Appropriate selection of convalescent plasma donors for COVID-19
Authors: Richard S Tedder, Malcolm G Semple
Journal: The Lancet Infectious Diseases (2020)

We read with considerable interest the Comment from Long Chen and colleagues1Chen L Xiong J Bao L Shi Y Convalescent plasma as a potential therapy for COVID-19.Lancet Infect Dis. 2020; 20: 398-400Summary Full Text Full Text PDF PubMed Scopus (775) Google Scholar about the potential use of convalescent plasma for the treatment of COVID-19. Chen and colleagues mention the earlier pragmatic WHO recommendation for the use of convalescent plasma as therapy in Ebola virus disease.2WHOUse of convalescent whole blood or plasma collected from patients recovered from Ebola virus disease for transfusion, as an empirical treatment during outbreaks.https://www.who.int/csr/resources/publications/ebola/convalescent-treatment/enDate: 2014Date accessed: June 3, 2020Google Scholar The absence of a clinically relevant therapeutic benefit in patients with Ebola virus infection described by Griensven and colleagues,3van Griensven J Edwards T de Lamballerie X et al.Evaluation of convalescent plasma for Ebola virus disease in Guinea.N Engl J Med. 2016; 374: 33-42Crossref PubMed Scopus (422) Google Scholar and more recently the finding of no therapeutic benefit in a small trial in patients with COVID-19 in Zhengzhou, China,4Zeng Q-L Yu Z-J Gou J-J et al.Effect of convalescent plasma therapy on viral shedding and survival in COVID-19 patients.J Infect Dis. 2020; (published online April 29.)DOI:10.1093/infdis/jiaa228Google Scholar will be used to question the usefulness of convalescent plasma in COVID-19. In the Guinea-Bissau Ebola study,3van Griensven J Edwards T de Lamballerie X et al.Evaluation of convalescent plasma for Ebola virus disease in Guinea.N Engl J Med. 2016; 374: 33-42Crossref PubMed Scopus (422) Google Scholar no attempt was made to select donors for the potency of their neutralising antibody. In the COVID-19 study,4Zeng Q-L Yu Z-J Gou J-J et al.Effect of convalescent plasma therapy on viral shedding and survival in COVID-19 patients.J Infect Dis. 2020; (published online April 29.)DOI:10.1093/infdis/jiaa228Google Scholar seropositive donors were recruited only after IgM antibody to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was no longer detected, and no attempt to quantify the antibody response was reported. We previously described the levels of detectable antibody and the inferred level of neutralising antibody in convalescent plasma donors for patients with Ebola virus disease in Sierra Leone,5Tedder RS Samuel D Dicks S et al.Detection, characterization, and enrolment of donors of Ebola convalescent plasma in Sierra Leone.Transfusion. 2018; 58: 1289-1298Crossref PubMed Scopus (21) Google Scholar showing 100-fold differences in the level of neutralising antibody. We described a strategy for selecting donors with the highest levels of neutralising antibody, which was not undertaken in donors in the Guinea-Bissau or Zhengzhou studies. For planned interventions in the treatment of patients with COVID-19 severe disease, we strongly recommend selection and qualification only of donors who carry the highest levels of detectable neutralising antibody to SARS-CoV-2. In this respect, we have data which indicate that quantification of specific antibody to the receptor-binding domain will indicate levels of neutralising antibody (unpublished). Commercial assays based on the receptor-binding domain alone, although not intended for the purpose of identifying suitable convalescent plasma donors, will probably be able to serve this need. MGS reports grants from DHSC National Institute for Health Research, Medical Research Council UK, and Health Protection Research Unit in Emerging and Zoonotic Infections at the University of Liverpool during the conduct of this work and being a minority owner of Integrum Scientific outside the submitted work. RST declares no competing interests. Convalescent plasma as a potential therapy for COVID-19The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which originated in Wuhan, China, has become a major concern all over the world. The pneumonia induced by the SARS-CoV-2 is named coronavirus disease 2019 (COVID-19). By Feb 22, 2020, this virus has affected more than 77 700 people worldwide and caused more than 2300 deaths. To date, no specific treatment has been proven to be effective for SARS-CoV-2 infection. Apart from supportive care, such as oxygen supply in mild cases and extracorporeal membrane oxygenation for the critically ill patients, specific drugs for this disease are still being researched. Full-Text PDF