Convalescent plasma transfusion in severe COVID-19 patients: Clinical and laboratory outcomes.

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.

National Blood Centre (NBC) experience on development of the guideline for collection, processing and the use of convalescent plasma (CP) for experimental treatment of COVID-19

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.

Clinical outcome of severe COVID-19 patients transfused with convalescent plasma in Malaysia

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.