP treatments by total immunoglobulin G (IgG) titer collection.

Methods: Three patients with COVID-19 in this study were laboratory confirmed to be positive for SARS-CoV-2, with radiographic and clinical features of pneumonia. CP was collected by total IgG titer of 160 (range, 200-225 mL), and patients were transfused between 20 and 30 days after disease onset at the critical illness stage as a trial in addition to standard care. The clinical courses of these patients, including laboratory results and pulmonary functional and image studies after receiving convalescent plasma infusions, were reviewed.

Results: No therapeutic effect of CP was observed in any of the patients; instead, all three patients deteriorated and required extracorporeal membrane oxygenation treatment. A potential cytokine storm 4 hours after infusion of CP in Patient 2 was observed. No more patients were put on the trial of CP transfusion.

Conclusions: We recommend extreme caution in using CP in critically ill patients more than 2 weeks after the onset of COVID-19 pneumonia.

FIGURE 1

Changes in patients' pulmonary function peri‐transfusion of CP. The lung dynamic compliance (left panel) of three patients and oxygenation index of two patients (right panel) before and after convalescent plasma infusion are shown here. Day 0 indicates the day of convalescent plasma infusion; negative number denotes the day before the infusion and positive number denotes the day after the infusion. Indicates bronchoscopic sputum suction plus bronchoalveolar lavage [Color figure can be viewed at wileyonlinelibrary.com]