Convalescent plasma for Covid-19. Our experience
Authors: D. Cubillas, M. I. Saez, M. P. Martin, E. Bolanos, B. Inigo, F. Medina, A. Alfayate, M. Menendez, M. A. Mora, C. Benavente
Journal: HemaSphere (2021)

Background: Passive immunotherapy has been widely used previously to treat severe acute respiratory syndrome (SARS), Middle East respiratory syndrome, Influenza A and Ebola virus disease with encouraging results. The use of convalescent plasma against SARS-CoV-2 has been suggested as one of the treatments of patients with coronavirus disease9 (Covid-9), specially as an early intervention. Aims: We assess the security and efectivity of the treatment with CP in severe or potentially severe covid-19 disease. Methods: We collect the data of all patients with Covid-19 who were treated with covalescent plasma (CP) in our hospital from April 2020 to February 2021. First of all, we assess the security of CP transfusion and then, we assess the efectivity of the CP transfusion. We assess the mortality rate in this patients by precocity of plasma transfusion, sex and WHO Ordinal Scale for Clinical Improvement. Results: Between April 2020 and February 2021, a total of 44 patients with Covid-19 were treated with CP in our hospital. 77.27% (n=34) were male and 22.73% (n=10) were female with a median age of 65 (28-92). Mortality rate by sex was 32.35% (n=11) in male and 30% (n=3) in female. In terms of security one of the patiens developed a mild rash that was managed with antihistamine and had a complete resolution. In terms of precocity of CP administration we separated the patients into two different groups. The first one, with those patients who had an early CP transfusion (ten days or less after symptom onsent) and the second one, with patients who had a late CP transfusion (more than ten days after symptom onsent). 56.80% (n=25) had and early CP administration, while 43.20% (n=19) of the patients had a late one. Mortality rate in the first group was6% (n=4) and 52.63% (n=11) in the second one. According to the WHO Ordinal Scale for Clinical Improvement, patients with a score of 6 (intubated or mechanical ventilation) or higher were2;patients with a score of 5 (non-invasive ventilation or high-flow oxygen) were3, and patients with a score of 4 (oxygen by mask or nasal prongs) were9. In our center, the mortality rate of these groups of patients was 50% (n=6), 38% (n=5) and6% (n=3) respectively. Summary/Conclusion: In this 44 patients group, the administration of CP has had an adverse event rate very low, similar to non convalescent plasma trasfusion adverse event rate. In those patients who had an early CP transfusion, the mortality rate is much lower than those who had a late CP transfusion. Possibly the elapsed time from symtom onset is the most important factor to assess efectivity. Mortality rate by WHO Ordinal Scale for Clinical Improvement shows differences between groups. Those patients with a higher score present higher mortality rates, probably similar to patients with Covid-19 treated with other therapeutic options. The mortality rate by sex was similar in both groups as we can observe in other studies. An early CP administration could be a therapeutic option in severe patients with Covid-19 considering that is a safe procedure that can improve survival rates.