Putter Jeffrey S, Seghatchian Jerard
Medical Biomechanics Inc., 100 E. San Marcos Blvd., #400, San Marcos, North San Diego County), CA 92069, United States.
International Consultancy in Strategic Safety/Quality Improvements of Blood- Derived Bioproducts and Suppliers Quality Audit / Inspection, London, England, UK.
Transfus Apher Sci. 2020 Oct;59(5):102934. doi: 10.1016/j.transci.2020.102934. Epub 2020 Sep 4.
This communication provides a compilation on aspects of COVID-19 infection control measures, describes the potential role of therapeutic plasma exchange to reduce fatality rates, addresses precautions concerning dexamethasone pharmacotherapy and updates the current status on the availability of vaccines. As part of passive immunotherapy, it focuses on various blood derivatives. These include coronavirus neutralising antibodies extracted from different sources to be administered as a pure hyper concentrate intramuscularly or for upgrading and standardising the specific potency of high affinity antibodies. These processes are intended to compose standardised pooled bioproducts of corona convalescent plasma/cryosupernatant that are pathogen inactivated for additional safety by well-established UV technologies. For the best practice of optimising plasma exchange, hyper concentrate NAb should be added to the cryosupernatant, which contains some of the active principles of corona convalescent plasma. The cryosupernatant apart from the high molecular weight viscous part of cold insoluble proteins that are removed, is equivalent to CCP, but makes it safer for general application. Such a bioproduct is often used routinely for substitution therapy of thrombotic thrombocytopaenic purpura. Alternative resources of large-scale specific coronavirus antibodies warrant further exploration such as cadaveric donations. The early uses of therapeutic plasma exchange and low molecular weight heparin, for any clinical trial in development is warranted, in order to interdict the intense inflammatory/kinin driven cascade. Because coronavirus positive patients are highly prone to thrombosis, thromboprophylaxis is necessary, even some time after recovery guided by the laboratory data.
本通讯提供了关于COVID-19感染控制措施各方面的汇编，描述了治疗性血浆置换在降低死亡率方面的潜在作用，阐述了地塞米松药物治疗的注意事项，并更新了疫苗的可用现状。作为被动免疫疗法的一部分，它聚焦于各种血液衍生物。这些包括从不同来源提取的冠状病毒中和抗体，可作为纯高浓缩物肌肉注射，或用于提升和标准化高亲和力抗体的特定效力。这些过程旨在制备经病原体灭活的标准化康复期新冠血浆/冷上清液混合生物制品，通过成熟的紫外线技术进一步提高安全性。为优化血浆置换的最佳实践，应将高浓缩中和抗体添加到冷上清液中，冷上清液含有康复期新冠血浆的一些活性成分。除了去除冷不溶性蛋白质的高分子量粘性部分外，冷上清液等同于康复期新冠血浆，但使其在一般应用中更安全。这种生物制品通常常规用于血栓性血小板减少性紫癜的替代治疗。大规模特异性冠状病毒抗体的替代来源，如尸体捐赠，值得进一步探索。对于任何正在开展的临床试验，早期使用治疗性血浆置换和低分子量肝素是必要的，以阻断强烈的炎症/激肽驱动的级联反应。由于冠状病毒阳性患者极易发生血栓形成，即使在康复后的一段时间内，也需要根据实验室数据进行血栓预防。
