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Convalescent Plasma to Treat COVID-19Possibilities and Challenges

Educational Objective
To understand the challenges and need for RCTs on convalescent plasma
1 Credit CME

In this issue of JAMA, Shen et al report findings from a preliminary study of 5 severely ill patients with coronavirus disease 2019 (COVID-19) who were treated in the Shenzhen Third People's Hospital, China, using plasma from recovered individuals.1 All patients had severe respiratory failure and were receiving mechanical ventilation; 1 needed extracorporeal membrane oxygenation (ECMO) and 2 had bacterial and/or fungal pneumonia. Four patients without coexisting diseases received convalescent plasma around hospital day 20, and a patient with hypertension and mitral valve insufficiency received the plasma transfusion at day 10. The donor plasma had demonstrable IgG and IgM anti–SARS-CoV-19 antibodies and neutralized the virus in in vitro cultures. Although these patients continued to receive antiviral treatment primarily with lopinavir/ritonavir and interferon, the use of convalescent plasma may have contributed to their recovery because the clinical status of all patients had improvement approximately 1 week after transfusion, as evidenced by normalization of body temperature as well as improvements in Sequential Organ Failure Assessment scores and Pao2/Fio2 ratio. In addition, the patients’ neutralizing antibody titers increased and respiratory samples tested negative for SARS-CoV-2 between 1 and 12 days after transfusion.

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Article Information

Corresponding Author: Jeannette Guarner, MD, Emory Medical Laboratories, Emory University Hospital-Midtown Core Laboratory, Emory University School of Medicine, 1364 Clifton Rd, Atlanta, GA 30322 (jguarne@emory.edu).

Published Online: March 27, 2020. doi:10.1001/jama.2020.4940

Conflict of Interest Disclosures: Dr Roback reports being a member of the American Red Cross Biomedical Services Medical Advisory Council; a consultant to CSL Plasma; a consultant to Secure Transfusion Services; and a cofounder, stockholder, and consultant to Cambium Medical Technologies. Dr Guarner reports no disclosures.

References
1.
Shen  C , Wang  Z , Zhao  F ,  et al.  Treatment of 5 critically ill patients with COVID-19 with convalescent plasma.   JAMA... Published online March 27, 2020 doi:10.1001/jama.2020.4783Google Scholar
2.
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Casadevall  A , Pirofski  LA .  The convalescent sera option for containing COVID-19.   J Clin Invest. 2020;138003. doi:10.1172/JCI138003PubMedGoogle Scholar
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Dean  CL , Hooper  JW , Dye  JM ,  et al.  Characterization of Ebola convalescent plasma donor immune response and psoralen treated plasma in the United States.   Transfusion. 2020. doi:10.1111/trf.15739PubMedGoogle Scholar
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