ABSTRACT
INTRODUCTION: The objective of this study was to investigate the effect of convalescent plasma (CP) transfusion on clinical and serial laboratory parameters in severe COVID-19 patients. The Coronavirus Disease 2019 (COVID-19) pandemic presents a challenge to the healthcare system worldwide due to the limited treatment options available. The body of evidence reported that CP containing anti- COVID-19 antibodies could be effective against the infection. MATERIALS AND METHODS: This was a cross-sectional study that involved retrospective data collection of severe COVID-19 adult patients who received CP transfusion along with the best-of-care (CP group, n: 53) and best-of-care only (control group, n: 53). An age, gender, and comorbidity were manually matched approximately at a 1:1 ratio. RESULTS: The prevalence of adverse transfusion reactions was 5.7%. A shorter duration of oxygen support (median: 12 days vs 14 days, P=0.030) and a shorter duration of mechanical ventilation (median: 6 days vs 10 days, P=0.048) were found in the CP group. The laboratory parameters were also improved. However, there was no significant difference in the mechanical ventilation rate, length of hospital stay, length of intensive care unit (ICU) stay, and mortality rate across both groups (P = 0.492, 0.614, 0.793, 0.374). CONCLUSION: CP transfusion is safe and effective in the treatment of severe COVID-19 patients. However, a revision of our approaches such as early CP transfusion and use of a high-titre anti-COVID-19 neutralising antibody (nAb) unit is necessary to unlock the full potential benefits of CP transfusion among COVID-19 patients.
Subject(s)
COVID-19 , Adult , Humans , COVID-19/therapy , SARS-CoV-2 , Blood Component Transfusion , Cross-Sectional Studies , Retrospective Studies , Immunization, Passive/adverse effects , COVID-19 Serotherapy , Plasma , Treatment OutcomeABSTRACT
Background: It's more than 2 years since the strike of a COVID-19 pandemic caused by severe acute respiratory syndrome Coronavirus 2. It had infected nearly 400 million populations globally and affected several important sectors worldwide such as the economy, social and healthcare services. To date, Malaysia recorded more than 3 million confirmed cases of COVID-19. The first nationwide Movement Control Order (MCO) started on 18th March 2020 then followed by multiple series of targeted MCOs on several states with a high surge up of cases. The National Blood Center (NBC) and State Blood Transfusion Services (SBTS) experienced significant reduction of blood collection, the shortage of blood availability and supply. The total blood collection in the year 2020 was 655,069 units, showing a 12% reduction compared with the year 2019. Blood supply management requires an integrated and holistic planning from all stakeholders to ensure the judicious use of blood and blood components in the normal situations, pandemics, crises, or during blood shortages. Aims: This study was to determine the characteristic of blood components mobilized during the COVID-19 Pandemic and to assess the coordination of inter-regional blood availability, supply, and transportation between the blood inventory of NBC, SBTS, or Hospital Blood Bank. Methods: A retrospective study was conducted from 18th March 2020 until 18th August 2021 where multiple series of MCOs were instated. Data from the blood inventory during the 18 months were analysed. All data were retrieved from Blood Bank Information System from NBC and SBTS. Results: A total of 17,144 units of blood components have been mobilized and distributed, comprised of 15,591 units of red cell, 1107 units of platelet concentrates, 299 units of Fresh Frozen Plasma, 125 units of Cryoprecipitate and 22 units of Convalescent Plasma. Overall, there were 20 blood collection centers comprised of NBC, state hospitals, and major hospitals involve as blood providers to the (Table Presented) several affected blood collection centers, beyond the state border. The states with major contributions for blood component mobilization were Kuala Lumpur, Sarawak and Johor while the collection centres that provided the most blood were National Blood Centre (4542 bags), Sultanah Aminah Hospital in Johor (1714 bags) and Malacca Hospital (1630 bags). The blood products have been shipped via hospitals' land transportation, air transportation by courier service and collaborative mercy flight by the Malaysian Air Force to the Malaysia East. The validated blood packaging and transportation procedure have been implemented to preserve the blood cold chain during blood mobilization through the air or by land transportation. Summary/Conclusions: The challenges during a pandemic are to deliver adequate, safe, and quality blood to the patient who needs blood transfusion for life-saving. Dynamic inter-state blood availability, supply and mobilization are essential to overcome the shortfall during a pandemic. Effective communication among NBC, SBTS, interagencies, governmental organizations, and postal service companies were among the great factors of success in transporting blood beyond borders to ensure blood availability. The plan was designed in response to the threat to the national blood supply from any untoward events that lead to blood shortages in a state, regional, or nationwide in Malaysia.
ABSTRACT
Background: Following the second wave of the COVID-19 outbreak, Malaysian authorities issued a Movement Control Order (MCO) on March 18, 2020. The emergency lockdown, while necessary to stop the spread, resulted in lower public attendance, cancellation of blood donation drives and eventually a nationwide blood shortage. Total blood collection decreased 21% by March 2020 compared to the previous year with the first 2 weeks of MCO witnessing 52% decline in collection. Consequently, emergency steps must be taken to secure a reliable blood supply. Aims: Explore interventions to mitigate the blood supply reduction during a pandemic. Methods: A forecast system using blood collection and supply data was utilized to discuss, formulate and implement an action plan. Daily to weekly meetings were held to assess and revise plans. Results: The key concept of sustaining blood supply is to balance a stable collection and allocating supply appropriately while preserving blood safety. Following initial discussions, staff were organized into three primary working groups to execute the plans. During the 84-days MCO and conditional MCO period, the blood reserve was below the safe threshold three times (3.6%). However, with these strategies in place, the blood reserve did not fall below critical level and 73% of hospital blood requests were met. Summary/Conclusions: In ensuring blood availability during a crisis, teamwork with various departments and clinicians plays a critical role. The ability of the transfusion service to adapt is critical, and key efforts done during the pandemic can be turned into effective blood supply preservation measures in the future.
ABSTRACT
Background: COVID-19 is an emerging infectious disease, caused by a novel coronavirus, now named SARS-CoV-2. It emerged in Wuhan city, Hubei province, China in December 2019 and continued peaking thereafter. There were only a few available antiviral treatments, which have limited efficacy on COVID-19 during the initial stage of the pandemic, which urged us to look into the use of convalescent plasma (CP) as an option Historically, CP had been applied to improve the survival rate of patients during various viral epidemics, including SARS, MERS, influenza and Ebola virus disease. It may also be a potentially effective treatment strategy for COVID-19 disease. Aims: This paper illustrated our experiences and strategies with regards to the development of the guideline for collection, processing and use of convalescent plasma (cp) for experimental treatment of covid-19. Methods: This guideline was created by a working group at the National Blood Centre Kuala Lumpur (NBCKL) with the collaboration of infectious disease (ID) experts from Sungai Buloh Hospital, who carefully examined the evidence and the combinations before suggesting the intervention. Results: The development of the guideline involved few phases. These include identification of the problem, systematic literature review for evidence on the guidelines, translation of evidence into a clinical practice guideline and finally, reviewing and submission of the guideline for publication to the Ministry of Health (MOH), Malaysia. Summary/Conclusions: In conclusion, we managed to publish the guideline for CP therapy as a potential treatment for COVID-19. The published guideline was readily assessable on the MOH website. It was a great collaboration between the transfusion and the infectious disease fraternity had made this possible.
ABSTRACT
Background: The Coronavirus Disease 2019 (COVID-19) pandemic was first detected in Wuhan, China. It is caused by a novel coronavirus known as Severe Acute Respiratory Distress Syndrome Coronavirus-2 (SARS-Cov-2). The pandemic presents a challenge to the healthcare system worldwide due to widespread infection and limited definitive therapeutic options available. The previous research suggested that convalescent plasma (CP) may be effective against infection. Aims: To investigate the effect of CP transfusion in the clinical outcome of severe COVID-19 patients. Methods: A cross-sectional study was conducted among severe COVID-19 adult patients admitted to six public hospitals across Malaysia from 1st August 2020 to 28th February 2021. A total of 53 patients received CP transfusion along with the standard care (intervention group) and another 53 patients received standard care only (control group) were recruited. An age, gender and comorbidity between the two groups were manually matched approximately at a 1:1 ratio. Each patient (intervention group) received at least a unit (approximately 250 ml) ABO-compatible CP over 1 or 2 h infusion. Another unit of CP was transfused after 24 h in 18 patients (34.0%) after being assessed by a treating physician. The convalescent plasma was collected from an individual who was recovered from COVID-19 infection, negative for COVID-19 reverse transcription-polymerase chain reaction (RT-PCR) and fulfilled the eligibility criteria for blood donation according to the national guideline. The anti-COVID-19 antibody was tested before the donation. However, the anti-COVID-19 neutralizing antibody (nAb) titre was not determined. The median interval between CP transfusion and severe COVID-19 staging was 2 days. The data were analysed using International Business Machines Corporation (IBM) Statistical Package for the Social Science (SPSS) Statistics Version 26 IBM, New York, USA. Results: The demographics of selected patients were male (60.4%), Malay race (83.0%), and has one or more comorbidity (74.5%). The commonest comorbidities were hypertension (47.2%), followed by diabetes mellitus (44.3%), dyslipidaemia (16.0%), and cardiovascular disease (16.0%). The commonest symptoms upon admission were cough (63.2%), followed by fever (60.4%), and shortness of breath (17.0%). The patients in the intervention group received a shorter duration of oxygen supplementation (median: 12 vs. 14 days, p = 0.030) and a shorter duration of mechanical ventilation (median: 6 vs. 10 days, p = 0.048). The difference in the mechanical ventilation rate, length of intensive care unit (ICU) stay, length of hospital stay, and mortality rate across both groups was not statistically significant (p = 0.492, 0.793, 0.614 and 0.374). The prevalence of adverse transfusion reactions was 5.7%. Summary/Conclusions: CP transfusion is safe and seems to be effective in the treatment of severe COVID-19 patients. However, a randomized-controlled trial with a larger sample size is necessary at the national level to ascertain the benefits of CP transfusion among severe COVID-19 patients.