Role of therapeutic plasma exchange in the management of COVID-19-induced cytokine storm syndrome.

The risk of mortality in patients with coronavirus disease 2019 (COVID-19) is largely related to an excessive immune response, resulting in a hyperinflammatory and hypercoagulable condition collectively referred to as cytokine storm syndrome (CSS). Management of critically ill patients with COVID-19 has included attempts to abate this process, prevent disease progression, and reduce mortality. In this context, therapeutic plasma exchange (TPE) offers an approach to eliminate inflammatory factors and cytokines, offset the pathologic coagulopathy, and reduce the CSS effects. The aim of this review is to analyze available data on the use of TPE for the treatment of CSS in patients with COVID-19. Systematic searches of PubMed, Scopus and COVID-19 Research were conducted to identify articles published between March 1, 2020 and May 26, 2021 reporting the use of TPE for the treatment of COVID-19-induced CSS. A total of 34 peer-reviewed articles (1 randomized controlled trial, 4 matched case-control series, 15 single-group case series, and 14 case reports), including 267 patients, were selected. Despite the low evidence level of the available data, TPE appeared to be a safe intervention for critically ill patients with COVID-19-induced CSS. Although inconsistencies exist between studies, they showed a general trend for decreased interleukin-6, C-reactive protein, ferritin, D-dimer, and fibrinogen levels and increased lymphocyte counts following TPE, supporting the immunomodulatory effect of this treatment. Moreover, TPE was associated with improvements in clinical outcomes in critically ill patients with COVID-19. While TPE may offer a valuable option to treat patients with COVID-19-induced CSS, high-quality randomized controlled clinical trials are needed to confirm its potential clinical benefits, feasibility, and safety. Moreover, clear criteria should be established to identify patients with CSS who might benefit from TPE.

Plasmapheresis and Plasma Donation: Challenges in the Blood/Plasma Supply Chain

Voluntary non-remunerated blood donation is well-established in many countries;however, this approach is under pressure to provide sufficient plasma for future needs. In this article we consider various aspects of plasma donation, including donor characteristics, health and safety issues, and motivating factors, including the potential role of incentives. The status of plasma donation in various European countries, and challenges associated with the COVID-19 pandemic are also discussed. Common motivators for plasma donors include the benefit that donated plasma provides for other people, the sense that helping others is in their nature, a sense of pride at undertaking a special task, and the desire to achieve donation goals. Motivations may differ between age groups and gender. Donating plasma is safe and adverse events are infrequent, with the most common being hypotensive/vasovagal events and phlebotomy events. The main reasons plasma donors discontinue are socioeconomic, relating to the time required and conflicts with work and other commitments. When persuading donors to convert from whole blood to plasma donation, face-to-face requests are more successful than leaflets or telephone/email requests, and clear information addressing health and safety concerns is needed. However, telephone/email communication can be helpful for encouraging plasma donors to return for future donations or to donate more frequently. There is ongoing debate about non-remunerated versus remunerated plasma donation. Remuneration may be an incentive for some individuals, whereas it may deter people who have a strong altruistic drive. It has been suggested that a combination of paid and unpaid donation systems could cover a wider range of potential donors. Most European countries currently have non-remunerated donor systems, but a few do allow monetary compensation.

Lessons learned from the use of convalescent plasma for the treatment of COVID-19 and specific considerations for immunocompromised patients.

Coronavirus disease 2019 (COVID-19) convalescent plasma (CovCP) infusions have been widely used for the treatment of hospitalized patients with COVID-19. The aims of this narrative review were to analyze the safety and efficacy of CovCP infusions in the overall population and in immunocompromised patients with COVID-19 and to identify the lessons learned concerning the use of convalescent plasma (CP) to fill treatment gaps for emerging viruses. Systematic searches (PubMed, Scopus, and COVID-19 Research) were conducted to identify peer-reviewed articles and pre-prints published between March 1, 2020 and May 1, 2021 on the use of CovCP for the treatment of patients with COVID-19. From 261 retrieved articles, 37 articles reporting robust controlled studies in the overall population of patients with COVID-19 and 9 articles in immunocompromised patients with COVID-19 were selected. While CovCP infusions are well tolerated in both populations, they do not seem to improve clinical outcomes in critically-ill patients with COVID-19 and no conclusion could be drawn concerning their potential benefits in immunocompromised patients with COVID-19. To be better prepared for future epidemics/pandemics and to evaluate potential benefits of CP treatment, only CP units with high neutralizing antibodies (NAbs) titers should be infused in patients with low NAb titers, patient eligibility criteria should be based on the disease pathophysiology, and measured clinical outcomes and methods should be comparable across studies. Even if CovCP infusions did not improve clinical outcomes in patients with COVID-19, NAb-containing CP infusions remain a safe, widely available and potentially beneficial treatment option for future epidemics/pandemics.