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.

Keywords: COVID-19; Convalescent plasma; Plasma exchange; SARS-CoV-2.

Fig. 1

Trends of body temperature and oxygen saturation. Trends of changes in body temperature (A) and oxygen saturation (B), in different time-points. The day before the first PE was considered as day 0. Values in day 0, 2, 3, 4, 7, and 11 are attributed to the baseline value (the day before the first PE), before second PE, before CP, one day post-CP, 4 days post-CP, and one week post-CP, respectively. Each line represents a patient. Normal range is illustrated as dashed lines in each figure.

Fig. 2

Trends of CRP and IL-6 levels. Trends of changes c-reactive protein (CRP) level (C), and IL-6 level (D) in different time-points. The day before the first PE was considered as day 0. Values in day 0, 2, 3, 4, 7, and 11 are attributed to the baseline value (the day before the first PE), before second PE, before CP, one day post-CP, 4 days post-CP, and one week post-CP, respectively. Each line represents a patient. Normal range is illustrated as dashed lines in each figure.

Fig. 3

Computed tomography (CT) scan of the lung of patients. The CT scan of the lung of patients before (A, C, E, G, I) and 4-9 days after the first plasma exchange (B, D, F, H, J) is illustrated. The images are in the order of the patients.