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1.
Annals of Critical Care ; 2022(2):108-120, 2022.
Article in English | Scopus | ID: covidwho-1904080

ABSTRACT

INTRODUCTION. High mortality during the pandemic of COVID-19 conducted the research for all available treatments. Convalescent plasma (CP) has become valuable empirical resource for health support, especially during the initial phase of COVID-19 pandemic. It still draws attention of many scientists, while data on the effectiveness of CP is rather controversial. OBJECTIVES. The purpose of this review is to analyze the results of modern studies on the efficacy and safety of the clinical use of CP. MATERIALS AND METHODS. The search for publications was carried out in electronic databases PubMed, MedRxiv, Cochrane Library, Cochrane COVID-19 study registry from June 7, 2021 to December 20, 2021. RESULTS. The article analyzes data from recent retrospective and prospective studies related to CP therapy. The use of CP is known since the 1880s in the treatment of diphtheria, Spanish flu, measles, polio. In the 21st century CP has been used in the epidemic of Ebola, H1N1pdm09, other SARS1 and MERS coronaviruses. CP therapy is based on the concept of passive immunization and includes the infusion of antibodies from convalescent donors with virus-neutralizing activi-ty (VNA). Pathogen reduction technologies are used to minimize the risks of transfusion-transmitted infections. Historical and current data confirm the safety of CP use. The criteria for effectiveness and timing for transfusion of the CP were considered. Clinical data is presented confirming the effectiveness of CP in certain groups of patients. CONCLUSIONS. The use of CP is safe and reasonable in seronegative patients with COVID-19 on the early stages of the disease or in the presence of an immunodeficiency. CP with high VNA titers has the highest efficiency. CP therapy in severe patients on the late stages of the disease does not provide disease regression and increased survival. © 2022, Practical Medicine Publishing House LLC. All rights reserved.

2.
Tromboz, Gemostaz i Reologiya ; 2021(3):12-15, 2021.
Article in Russian | Scopus | ID: covidwho-1776792

ABSTRACT

Hypercoagulable character of coagulopathy associated with the novel coronavirus infection COVID-19, and the high risk of associated thrombotic complications is a well-known fact. However, there are also case reports of hemorrhagic events in COVID patients in the literature. The review summarizes the publications describing bleedings in coronavirus infection;their overall frequency is on average 4–8%. Gastrointestinal bleeding are prevalent, intermuscular hematomas and hemorrhages in the skin and mucous membranes are frequent. The predictive role of anticoagulants use in therapeutic doses and hypofibrinogenemia is shown. The absence of clear understanding of the pathophysiological mechanisms is noted. © Simarova I. B., Perehodov S. N., Bulanov A.Yu., 2021 © Gemostaz i Reologia LLC, 2021.

3.
Klin Lab Diagn ; 66(11): 661-665, 2021 Nov 29.
Article in English | MEDLINE | ID: covidwho-1625999

ABSTRACT

The frequency of AB0 and Rhesus blood groups was studied in 12120 patients with COVID-19, 5180 convalescent plasma donors and 118801 healthy donors from Moscow, Smolensk, Yakutsk, Minsk and Gomel. In infected individuals, the frequency of blood group A was significantly higher than in uninfected individuals (41,54 % and 34,39 % respectively, p<0,05), and the frequency of blood group 0, on the contrary, was significantly lower (27,69 % and 36,71 %, p<0,05). The frequency of blood group A was particularly high among patients who died from ARVI COVID-19 - 45,51 % vs. 34,39 %, p=0,008. In some groups of patients, there was a decrease in the frequency of Rh-negative individuals (2,23 % vs. 8,30 %, p<0,001).


Subject(s)
COVID-19 , ABO Blood-Group System , COVID-19/therapy , Humans , Immunization, Passive , Risk Factors , SARS-CoV-2
4.
Pediatriya. Zhurnal im. G.N. Speranskogo ; 99(6):62-73, 2020.
Article in Russian | Russian Science Citation Index | ID: covidwho-1094689

ABSTRACT

Materials and methods: a prospective non-randomized pilot multicenter study of the informativeness and clinical significance of hemostasis laboratory tests in 1210 patients with COVID-19 in disease course, including favorable and unfavorable outcomes, was performed. Hemostasis was assessed using clotting tests and D-dimer concentration, thromboelastography (TEG) and thrombodynamics (TD). Results: comparison of COVID-19 laboratory parameters and clinical picture showed that 75% of patients have pronounced activation of the plasma coagulation system upon admission to the hospital. Hypercoagulation is recorded in all tests, reaching a maximum in patients with subtotal (CT-3) and total (CT-4) lung lesion and/or resuscitation patients with a clinical picture of pulmonary embolism and unfavorable outcome. Low molecular weight heparins (LMWH) in a standard dosage leads to suppression of the initial hypercoagulable syndrome in more than half of the patients (from 75 to 31%). All patients without LMWH laboratory effect developed thrombotic complications. For clotting tests, insufficient sensitivity to changes in hemostasis against the background of LMWH was revealed. The D-dimer test effectively correlates with the severity and outcomes of COVID-19, but is not suitable for the control of heparin therapy, which is associated with the effect of lysis of existing blood clots and the lack of response to a decrease in the coagulation activity of patients. Methods of thromboelastography and thrombodynamics effectively record a decrease in the activity of the coagulation system and can be used to control heparin therapy. The correlation coefficient between the methods was 0,77. The dynamic indices of D-dimers, TEG and TD in severe patients and, especially, in patients with fatal outcomes revealed the greatest sensitivity to the control of heparin therapy in the Thrombodynamics test, which allows, along with thrombosis, to record hypercoagulable states and the risk of bleeding, which are the outcome of thrombohemorrhagic syndrome in patients with COVID-19. Материалы и методы исследования: проведено проспективное открытое нерандомизированное пилотное многоцентровое исследование информативности и клинической значимости лабораторных тестов гемостаза у 1210 пациентов с COVID-19 в динамике заболевания, включая благоприятные и неблагоприятные исходы. Оценку гемостаза проводили с использованием клоттинговых тестов и концентрации D-димера, тромбоэластографии (ТЭГ) и тромбодинамики (ТД). Результаты: при сопоставлении лабораторных показателей и клинической картины COVID-19 показано, что у 75% больных при поступлении в стационар наблюдается выраженная активация плазменной системы свертывания. Гиперкоагуляция фиксируется по всем тестам, достигая максимума у больных с субтотальным (КТ-3) и тотальным (КТ-4) поражением легких и/или реанимационных больных с клинической картиной тромбоэмболии легочной артерии и неблагоприятным исходом. Назначение низкомолекулярных гепаринов (НМГ) в стандартной дозировке приводит к подавлению исходного гиперкоагуляционного синдрома более чем у половины больных (с 75 до 31%). Все пациенты без лабораторного эффекта НМГ развили тромботические осложнения. Для клоттинговых тестов выявлена недостаточная чувствительность к изменениям гемостаза на фоне НМГ. Тест на D-димер эффективно коррелирует с тяжестью и исходами COVID-19, но непригоден для контроля гепаринотерапии, что связано с эффектом лизиса существующих тромбов и отсутствием ответа на снижение коагуляционной активности больных. Методы ТЭГ и ТД эффективно регистрируют снижение активности свертывающей системы и могут использоваться для контроля гепаринотерапии. Коэффициент корреляции между методами составил 0,77. Заключение: динамические индексы D-димеров, ТЭГ и ТД у тяжелых больных и особенно у пациентов с летальными исходами выявили наибольшую чувствительность к контролю гепаринотерапии у теста ТД, что позволяет наряду с тромбозами фиксировать гиперкоагуляционные состояния и риск кровотечений - исходы тромбогеморрагического синдрома у больных с COVID-19.

5.
Profilakticheskaya Meditsina ; 23(6):85-89, 2020.
Article in Russian | EMBASE | ID: covidwho-1006800

ABSTRACT

Blood coagulation abnormalities play an important role in the pathophysiology of COVID-19. However, the specific details of hy-per-coagulation and anticoagulant treatment require further investigations. The objective was to study the indicators of two global tests for the status of the hemostasis system assessment in patients with CO-VID-19 at the time of admission to the clinic (before the start of anticoagulant therapy) and in patients receiving heparin during treatment in the clinic. Material and methods. Global thrombodynamics (TD) and thromboelastography (TEG) tests, as well as coagulogram screening tests (APTT, PT, INR, and fibrinogen) were performed in 136 patients with COVID-19 observed in a hospital setting. All patients received low molecular weight heparins at therapeutic dosages relatively to body weight in accordance with the hospital proto-col for patients with COVID-19. Results. In patients prior to treatment, marked hypercoagulability was observed in all global tests. The main parameters of TD (clot growth rate Vi and Vs) exceeded the reference range in more than 83% and 75% of patients, respectively. Citrate native TEG parameters (R, K, angle α and MA) also showed hyper-coagulation before anticoagulant therapy initiation in 24%, 17%, 48% and 53% of patients, respectively. After the start of treatment, a significant heparin response was obtained for the Vs parameter (the most sensitive to heparin parameter of TD): in 75% of cases, TD recorded hypo-coagulation, in 15% — normocoagulation, and in 10% of measurements, TD parameters continued to be in the hyper-coagulation range. The TEG parameter most sensitive to heparin (angle α) showed a lower response to heparin: it registered hypo-coagulation only in 25% of measurements, in 60% — normoco-agulation, and in 15% the parameter was in the hyper-coagulation range. Conclusion. The significant share of hypercoagulant results (10-15%) may indicate that some patients have not achieved a suffi-cient anticoagulant effect under the therapy.

6.
Russian Journal of Hematology and Transfusiology ; 65(3):242-250, 2020.
Article in English | Web of Science | ID: covidwho-859444

ABSTRACT

Background. The application of convalescent plasma (CP) is currently seen as a feasible therapeutic approach in the treatment of COVID-19.Aim. To analyze the experience of recruiting a donor cohort from COVID-19 convalescents for banking of CP as part of a pilot project at the Moscow Healthcare Department.Materials and methods. A retrospective research included 493 COVID-19 convalescents as potential CP donors, all examined at the Sklifosovsky Research Institute for Emergency Medicine. CP was banked using the plasmapheresis method. Only those donors with a documented medical history of COVID-19, which was confi rmed by polymerase chain reaction of SARS-CoV-2 RNA in pharyngeal swabs, and no sooner than 14 days after complete recovery were eligible for donation. Viral neutralizing activity (VNA) was chosen as the key characteristic of the immunological viability of CP. All the donors having VNA titers were characterized in terms of gender, age, time interval since the disease onset, regression of clinical symptoms and clinical features of the COVID 19 course.Results. Effective (1:160 or more) and acceptable (1:80) VNA titers were found in 21.1 % and 24.75 % of donors, respectively. Signifi cant predictors for a donor having a high VNA titer included: male sex, age over 36 years and verifi ed viral pneumonia. The absence of a signifi cant body temperature response (38.5 °С) can be considered as a negative marker of a potential donor. Введение. Трансфузии плазмы антиковидной патогенредуцированной (ПАП) рассматривается как один из методов лечения COVID-19. Цель: проанализировать опыт формирования донорского резерва из реконвалесцентов COVID-19 для заготовки ПАП.Материалы и методы. В ретроспективное исследование включено 493 реконвалесцента COVID-19, проходивших обследование в ГБУЗ «НИИ скорой помощи им. Н. В. Склифосовского ДЗМ» в качестве потенциальных доноров ПАП. Заготовку ПАП осуществляли методом плазмафереза. К процедуре плазмодачи допускали доноров, у которых в анамнезе была перенесенная инфекция COVID-19, подтвержденная выявлением методом полимеразной цепной реакции РНК SARS-CoV-2 в мазках из глотки, наличие медицинской документации, срок с момента разрешения заболевания не менее 14 суток. В качестве характеристики иммунологической состоятельности ПАП был выбран титр вируснейтрализующих антител (ВНА). Сопоставлены характеристики доноров (пол, возраст, давность с момента начала заболевания и регресса клинической симптоматики, особенности течения COVID-19) с титром ВНА.Результаты. Эффективный титр ВНА (1:160 и более) выявлен у 21,10 % доноров, допустимый (1:80) - у 24,75 %. Значимыми предикторами высокого титра ВНА оказались: мужской пол донора, возраст старше 36 лет, наличие верифицированной вирусной пневмонии. Отсутствие значимой температурной реакции (38,5 °C) может рассматриваться как отрицательный маркер для привлечения потенциального донора. Заключение. Для получения ПАП с высокими титрами ВНА оптимально привлечение в качестве доноров-реконвалесцентов мужчин, переболевших COVID-19 с клинической картиной вирусной пневмонии и значимой температурной реакцией.

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