ABSTRACT
Background: Presence of Anti-PF4 ELISA antibodies (APF4) has been reported among patients with SARS-CoV- 2 (COVID) infection and individuals who received COVID vaccines. These data are mostly limited to adults with sparse data among pediatric patients. Aim(s): This study aimed to determine the prevalence and demographics of APF4 positivity among hospitalized COVID pediatric patients and its impact on morbidity and mortality including ICU admission, length of stay (LOS), requirement of mechanical ventilation (MV), thrombosis and heparin therapy (HT). Method(s): Seventy-nine plasma samples from COVID positive (via PCR) patients (identified via in-house COVID testing) were tested for APF4 using PF4 Enhanced assay (Immucor GTI Diagnostics, USA). Demographics and clinical data were collected via retrospective review of electronic medical records. Result(s): Twenty patients of 79 (25%) COVID positive patients were found to have APF4 compared with 5% among COVID negative age and sex matched controls. There were no differences in age and gender between APF4 positive vs. APF4 negative COVID patients. Proportionally more Hispanic and Asian patients were APF4 positive (60% vs. 45% and 10% vs. 5% respectively). Table 1 highlighted the morbidity and mortality data of APF4 positive vs. negative patients. Among patients with thrombotic complications, only 3/8 (37%) patients had APF4. Lastly, there were no significant differences between APF4 positive vs. negative patients on HT in terms of thrombosis, percentage with thrombocytopenia as defined by platelet count <150,000/mul, ICU admission, LOS and MV. Conclusion(s): There is a high prevalence of APF4 positivity among pediatric COVID patients. However, the presence of APF4 appears to have no significant impact on morbidity and mortality. In addition, the presence of incidental APF4 should not limit the use of heparin therapy in pediatric COVID patients. (Table Presented).
ABSTRACT
Background. Published data on COVID-19 convalescent plasma (CCP) use in children and obstetric patients is limited. We describe a single-center experience of hospitalized patients who received CCP for acute COVID-19. Methods. We performed a retrospective review of children 0-18-years-old and pregnant patients hospitalized with laboratory-confirmed acute COVID-19 who received CCP from March 1st, 2020 to March 1st, 2021. Clinical and laboratory data were collected to assess the safety of CCP administration. Antibodies to SARS-CoV-2 were measured before and at various timepoints post CCP transfusion. Correlation between SARS-CoV-2 immunoglobulin administered versus the SARS-CoV-2 anti-Spike immunoglobulin response in patient serum was assessed. Results. Twenty-two children and 10 obstetric patients were eligible. 12 pediatric and 8 obstetric patients had moderate disease and 10 pediatric and 2 obstetric patients had severe disease. 5 pediatric patients died. 18/37 (48.6%) CCP units that were measured met FDA criteria for a high IgG titer. There were no complications with transfusion based on CDC, NHSN Biovigilance Component: Hemovigilance Module Surveillance Protocol. Two pediatric patients had fevers a few hours after CCP with low suspicion for a transfusion reaction. Median SARS-CoV-2 anti-spike antibody levels of pediatric patients post-transfusion for 0-7 days was 80.6AU/mL (range: 2-1070), 8-21 days was 180AU/mL (range: 12-661) and >21 days was 210AU/mL (range: 4.1-1220). For obstetric patients, post-transfusion antibody levels were only obtained 0-7 days post-transfusion with median 45AU/mL (range: 9.5-100). High-titer CCP showed a positive correlation with rise in patient immunoglobulin levels only in the obstetric patients but not in pediatric patients. Conclusion. CCP was administered safely to our moderately to severely ill pediatric and obstetric patients. Among pediatric patients, the median serum antibody level increased over time after transfusion and suggested that CCP did not interfere with the endogenous antibody production. Antibody dose of high-titer CCP correlated with post-transfusion response in only obstetric patients. Randomized trials in pediatric and obstetric patients are needed to further understand how to dose CCP and evaluate efficacy.
ABSTRACT
Background : One of the biggest challenges in the care of COVID-19 infected patients is predicting the severity of disease course and the need for ICU care and/or ventilator support. Published studies have suggested that D-dimer on admission can predict in-hospital mortality and prognosis. However, these data are mostly limited to adult populations with limited studies in pediatric populations. Aims : To determine if coagulation parameters at admission are associated with clinical severity of COVID-19 infection among pediatric patients. Methods : We retrospectively reviewed admission coagulation studies [Diagnostica Stago, Inc] (D-dimer, Prothrombin Time, PTTHepzyme, Fibrinogen and Platelet (PLT) count) in children with a COVID-19 diagnosis at a tertiary care pediatric hospital from April 2020 through February 2021. Disease severity was determined by ICU admission, length of stay (LOS), and need for ventilator support. Statistical analysis, including Mann Whitney U test and Pearson correlation was performed with data presented as mean ± SD with significance of P < 0.05. Results : There were 110 pediatric patients (57 females) ranging from 0.5 months to 18 years who had coagulation studies collected within 24 h of admission. Patients were divided into three groups based on ICU admission and ventilation support (see Table). Patients who required ICU admission and ventilation support had significantly higher D-dimer ( P = 0.0006) and PT ( P = 0.0083) values compared to patients who required neither. In addition, D-dimer was higher in this group when compared to those in the ICU only group ( P = 0.0099). Only D-dimer showed moderate correlation with LOS in the total cohort of patients ( r = 0.46, P < 0.0001) (Fig. 1). Conclusions : Elevated D-dimer significantly correlated with severity of disease and LOS, while elevated PT only correlated with disease severity. Our data suggest that D-dimer at admission may predict a pediatric patient's need for ICU care or ventilator support.