Multi-institutional experience with COVID-19 convalescent plasma in children

Cyril Jacquot^{1

2}, Oren Gordon³, Daniel Noland⁴, Jeffrey R Donowitz⁵, Emily Levy⁶, Sanjay Jain³, Zachary Willis⁷, Casey Rimland⁷, Michele Loi^{8

9}, Antonio Arrieta^{10

11}, Kyle Annen^{8

9}, Noelle Drapeau⁶, Stephanie Osborne¹⁰, Monica I Ardura¹², Satyam Arora¹³, Elise Zivick¹⁴, Meghan Delaney^{1

2}

Affiliations

¹ Department of Laboratory Medicine, Children's National Hospital, District of Columbia, Washington, USA.
² Departments of Pathology and Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
³ Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland, USA.
⁴ Children's Health Dallas/UTSW, Dallas, Texas, USA.
⁵ Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia, USA.
⁶ Mayo Clinic, Rochester, Minnesota, USA.
⁷ UNC Chapel Hill, Chapel Hill, North Carolina, USA.
⁸ Children's Hospital Colorado, Aurora, Colorado, USA.
⁹ University of Colorado-Anschutz School of Medicine Dept. of Pathology, Aurora, Colorado, USA.
¹⁰ Division of Infectious Diseases, Children's Hospital of Orange County, Orange, California, USA.
¹¹ Department of Pediatrics, University of California at Irvine, Irvine, California, USA.
¹² Pediatric Infectious Diseases & Host Defense Program, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA.
¹³ Postgraduate Institute of Child Health, Delhi, India.
¹⁴ Medical University of South Carolina, Charleston, South Carolina, USA.

PMID: 36965173
PMCID: PMC10175190
DOI: 10.1111/trf.17318

Multi-institutional experience with COVID-19 convalescent plasma in children

Cyril Jacquot et al. Transfusion. 2023 May.

. 2023 May;63(5):918-924.

doi: 10.1111/trf.17318. Epub 2023 Mar 30.

Authors

Affiliations

¹ Department of Laboratory Medicine, Children's National Hospital, District of Columbia, Washington, USA.
² Departments of Pathology and Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
³ Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland, USA.
⁴ Children's Health Dallas/UTSW, Dallas, Texas, USA.
⁵ Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia, USA.
⁶ Mayo Clinic, Rochester, Minnesota, USA.
⁷ UNC Chapel Hill, Chapel Hill, North Carolina, USA.
⁸ Children's Hospital Colorado, Aurora, Colorado, USA.
⁹ University of Colorado-Anschutz School of Medicine Dept. of Pathology, Aurora, Colorado, USA.
¹⁰ Division of Infectious Diseases, Children's Hospital of Orange County, Orange, California, USA.
¹¹ Department of Pediatrics, University of California at Irvine, Irvine, California, USA.
¹² Pediatric Infectious Diseases & Host Defense Program, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA.
¹³ Postgraduate Institute of Child Health, Delhi, India.
¹⁴ Medical University of South Carolina, Charleston, South Carolina, USA.

PMID: 36965173
PMCID: PMC10175190
DOI: 10.1111/trf.17318

Abstract

Background and objectives: Convalescent COVID-19 plasma (CCP) was developed and used worldwide as a treatment option by supplying passive immunity. Adult studies suggest administering high-titer CCP early in the disease course of patients who are expected to be antibody-negative; however, pediatric experience is limited. We created a multi-institutional registry to characterize pediatric patients (<18 years) who received CCP and to assess the safety of this intervention.

Methods: A REDCap survey was distributed. The registry collected de-identified data including demographic information (age, gender, and underlying conditions), COVID-19 disease features and concurrent treatments, CCP transfusion and safety events, and therapy response.

Results: Ninety-five children received CCP: 90 inpatients and 5 outpatients, with a median age of 10.2 years (range 0-17.9). They were predominantly Latino/Hispanic and White. The most frequent underlying medical conditions were chronic respiratory disease, immunosuppression, obesity, and genetic syndromes. CCP was primarily given as a treatment (95%) rather than prophylaxis (5%). Median total plasma dose administered and transfusion rates were 5.0 ml/kg and 2.6 ml/kg/h, respectively. The transfusions were well-tolerated, with 3 in 115 transfusions reporting mild reactions. No serious adverse events were reported. Severity scores decreased significantly 7 days after CCP transfusion or at discharge. Eighty-five patients (94.4%) survived to hospital discharge. All five outpatients survived to 60 days.

Conclusions: CCP was found to be safe and well-tolerated in children. CCP was frequently given concurrently with other COVID-19-directed treatments with improvement in clinical severity scores ≥7 days after CCP, but efficacy could not be evaluated in this study.

Trial registration: ClinicalTrials.gov NCT04377672.

Keywords: COVID-19 convalescent plasma; pediatric transfusion; transfusion safety.

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Conflict of interest statement

Conflicts of Interest: All authors declare no conflicts of interest

Figures

**Figure 1.**
Patient and plasma donor ABO blood types. Only one transfusion was ABO-incompatible.

See this image and copyright information in PMC

References

1. Estcourt LJ, Cohn CS, Pagano MB, et al. Clinical Practice Guidelines From the Association for the Advancement of Blood and Biotherapies (AABB): COVID-19 Convalescent Plasma. Ann Intern Med 2022;175: 1310–21. - PMC - PubMed
1. Sullivan DJ, Gebo KA, Shoham S, et al. Early Outpatient Treatment for Covid-19 with Convalescent Plasma. N Engl J Med 2022;386: 1700–11. - PMC - PubMed
1. Bhimraj A, Morgan RL, Shumaker AH, et al. Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19. Clin Infect Dis 2022. - PMC - PubMed
1. Gordon O, Brosnan MK, Yoon S, et al. Pharmacokinetics of high-titer anti-SARS-CoV-2 human convalescent plasma in high-risk children. JCI Insight 2022;7. - PMC - PubMed
1. FDA. Recommendations for Investigational COVID-19 Convalescent Plasma [monograph on the internet]. 2022. Available from: https://www.fda.gov/vaccines-blood-biologics/investigational-new-drug-ap...

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Multi-institutional experience with COVID-19 convalescent plasma in children

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Multi-institutional experience with COVID-19 convalescent plasma in children

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