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COVID-19 management : Convalescent plasma & hyperimmune globulin

Coronavirus disease 2019 (COVID-19): Convalescent plasma & hyperimmune globulin

 

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Coronavirus disease 2019 (COVID-19): Convalescent plasma & hyperimmune globulin

 

Definition: Convalescent ptn plasma can be extracted from subjects who have already recovered from COVID-19 infection and have developed appropriate immune response. More than 100,000 units have been provided to ptns diagnosed with coronavirus disease 2019 (COVID-19) through an extended access programs, emergent use authorization, and clinical studies.

Criteria for donation: Subjects can provide convalescent plasma if they have the criteria for donation and already with full recovery from COVID-19 infection for at least 2 wks. The related information about donation details have been provided via the US Food & Drug Administration (FDA), local blood centers, and the concerned local institution. Methodology for plasma recruitment may vary according to local policies.  

Plasma collection: Plasma can be collected via PE (plasma apheresis). The level of the relevant AB can be recognized either on the donating subject or on the plasma unit using a functional or through serologic assessment.

Donors of the plasma should undergo the necessary infectious disease screening in addition to the ABO & RhD typing. The anti-human leukocyte antigen (HLA) AB (donor excluded if +ve) is used in parous female donors to decrease the risk of transfusion-related acute lung injury (TRALI).

Indication for use:  The routine administration of convalescent plasma outside a clinical trial is not currently advised, as its benefit still uncertain. However, it’s available via an emergency authorization, and other physicians may prefer to utilize it. If so, the potential benefit of convalescent plasma seems to be most beneficial if administered early in the course of severe illness.

 

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Optimal administration: Convalescent plasma is most likely to be effective if administered early in the course of the disease and if the reported titer is minimally 1:160, despite the need for additional studies to recognize the optimum timing & titer. However, a single dose of 1-2 units is typically administrated with no pre-medication, and the ptn should be monitored clinically.  

How to obtain the plasma: Contact information for obtaining plasma or participating in clinical trials and special considerations for resource-limited settings are summarized above.  

Safety: Convalescent plasma administration may be complicated by the risk of transfusion reaction, as it occurs with standard plasma. AB-dependent enhancement (ADE) has not been observed but theoretically considered a possible risk. AB-containing products may interfere with the efficacy of vaccination , but this assumption should be clinically assessed.  

Hyperimmune globulin (HG): HG is a concentrated product manufactured from thousands of units of convalescent plasma that’s also being pursued. The appropriate evidence of efficacy still lacking.

 

REFERENCES

1.    https://www.uscovidplasma.org/ (Accessed on November 03, 2020).

2.    Casadevall A, Pirofski LA. The convalescent sera option for containing COVID-19. J Clin Invest 2020; 130:1545.

3.    Bloch EM, Shoham S, Casadevall A, et al. Deployment of convalescent plasma for the prevention and treatment of COVID-19. J Clin Invest 2020; 130:2757.

4.    Marovich M, Mascola JR, Cohen MS. Monoclonal Antibodies for Prevention and Treatment of COVID-19. JAMA 2020; 324:131.

5.    Nguyen AA, Habiballah SB, Platt CD, et al. Immunoglobulins in the treatment of COVID-19 infection: Proceed with caution! Clin Immunol 2020; 216:108459.

6.    Wu F, Liu M, Wang A, et al. Evaluating the Association of Clinical Characteristics With Neutralizing Antibody Levels in Patients Who Have Recovered From Mild COVID-19 in Shanghai, China. JAMA Intern Med 2020; 180:1356.

7.    Liu STH, Lin HM, Baine I, et al. Convalescent plasma treatment of severe COVID-19: a propensity score-matched control study. Nat Med 2020.

8.    Roberts DJ, Miflin G, Estcourt L. Convalescent plasma for COVID-19: Back to the future. Transfus Med 2020; 30:174.

9.    Sun B, Feng Y, Mo X, et al. Kinetics of SARS-CoV-2 specific IgM and IgG responses in COVID-19 patients. Emerg Microbes Infect 2020; 9:940.

10.  Okba NMA, Müller MA, Li W, et al. Severe Acute Respiratory Syndrome Coronavirus 2-Specific Antibody Responses in Coronavirus Disease Patients. Emerg Infect Dis 2020; 26:1478.

11.  Wu Y, Wang F, Shen C, et al. A noncompeting pair of human neutralizing antibodies block COVID-19 virus binding to its receptor ACE2. Science 2020; 368:1274.

12.  Engin AB, Engin ED, Engin A. Dual function of sialic acid in gastrointestinal SARS-CoV-2 infection. Environ Toxicol Pharmacol 2020; 79:103436.

13.  Ye Q, West AMV, Silletti S, Corbett KD. Architecture and self-assembly of the SARS-CoV-2 nucleocapsid protein. bioRxiv 2020.

14.  Maiztegui JI, Fernandez NJ, de Damilano AJ. Efficacy of immune plasma in treatment of Argentine haemorrhagic fever and association between treatment and a late neurological syndrome. Lancet 1979; 2:1216.

15.  Mair-Jenkins J, Saavedra-Campos M, Baillie JK, et al. The effectiveness of convalescent plasma and hyperimmune immunoglobulin for the treatment of severe acute respiratory infections of viral etiology: a systematic review and exploratory meta-analysis. J Infect Dis 2015; 211:80.

 

 



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