Erber Johanna, Wiessner Johannes R, Huberle Christina, Schneider Jochen, Mijočević Hrvoje, von Bomhard Doris, Luppa Peter, Schmid Roland M, Rasch Sebastian, Lahmer Tobias
Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Department of Internal Medicine II, 81675 Munich, Germany.
Technical University of Munich, School of Medicine, Institute of Virology, Munich, Germany.
Transfus Apher Sci. 2021 Dec;60(6):103278. doi: 10.1016/j.transci.2021.103278. Epub 2021 Sep 17.
To investigate the effect of convalescent plasma therapy (CPT) on clinical courses of B-cell-sufficient and B-cell-depleted patients with life-threatening COVID-19.
In this case series, we retrospectively analysed clinical, laboratory and cardiopulmonary parameters of six patients with life-threatening COVID-19 receiving convalescent plasma (CP) as rescue therapy between April 11, 2020 to October 10, 2020. Clinical and laboratory parameters before and after transfusion were compared in two B-cell-depleted patients and four B-cell sufficient patients (control group).
Both B-cell-depleted patients cleared SARS-CoV-2 virus and survived, while all other patients died within 14 days from intervention despite maximal therapeutic efforts. D-dimer levels increased in both cohorts subsequent to CPT. In control patients, mean Interleukin-6 increased and platelet levels decreased as opposed to decreasing and stable levels in B-cell-depleted patients, respectively. Control patients required increased doses of vasopressor compared to decreasing doses in B-cell depleted patients subsequent to CPT. PO/FiO decrease was more pronounced and respiratory deterioration required postinterventional extracorporeal membrane oxygenation in two control patients. Transpulmonary thermodilution revealed a further increase of the Extravascular Lung Water Index upon CPT in control patients.
Use of CP in late stages of life-threatening COVID-19 should be used with caution but may be beneficial in B-cell-depleted patients. Further studies are necessary to assess factors predicting potential therapeutic benefits as well as possible hazards.
探讨恢复期血浆疗法（CPT）对患有危及生命的新型冠状病毒肺炎（COVID-19）的B细胞充足和B细胞耗竭患者临床病程的影响。
在这个病例系列中，我们回顾性分析了2020年4月11日至2020年10月10日期间6例接受恢复期血浆（CP）作为抢救治疗的危及生命的COVID-19患者的临床、实验室和心肺参数。比较了2例B细胞耗竭患者和4例B细胞充足患者（对照组）输血前后的临床和实验室参数。
两名B细胞耗竭患者均清除了严重急性呼吸综合征冠状病毒2（SARS-CoV-2）病毒并存活，而所有其他患者尽管进行了最大程度的治疗努力，但在干预后14天内死亡。CPT后两个队列中的D-二聚体水平均升高。在对照组患者中，平均白细胞介素-6升高而血小板水平降低，而在B细胞耗竭患者中分别为降低和稳定水平。与CPT后B细胞耗竭患者剂量减少相比，对照组患者需要增加血管升压药剂量。两名对照患者的动脉血氧分压/吸入氧分数（PO/FiO）下降更明显，呼吸恶化需要在干预后进行体外膜肺氧合。经肺热稀释法显示，对照组患者在CPT后血管外肺水指数进一步升高。
在危及生命的COVID-19晚期使用CP应谨慎，但可能对B细胞耗竭患者有益。有必要进行进一步研究以评估预测潜在治疗益处以及可能危害的因素。
