#32: Single Center Experience with the Use of Convalescent Plasma Transfusion (CPT) for COVID-19 + Patients in Argentina

Abstract

BackgroundCOVID-19 pandemic challenged health sanitary systems worldwide. 1.65 million cases have been reported in Argentina with 43.635 deaths. CPT emerged as a possible and feasible treatment. Transfusion cardiovascular overload (TACO), acute lung injury (TRALI) and anaphylactic reactions (AR) have raised safety concerns; in the other hand, it is still unknown its efficacy but preliminary reports have claimed that if it is delivered early, mortality or morbidity could be decreased. Pediatric use of CPT is emerging from adults’ studies.ObjectiveTo review clinical outcomes, laboratory parameters and side effects of CPT in a single center in Argentina and determine the mortality rate.MethodsThis is a single-center single-arm exploratory-descriptive prospective study, starting on May 1, 2021 until October 31, 2021. A protocol developed for donation of CPT included those individuals with SARS-CoV-2 RT- PCR positive in respiratory secretions and SARS-CoV-2 antibody positive by immunochromatography o chemiluminescence, with a titer by ELISA (Covidar®) > 1:400 and 200 – 250 mL were considered 1 Unit. Recipients weighing <70 kg received 1 unit, and those recipients weighing >70kg received 2 units. CPT was prescribed within 14 days of starting SARS-CoV-2 symptoms. All patients received dexamethasone and standard support measures. We used percentages and frequencies for reporting the results of this study. Categorical variables were compared with Chi2 and numeric Fisher/Mann Whitney. Time dependent survival variables were calculated with Kaplan Meier method. SPPS 20 software was used for data processing.ResultsThe CPT recipients median age (IQR) was 47 years of age (range 43–59 years); 65.5 % were; 12,5% had either hypertension or obesity, 3.1% chronic obstructive lung disease; 30% had diabetes. The median temperature at diagnosed was (IQR) 37.7°C (range 36.6°C - 38.9°C). A total of 39 CPT units were infused in 32 patients. 25 patients (78%) received 1 unit, 6 patients (19%) received 2 units and 1 patient (3%) received 3 units (3%). Donor median (IQR), SARS-CoV-2 antibody titer was 1:400 (range 400–1600); median time (IQR) to transfusion was 1 day (range 1–4). Coverage was 100%.Outcomes29 patients (91%) survived and 3 (9%) died for COVID-19. Only 3 patients (8%) developed moderate/reversible side effects: allergic reaction (2 pts) and TRALI(1pt) At a median time of 100 days, the median survival was 85% (0.5) and the mortality rate was 19 % (0.6).Laboratory features:Pre CPTPost CPTP valueWBC median (IQR),mm 39050 (7025–11150)9250 (7400–11625)0.27Lymphocytes, median (IQR),%10.8 (7.0–14.7)16.9 (9.2.-28.1)0.004Neutrophiles, median (IQR),%83.7 (78.0–87.5)72.5 (63.9–80.8)0.02Platelets, median (IQR) mm3226.000 (184.250–322.000)384.000(266.250–487.250)0.002Hemoglobin, median (DS) gr/dl12.8 (2)12.7 (2)0.75D-Dimer, median (IQR) ug/l731.0 (387.2–1460)955 (603–1300)0.21LDH, median (IQR), UI/l361 (319–508)276 (229–489)0.236Ferritin1068 (387–2445)764.6 (279.8–13810.01Troponin, mean (DS) ng/ml5.87 (11)4.66 (7)0.479CRP, media (DS) mg/l135 (103)32.5 (46.8)0.000ConclusionCPT was feasible to deliver and could be implemented in a less resourced country in a timely fashion. All our patients could afford plasma therapy. No severe adverse events were reported. Pediatric studies can be based on the results of this type of study. Research should focus now on a control case cohort study to determine efficacy of CPT.