J Korean Med Sci.  2020 Apr;35(14):e149. 10.3346/jkms.2020.35.e149.

Use of Convalescent Plasma Therapy in Two COVID-19 Patients with Acute Respiratory Distress Syndrome in Korea

• Ahn JY
• Sohn Y
• Lee SH
• Cho Y
• Hyun JH
• Baek YJ
• Jeong SJ
• Kim JH
• Ku NS
• Yeom JS
• Roh J
• Ahn MY
• Chin BS
• Kim YS
• Lee H
• Yong D
• Kim HO
• Kim S
• Choi JY

• KMID: 2509617
• DOI: http://doi.org/10.3346/jkms.2020.35.e149

Abstract

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 not yet has established its treatment, but convalescent plasma has been expected to increase survival rates as in the case with other emerging viral infections. We describe two cases of COVID-19 treated with convalescent plasma infusion. Both patients presented severe pneumonia with acute respiratory distress syndrome and showed a favorable outcome after the use of convalescent plasma in addition to systemic corticosteroid. To our knowledge, this is the first report of the use of convalescent plasma therapy for COVID-19 in Korea.

Keyword

Coronavirus; SARS-CoV-2; COVID-19; Treatment; Convalescent Plasma

Figure

• 

  Fig. 1 Case 1, responses to treatment. (A) Timelines of changes in PaO2/FiO2 and CRP during hospitalization. (B) Timelines of detection of the RNA-dependent RNA polymerase region of the ORF1b gene of severe acute respiratory syndrome coronavirus-2 in sputum by real-time reverse transcription polymerase chain reaction; cycle threshold is shown.CRP = C-reactive protein.

• 

  Fig. 2 Chest X-rays of Case 1 taken before and after convalescent plasma infusion. Taken on day 7, just before the convalescent plasma infusion (left). Taken on day 13 shows marked improvement of bilateral infiltrations (right). The images are published under agreement of the patient.

• 

  Fig. 3 Case 2, responses to treatment. (A) Timelines of changes in PaO2/FiO2 and CRP during hospitalization. (B) Timelines of detection of the RNA-dependent RNA polymerase region of the ORF1b gene of severe acute respiratory syndrome coronavirus-2 in sputum by real-time reverse transcription polymerase chain reaction; cycle threshold is shown.CRP = C-reactive protein.

• 

  Fig. 4 Chest X-rays of Case 2 taken before and after convalescent plasma infusion. Taken on day 2, before the convalescent plasma infusion (left). Taken on day 6 shows marked improvement of bilateral infiltrations (right). The images are published under agreement of the patient.

Reference

1. Mair-Jenkins J, Saavedra-Campos M, Baillie JK, Cleary P, Khaw FM, Lim WS, 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(1):80–90. PMID: 25030060.

2. Marano G, Vaglio S, Pupella S, Facco G, Catalano L, Liumbruno GM, et al. Convalescent plasma: new evidence for an old therapeutic tool? Blood Transfus. 2016; 14(2):152–157. PMID: 26674811.

3. Burnouf T, Seghatchian J. Ebola virus convalescent blood products: where we are now and where we may need to go. Transfus Apheresis Sci. 2014; 51(2):120–125.

4. Public Health England I. Treatment of MERS-CoV: information for clinicians. Updated 2017. Accessed February 2, 2020. http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317139281416.

5. Hung IF, To KK, Lee CK, Lee KL, Chan K, Yan WW, et al. Convalescent plasma treatment reduced mortality in patients with severe pandemic influenza A (H1N1) 2009 virus infection. Clin Infect Dis. 2011; 52(4):447–456. PMID: 21248066.

6. Soo YO, Cheng Y, Wong R, Hui DS, Lee CK, Tsang KK, et al. Retrospective comparison of convalescent plasma with continuing high-dose methylprednisolone treatment in SARS patients. Clin Microbiol Infect. 2004; 10(7):676–678. PMID: 15214887.

7. Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet. 2020; 395(10223):473–475. PMID: 32043983.

8. World Health Organization. Geneva: World Health Organization;2020. 1. 28. Updated 2020. Accessed February 2, 2020. https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected.

9. Hanley B, Lucas SB, Youd E, Swift B, Osborn M. Autopsy in suspected COVID-19 cases. J Clin Pathol. 2020.

10. Wong VW, Dai D, Wu AK, Sung JJ. Treatment of severe acute respiratory syndrome with convalescent plasma. Hong Kong Med J. 2003; 9(3):199–201. PMID: 12777656.

11. Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020.

12. Arabi YM, Mandourah Y, Al-Hameed F, Sindi AA, Almekhlafi GA, Hussein MA, et al. Corticosteroid therapy for critically ill patients with Middle East respiratory syndrome. Am J Respir Crit Care Med. 2018; 197(6):757–767. PMID: 29161116.

13. Lee N, Allen Chan KC, Hui DS, Ng EK, Wu A, Chiu RW, et al. Effects of early corticosteroid treatment on plasma SARS-associated Coronavirus RNA concentrations in adult patients. J Clin Virol. 2004; 31(4):304–309. PMID: 15494274.

14. Chen L, Xiong J, Bao L, Shi Y. Convalescent plasma as a potential therapy for COVID-19. Lancet Infect Dis. 2020; 20(4):398–400. PMID: 32113510.

15. Lu CL, Murakowski DK, Bournazos S, Schoofs T, Sarkar D, Halper-Stromberg A, et al. Enhanced clearance of HIV-1-infected cells by broadly neutralizing antibodies against HIV-1 in vivo. Science. 2016; 352(6288):1001–1004. PMID: 27199430.

16. Liu Y, Yan LM, Wan L, Xiang TX, Le A, Liu JM, et al. Viral dynamics in mild and severe cases of COVID-19. Lancet Infect Dis. 2020.

17. Zou L, Ruan F, Huang M, Liang L, Huang H, Hong Z, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med. 2020; 382(12):1177–1179. PMID: 32074444.

18. Gu J, Gong E, Zhang B, Zheng J, Gao Z, Zhong Y, et al. Multiple organ infection and the pathogenesis of SARS. J Exp Med. 2005; 202(3):415–424. PMID: 16043521.

19. Li T, Qiu Z, Zhang L, Han Y, He W, Liu Z, et al. Significant changes of peripheral T lymphocyte subsets in patients with severe acute respiratory syndrome. J Infect Dis. 2004; 189(4):648–651. PMID: 14767818.

20. Choe PG, Perera RA, Park WB, Song KH, Bang JH, Kim ES, et al. MERS-CoV Antibody Responses 1 Year after Symptom Onset, South Korea, 2015. Emerg Infect Dis. 2017; 23(7):1079–1084.

21. Ko JH, Seok H, Cho SY, Ha YE, Baek JY, Kim SH, et al. Challenges of convalescent plasma infusion therapy in Middle East respiratory coronavirus infection: a single centre experience. Antivir Ther. 2018; 23(7):617–622. PMID: 29923831.