Blood Res.  2023 Jun;58(2):91-98. 10.5045/br.2023.2022201.

Efficacy of plasmapheresis in neutropenic patients suffering from cytokine storm because of severe COVID-19 infection

Affiliations
  • 1Department of Internal Medicine, School of Medicine, Isfahan, Iran
  • 2Infectious Diseases and Tropical Medicine Research Center, Isfahan, Iran
  • 3Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan, Iran
  • 4Cancer Prevention Research Center Seyed Al-Shohada Hospital, Isfahan, Iran
  • 5Mycology Reference Laboratory, Research Core Facilities Laboratory, Isfahan, Iran
  • 6Acquired Immunodeficiency Research Center, Isfahan, Iran
  • 7Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background
With the emergence of the coronavirus disease 2019 (COVID-19) and inability of healthcare systems to control the disease, various therapeutic theories with controversial responses have been proposed. Plasmapheresis was administered as a medication. However, the knowledge of its efficacy and indications is inadequate. This study evaluated the use of plasmapheresis in critically ill patients with cancer.
Methods
This randomized clinical trial was conducted on 86 patients with malignancies, including a control group (N=41) and an intervention group (N=45) with severe COVID-19 during 2020-21. Both groups were treated with routine medications for COVID-19 management according to national guidelines, and plasmapheresis was applied to the intervention group. C-reactive protein (CRP), D-dimer, ferritin, lactate dehydrogenase, hemoglobin, and white blood cell, polymorphonuclear, lymphocyte, and platelet levels were measured at admission and at the end of plasmapheresis. Other variables included neutrophil recovery, intensive care unit admission, intubation requirements, length of hospital stay, and hospitalization outcomes.
Results
CRP (P <0.001), D-dimer (P <0.001), ferritin (P =0.039), and hemoglobin (P =0.006) levels were significantly different between the groups after the intervention. Neutrophil recovery was remarkably higher in the case than in the control group (P <0.001). However, plasmapheresis did not affect the length of hospital stay (P =0.076), which could have significantly increased survival rates (P <0.001).
Conclusion
Based on the study findings, plasmapheresis led to a significant improvement in laboratory markers and survival rate in patients with severe COVID-19. These findings reinforce the value of plasmapheresis in cancer patients as a critical population suffering from neutropenia and insufficient immune responses.

Keyword

COVID-19; Plasmapheresis; Survival; Neutropenia

Figure

  • Fig. 1 Consort diagram of the studied population.


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