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Reactions associated with COVID-19 convalescent plasma therapy

"Our findings support the use of CP as a safe therapeutic option from a transfusion reaction perspective, in the setting of COVID-19" Nguyen et al (2020).

Abstract:

Background: Convalescent plasma (CP) for treatment of SARS-CoV-2 has shown preliminary signs of effectiveness in moderate to severely ill patients in reducing mortality1, 2 . While studies have demonstrated a low risk of serious adverse events, the comprehensive incidence and nature of the spectrum of transfusion reactions to convalescent plasma is unknown. We retrospectively examined 427 adult inpatient CP transfusions to determine incidence and types of reactions, as well as clinical parameters and risk factors associated with transfusion reactions.

Study design and methods: Retrospective analysis was performed for 427 transfusions to 215 adult COVID-19 patients within the Mount Sinai Health System, through the FDA eIND and EAP approval pathways. Transfusions were blindly evaluated by two reviewers and adjudicated by a third reviewer in discordant cases. Patient demographics, clinical, and laboratory parameters were compared and analyzed.

Results: Fifty-five reactions from 427 transfusions were identified (12.9% incidence), and thirteen were attributed to transfusion (3.1% incidence). Reactions were classified as underlying COVID-19 (76%), febrile non-hemolytic (10.9%), transfusion-associated circulatory overload (9.1%), allergic (1.8%), and hypotensive (1.8%) reactions. Statistical analysis identified increased transfusion reaction risk for ABO blood group B or Sequential Organ Failure Assessment scores of 12-13, and decreased risk within the age group of 80-89 years.

Conclusion: Our findings support the use of CP as a safe therapeutic option from a transfusion reaction perspective, in the setting of COVID-19. Further studies are needed to confirm the clinical significance of ABO group B, age, and predisposing disease severity in the incidence of transfusion reaction events.

Reference:

Nguyen FT, van den Akker T, Lally K, Lam H, Lenskaya V, Liu STH, Bouvier NM, Aberg JA, Rodriguez D, Krammer F, Strauss D, Shaz BH, Rudon L, Galdon P, Jhang JS, Arinsburg SA, Baine I; Mount Sinai Health System Convalescent Plasma Team. Transfusion Reactions Associated with COVID-19 Convalescent Plasma Therapy for SARS-CoV-2. Transfusion. 2020 Oct 30. doi: 10.1111/trf.16177. Epub ahead of print. PMID: 33125158.