Development and implementation of a COVID-19 convalescent plasma program in a middle-income economy

Abstract Introduction Convalescent Plasma therapy is one of the therapeutic strategies that has been used for patients with the Covid-19 disease. Implementing a program with national extension to supply hospitals with this blood component is a great challenge mainly in a middle-income economy. Objectives Our objective was to develop and implement a Covid-19 Convalescent Plasma Program which met established quality standards and was adapted to a reality of limited resources. Methods A multicentric convalescent plasma collection program was developed and implemented, based on four main sequential procedures: selective donor recruitment, pre-donation antibody screening (Anti-SARS-CoV-2- Chemiluminescence IgG Abbott), convalescent plasma collection by apheresis or whole-blood processing and distribution to the hospitals according to local demand. Results From the 572 candidates submitted to the pre-donation antibody screening, only 270 (47%) were considered eligible for plasma donation according to the established criteria. Higher levels of total antibody were associated with the donor age being above 45 years old (p= 0.002), hospital admission (p= 0.018), and a shorter interval between the diagnosis of the SARS-CoV-2 infection and plasma donation (p < 0.001). There was no association between the ABO and Rh blood groups and their antibody levels. Of the 468 donations made, 61% were from the collection of whole-blood and 39%, from apheresis. The Covid-19 Convalescent Plasma units obtained were distributed to 21 different cities throughout the country by air or ground transportation. Conclusion The implementation of a Covid-19 Convalescent Plasma program in a continental country with relatively scarce resources is feasible with alternative strategies to promote lower cost procedures, while complying with local regulations and meeting quality standards.

Conteúdo do zinco contaminante nas soluçöes rotineiramente utilizadas em hidrataçäo e/ou alimentaçäo parenteral / Contaminant zinc content in solutions routinarily used in rehydration and or parenteral feeding

Com o objetivo de avaliar as necessidades de suplementaçäo de zinco a crianças submetidas à hidrataçäo e/ou alimentaçäo parenteral, foi analisado o teor de zinco contaminante em soluçöes para uso endovenoso de uso rotineiro no Hospital das Clínicas da Faculdade de Medicina de Ribeiräo Preto, da Universidade de Säo Paulo (HC-FMRPUSP). Foi dosado o zinco em 40 frascos de soros contendo água desionizada, submetidos ao tratamento de rotina empregado na industrializaçäo dos soros para uso parenteral, segundo as normas da Farmácia Industrial do HC-FMRPUSP. Foi observada a influência do tipo de material empregado na vedaçäo dos fracos (rolha vermelha, polida, e rolha preta, näo polida), bem como do tempo de contato das soluçöes com as tampas de borrachas e lâminas de látex ou da forma de acondicionamento dos fracos (posiçäo vertical ou horizontal), que permitem o contato das soluçöes com as tampas de borracha. Soluçöes glico-salinas industrializadas no HC-FMRPUSP armazenadas em frascos de vidro com rolhas de borracha preta näo polida e lâmina de látex, apresentaram teores consideráveis de zinco (1,220 a 4,860 microgramas/ml, n= 30). As mesmas soluçöes, em ampolas de vidro ou frascos de plásticos, foram isentas do oligoelemento. As maiores concentraçöes de zinco foram constatadas nas soluçöes de aminoácidos acondicionadas em frascos vedados com a rolha preta näo polida (11,690 a 24,310 microgramas/ml, n = 20). É necessário levar-se em conta o conhecimento desses valores de zinco contaminante, para uma terapêutica adequada em relaçäo a esse micronutriente