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1.
J Clin Apher ; 36(4): 628-633, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1748739

ABSTRACT

BACKGROUND: Criteria for selection of FFP blood type has not been clearly established and use of group AB plasma is preferred by numerous transplantation protocols. AIMS: This study assesses the safety and efficacy of alternative group A or B plasma in ABO incompatible solid organ transplantation. MATERIALS & METHODS: Alternative use of group A or B plasma (incompatible plasma) was inevitable during the shortage of group AB plasma. Experience from select number of patients during the period of extreme group AB plasma shortage is described. RESULTS: The result of alternative use of group A or B plasma was within expectation, showing effective reduction of isoagglutinin titers for pre-operative desensitization and efficacy for treatment of post-operative patients. No immediate hemolytic transfusion reaction was reported. DISCUSSION: While validation in a larger cohort of patients is necessary, our limited experience have shown satisfactory clinical outcomes without adverse events. CONCLUSIONS: Use of incompatible group A or B plasma is a viable option when group AB plasma is limited.


Subject(s)
ABO Blood-Group System , Blood Group Incompatibility/therapy , Plasma Exchange/methods , Transplantation/methods , Agglutinins/chemistry , Blood Banks/supply & distribution , Graft Survival , Hemolysis , Humans , Kidney Transplantation/adverse effects , Patient Safety , Plasma/immunology , Plasmapheresis , Transfusion Reaction , Treatment Outcome
2.
Sci Rep ; 12(1): 3890, 2022 03 10.
Article in English | MEDLINE | ID: covidwho-1740469

ABSTRACT

The new outbreak of coronavirus disease 2019 (COVID-19) has infected and caused the death of millions of people worldwide. Intensive efforts are underway around the world to establish effective treatments. Immunoglobulin from immunized animals or plasma from convalescent patients might constitute a specific treatment to guarantee the neutralization of the virus in the early stages of infection, especially in patients with risk factors and a high probability of progressing to severe disease. Worldwide, a few clinical trials using anti-SARS-CoV-2 immunoglobulins from horses immunized with the entire spike protein or fragments of it in the treatment of patients with COVID-19 are underway. Here, we describe the development of an anti-SARS-CoV-2 equine F(ab')2 immunoglobulin using a newly developed SARS-CoV-2 viral antigen that was purified and inactivated by radiation. Cell-based and preclinical assays showed that the F(ab')2 immunoglobulin successfully neutralizes the virus, is safe in animal models, and reduces the severity of the disease in a hamster model of SARS-CoV-2 infection and disease.


Subject(s)
COVID-19/therapy , Immunoglobulins/therapeutic use , Receptors, Immunologic/therapeutic use , SARS-CoV-2/immunology , Animals , Enzyme-Linked Immunosorbent Assay , Female , Horses/immunology , Humans , Immunoglobulins/immunology , Immunoglobulins/isolation & purification , Male , Mesocricetus/immunology , Plasmapheresis/veterinary , Receptors, Immunologic/immunology
3.
Zh Nevrol Psikhiatr Im S S Korsakova ; 121(9): 100-103, 2021.
Article in Russian | MEDLINE | ID: covidwho-1485581

ABSTRACT

The article presents a clinical example of Guillain-Barre syndrome with a predominant involvement of cranial nerves, which developed after COVID-19. Comprehensive clinical and laboratory diagnostics, including examination of cerebrospinal fluid, electromyography, examination for possible etiological infectious agents, was carried out. A course of pathogenetic therapy was used in the form of plasmapheresis sessions, supportive therapy. A good clinical effect was obtained. To this moment, only a few cases of the development of Guillain-Barré syndrome after a new coronavirus infection have been described. The peculiarity of our case is the development of a clinical picture of insufficiency of predominantly cranial nerves with subclinical involvement of the nerves of the extremities.


Subject(s)
COVID-19 , Guillain-Barre Syndrome , Cranial Nerves , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/etiology , Guillain-Barre Syndrome/therapy , Humans , Plasmapheresis , SARS-CoV-2
4.
Respir Med ; 189: 106669, 2021.
Article in English | MEDLINE | ID: covidwho-1482946

ABSTRACT

INTRODUCTION: Cytokine storm is one of the consequences of the severe forms of COVID-19 due to excessive immune response. In this study, we investigated the therapeutic effect of plasmapheresis and its role on the inflammatory cytokines levels in patients suffering from severe COVID-19. METHODS: In plasmapheresis group, 22 severe cases of COVID-19 receiving three cycles of plasmapheresis with time interval of 24-36 h and 22 COVID-19 patients as the control group were enrolled. Clinical history and laboratory parameters as well as IL-1, IL-6, IFN-γ and IL-17 cytokines serum levels in the time points of before and after plasmapheresis were studied. RESULTS: In severe COVID-19 patients, plasmapheresis significantly improved clinical and laboratory parameters such as cough, weakness, fever, blood oxygen saturation and CRP levels. Serum levels of IL-1, IL-6, IFN-γ and IL-17 in the group of patients receiving plasmapheresis, had a significant decrease following plasmapheresis courses. Although only IL-6 level in the control group had a significant decrease between the days 1-14 of disease. Also, at both time points of before and after plasmapheresis, serum levels of IL-1, IL-6, IFN-γ and IL-17 were inversely correlated to blood oxygen saturation. CONCLUSION: Based on the obtained results, plasmapheresis therapy in severe forms of COVID-19 can effectively improve the clinical symptoms of the disease and reduce inflammatory markers. Therefore, it is suggested that plasmapheresis can be evaluated in standard treatment protocols for severe forms of COVID-19.


Subject(s)
COVID-19/diagnosis , COVID-19/therapy , Cytokines/blood , Inflammation Mediators/blood , Plasmapheresis/methods , Adult , Aged , Biomarkers/blood , COVID-19/immunology , Female , Humans , Interferon-gamma/blood , Interleukin-1/blood , Interleukin-17/blood , Interleukin-6/blood , Male , Middle Aged , Patient Acuity , Treatment Outcome
7.
J Neurovirol ; 27(5): 797-801, 2021 10.
Article in English | MEDLINE | ID: covidwho-1432669

ABSTRACT

Guillain-Barré syndrome (GBS) is an ascending demyelinating polyneuropathy often associated with recent infection. Miller Fisher syndrome represents a variant with predominant facial and cranial nerve involvement, although Miller Fisher and Guillain-Barré overlap syndromes can occur. Guillain-Barré spectrum syndromes have been thought to be rare among solid organ transplant recipients. We describe an immunocompromised patient with a liver transplant who presented with ophthalmoplegia and bulbar deficits. His symptoms rapidly progressed to a state of descending paralysis involving the diaphragm; he then developed acute respiratory failure and eventually developed quadriparesis. Electromyography and a nerve conduction study demonstrated a severe sensorimotor axonal polyneuropathy consistent with Miller Fisher variant Guillain-Barré syndrome. Despite several negative nasopharyngeal swabs for COVID-19 polymerase chain reaction, a serology for SARS-CoV-2 IgG was positive. He was diagnosed with Miller Fisher-Guillain-Barré overlap syndrome with rapid recovery following treatment with plasma exchange. Although Guillain-Barré is a rare complication in solid organ transplant recipients, this case highlights the importance of rapid diagnosis and treatment of neurologic complications in transplant patients. Furthermore, it demonstrates a possible case of neurological complications from COVID-19 infection.


Subject(s)
COVID-19/complications , Guillain-Barre Syndrome/immunology , Guillain-Barre Syndrome/virology , Miller Fisher Syndrome/immunology , Miller Fisher Syndrome/virology , Guillain-Barre Syndrome/therapy , Humans , Immunocompromised Host , Liver Transplantation , Male , Middle Aged , Miller Fisher Syndrome/therapy , Plasmapheresis , SARS-CoV-2 , Transplant Recipients
8.
Int J Dermatol ; 61(2): 252-256, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1406554

ABSTRACT

Bullous pemphigoid (BP) patients were vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection because they have similar risk factors, so we should pay attention to patients with BP during the epidemic of coronavirus disease-19 (COVID-19). As far as treatment is concerned, many strategies for BP were changed during the epidemic. Plasmapheresis not only has been included in the guidelines for BP but also has been used successfully to rescue COVID-19 patients, especially in severe cases. Therefore, it is a feasible choice for BP patients, especially for refractory BP patients, infected with SARS-CoV-2. Apart from these, we have reviewed some points for attention during the plasmapheresis session.


Subject(s)
COVID-19 , Pemphigoid, Bullous , Humans , Pemphigoid, Bullous/therapy , Plasmapheresis , SARS-CoV-2
9.
Neurologist ; 26(5): 196-224, 2021 Sep 07.
Article in English | MEDLINE | ID: covidwho-1398198

ABSTRACT

BACKGROUND: Central nervous system complications are reported in an increasing number of patients with Coronavirus Disease 2019 (COVID-19). COVID-19-related Guillain-Barré syndrome (GBS) is of particular importance given its association with higher mortality rates and prolonged respiratory failure. REVIEW SUMMARY: We conducted a systematic review of published cases for COVID-19-related GBS, and provide a summary of clinical management strategies for these cases. Sixty-three studies, including 86 patients, were included. Seventy-six cases with reported outcome data were eligible for the outcome analysis. Ninety-nine percent of patients were diagnosed with COVID-19 before diagnosis of GBS (median: 14 d prior, interquartile range: 7 to 20). Intravenous immunotherapy (intravenous immunoglobulin: 0.4 g/kg/d for 5 d) was the most frequently used treatment approach. The review indicated that the outcome was not favorable in 26% of cases (persistent neurological deficits). A mortality rate of 3.5% was observed in patients with COVID-19-related GBS. CONCLUSIONS: Although evidence to support specific treatments is lacking, clinicians should consider the benefits of immunotherapy and plasma exchange in addition to the standard antimicrobial and supportive therapies for patients who meet the diagnostic criteria for acute sensory and motor polyradiculoneuritis. Intravenous immunoglobulin treatment alone is not shown to result in improved outcomes or mortality. More extensive studies aimed at exploring the neurological manifestations and complications of COVID-19 and distinctive treatment options for COVID-19-related GBS are warranted.


Subject(s)
COVID-19/drug therapy , Guillain-Barre Syndrome/drug therapy , Immunoglobulins, Intravenous/therapeutic use , SARS-CoV-2/drug effects , Thyroid Neoplasms/drug therapy , Guillain-Barre Syndrome/diagnosis , Humans , Plasma Exchange/methods , Plasmapheresis/adverse effects , Plasmapheresis/methods
13.
Neurol Neuroimmunol Neuroinflamm ; 8(6)2021 11.
Article in English | MEDLINE | ID: covidwho-1376615

ABSTRACT

BACKGROUND AND OBJECTIVES: Since the onset of the COVID-19 pandemic, a growing number of reports have described cases of acute disseminated encephalomyelitis (ADEM) and acute hemorrhagic leukoencephalitis (AHLE) following infection with COVID-19. Given their relatively rare occurrence, the primary objective of this systematic review was to synthesize their clinical features, response to treatments, and clinical outcomes to better understand the nature of this neurologic consequence of COVID-19 infection. METHODS: Patients with a history of COVID-19 infection were included if their reports provided adequate detail to confirm a diagnosis of ADEM or AHLE by virtue of clinical features, radiographic abnormalities, and histopathologic findings. Cases purported to be secondary to vaccination against COVID-19 or occurring in the context of a preexisting relapsing CNS demyelinating disease were excluded. Case reports and series were identified via PubMed on May 17, 2021, and 4 additional cases from the authors' hospital files supplemented the systematic review of the literature. Summary statistics were used to describe variables using a complete case analysis approach. RESULTS: Forty-six patients (28 men, median age 49.5 years, 1/3 >50 years old) were analyzed, derived from 26 case reports or series originating from 8 countries alongside 4 patient cases from the authors' hospital files. COVID-19 infection was laboratory confirmed in 91% of cases, and infection severity necessitated intensive care in 67%. ADEM occurred in 31 cases, whereas AHLE occurred in 15, with a median presenting nadir modified Rankin Scale score of 5 (bedridden). Anti-MOG seropositivity was rare (1/15 patients tested). Noninflammatory CSF was present in 30%. Hemorrhage on brain MRI was identified in 42%. Seventy percent received immunomodulatory treatments, most commonly steroids, IV immunoglobulins, or plasmapheresis. The final mRS score was ≥4 in 64% of patients with adequate follow-up information, including 32% who died. DISCUSSION: In contrast to ADEM cases from the prepandemic era, reported post-COVID-19 ADEM and AHLE cases were often advanced in age at onset, experienced severe antecedent infection, displayed an unusually high rate of hemorrhage on neuroimaging, and routinely had poor neurologic outcomes, including a high mortality rate. Findings are limited by nonstandardized reporting of cases, truncated follow-up information, and presumed publication bias.


Subject(s)
COVID-19/complications , Encephalomyelitis, Acute Disseminated/etiology , Brain/diagnostic imaging , Brain/pathology , Encephalomyelitis, Acute Disseminated/mortality , Encephalomyelitis, Acute Disseminated/physiopathology , Encephalomyelitis, Acute Disseminated/therapy , Glucocorticoids/therapeutic use , Humans , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , Intensive Care Units , Leukoencephalitis, Acute Hemorrhagic/etiology , Leukoencephalitis, Acute Hemorrhagic/mortality , Leukoencephalitis, Acute Hemorrhagic/physiopathology , Leukoencephalitis, Acute Hemorrhagic/therapy , Magnetic Resonance Imaging , Plasmapheresis , SARS-CoV-2 , Severity of Illness Index
14.
Vox Sang ; 116(7): 798-807, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1370878

ABSTRACT

BACKGROUND AND OBJECTIVES: Cytokine release syndrome in COVID-19 is due to a pathological inflammatory response of raised cytokines. Removal of these cytokines by therapeutic plasma exchange (TPE) prior to end-organ damage may improve clinical outcomes. This manuscript is intended to serve as a preliminary guidance document for application of TPE in patients with severe COVID-19. MATERIAL AND METHODS: The available literature pertaining to the role of TPE for treatment of COVID-19 patients was reviewed to guide optimal management. It included indication, contraindication, optimal timing of initiation and termination of TPE, vascular access and anticoagulants, numbers and mode of procedures, outcome measures and adverse events. RESULTS: Out of a total of 78 articles, only 65 were directly related to the topic. From these 65, only 32 were acceptable as primary source, while 33 were used as supporting references. TPE in critically ill COVID-19 patients may be classified under ASFA category III grade 2B. The early initiation of TPE for 1-1·5 patient's plasma volume with fresh frozen plasma, or 4-5% albumin or COVID-19 convalescent plasma as replacement fluids before multiorgan failure, has better chances of recovery. The number of procedures can vary from three to nine depending on patient response. CONCLUSION: TPE in COVID-19 patients may help by removing toxic cytokines, viral particles and/or by correcting coagulopathy or restoring endothelial membrane. Severity score (SOFA & APACHE II) and cytokine levels (IL-6, C-reactive protein) can be used to execute TPE therapy and to monitor response in COVID-19 patients.


Subject(s)
COVID-19 , Plasma Exchange , COVID-19/therapy , Humans , Immunization, Passive , Plasmapheresis , Retrospective Studies , SARS-CoV-2 , Treatment Outcome
15.
Front Immunol ; 12: 711915, 2021.
Article in English | MEDLINE | ID: covidwho-1317228

ABSTRACT

Passive antibody therapy has been used to treat outbreaks of viral disease, including the ongoing pandemic of severe respiratory acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2) or COVID-19. However, the real benefits of the procedure are unclear. We infused a concentrated solution of neutralizing anti-SARS-CoV-2 antibodies obtained from a convalescent donor with a single session of double filtration plasmapheresis (DFPP) into a 56-year-old woman with long history of unremitting, severe COVID-19. She was unable to establish an adequate antiviral immune response because of previous chemotherapy, including the infusion of the anti-CD20 monoclonal antibody rituximab, administered to treat a diffuse large B-cell lymphoma. The disease promptly recovered despite evidence of no endogenous anti-SARS-CoV-2 antibody production. The observation that passive antibody therapy might prove particularly effective in immunodepressed COVID-19 patients requires evaluation in prospective randomized controlled trial.


Subject(s)
Antibodies, Neutralizing/therapeutic use , Antibodies, Viral/therapeutic use , COVID-19/therapy , Immunization, Passive/methods , Immunocompromised Host , Immunoglobulin G/therapeutic use , Plasmapheresis/methods , SARS-CoV-2/genetics , Antineoplastic Agents, Immunological/adverse effects , Antiviral Agents/therapeutic use , COVID-19/immunology , COVID-19/virology , Female , Humans , Immunity/drug effects , Lymphoma, Large B-Cell, Diffuse/drug therapy , Middle Aged , RNA, Viral/genetics , Rituximab/adverse effects , Treatment Outcome
17.
Transfusion ; 61(7): 1998-2007, 2021 07.
Article in English | MEDLINE | ID: covidwho-1258988

ABSTRACT

BACKGROUND: In order to tackle the COVID-19 pandemic, a COVID-19 convalescent plasma (CCP) procurement program was initiated in Japan in April 2020. The program was a collaboration between a government-managed national hospital, an infectious disease research institute, and a blood banking organization. Each party assumed different responsibilities: recruitment, SARS-CoV-2 antibody profiling, and plasmapheresis; conduction of screening tests; and SARS-CoV-2 blood testing, respectively. METHODS: We adopted a two-point screening approach before the collected CCP was labeled as a CCP product for investigational use, for which we mainly tested anti-SARS-CoV-2 antibody eligibility and blood product eligibility. Anti-SARS-CoV-2 spike protein titer was measured using enzyme-linked immunosorbent assay, and the IC50 value was denoted as the neutralizing activity. Blood donor eligibility was extended beyond the normal blood donation guidelines to include a broader range of participants. After both eligibility criteria were confirmed, participants were asked to revisit the hospital for blood donation, which is a unique aspect of the Japanese CCP program, as most donations are taking place in normal blood donation venues in other countries. Some donors were re-scheduled for repeat plasma donations. As public interest in anti-SARS-CoV-2 antibodies increased, test results were given to the participants. RESULTS: As of September 17, 2020, our collection of CCP products was sufficient to treat more than 100 patients. As a result, projects for administration and distribution are also being conducted. CONCLUSIONS: We successfully implemented a CCP procurement scheme with the goal to expand to other parts of the country to improve treatment options for COVID-19.


Subject(s)
Blood Donors , COVID-19/immunology , COVID-19/virology , Convalescence , Immune Sera/immunology , SARS-CoV-2/immunology , Adult , Aged , Antibodies, Viral/blood , Antibodies, Viral/immunology , Blood Preservation , COVID-19/diagnosis , COVID-19/epidemiology , Female , Humans , Immunization, Passive/methods , Japan , Male , Mass Screening , Middle Aged , Pandemics , Plasmapheresis , Young Adult
18.
Medicine (Baltimore) ; 100(18): e25701, 2021 May 07.
Article in English | MEDLINE | ID: covidwho-1216694

ABSTRACT

RATIONALE: Myasthenia gravis (MG) patients are at increased risk of COVID-19 infection and its complications due to chronic immunosuppression. COVID-19 infection can also increase the risk of myasthenia exacerbation. PATIENT CONCERNS: The patient presented with respiratory distress, fever and chills and was diagnosed with COVID-19 pneumonia. His past medical history includes seropositive generalized MG diagnosed in 2019, hypertension, atrial fibrillation and congestive heart failure with reduced ejection failure. DIAGNOSES: Refractory seropositive generalized MG having COVID-19 pneumonia and respiratory failure (needing mechanical ventilation) with sepsis. INTERVENTION: Use of intravenous remdesivir and dexamethasone and patient's myasthenic exacerbation (due to COVID-19 and its complications) was successfully treated with plasmapheresis. OUTCOMES: Patient was successfully weaned off ventilator to trach collar and was discharged to inpatient rehabiliation. He was followed up 1 month post hospital discharge and was on trach collar. LESSONS: This case report illustrates early use of the combination therapy might be beneficial in refractory myasthenia gravis cases even with chronic immunosuppression and severe COVID-19 infection.


Subject(s)
Adenosine Monophosphate/analogs & derivatives , Alanine/analogs & derivatives , Antiviral Agents/therapeutic use , COVID-19/drug therapy , Dexamethasone/therapeutic use , Glucocorticoids/therapeutic use , Myasthenia Gravis/complications , Pneumonia, Viral/drug therapy , Adenosine Monophosphate/therapeutic use , Aged , Alanine/therapeutic use , Drug Therapy, Combination , Humans , Male , Plasmapheresis , SARS-CoV-2
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