NHS Blood and Transplant and Radcliffe Department of Medicine, University of Oxford, United Kingdom (L.J.E.).
University of Minnesota, Department of Laboratory Medicine and Pathology, Minneapolis, Minnesota (C.S.C.).
Ann Intern Med. 2022 Sep;175(9):1310-1321. doi: 10.7326/M22-1079. Epub 2022 Aug 16.
Coronavirus disease 2019 convalescent plasma (CCP) has emerged as a potential treatment of COVID-19. However, meta-analysis data and recommendations are limited. The Association for the Advancement of Blood and Biotherapies (AABB) developed clinical practice guidelines for the appropriate use of CCP.
These guidelines are based on 2 living systematic reviews of randomized controlled trials (RCTs) evaluating CCP from 1 January 2019 to 26 January 2022. There were 33 RCTs assessing 21 916 participants. The results were summarized using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method. An expert panel reviewed the data using the GRADE framework to formulate recommendations.
RECOMMENDATION 1 (OUTPATIENT): The AABB suggests CCP transfusion in addition to the usual standard of care for outpatients with COVID-19 who are at high risk for disease progression (weak recommendation, moderate-certainty evidence).
RECOMMENDATION 2 (INPATIENT): The AABB recommends against CCP transfusion for unselected hospitalized persons with moderate or severe disease (strong recommendation, high-certainty evidence). This recommendation does not apply to immunosuppressed patients or those who lack antibodies against SARS-CoV-2.
RECOMMENDATION 3 (INPATIENT): The AABB suggests CCP transfusion in addition to the usual standard of care for hospitalized patients with COVID-19 who do not have SARS-CoV-2 antibodies detected at admission (weak recommendation, low-certainty evidence).
RECOMMENDATION 4 (INPATIENT): The AABB suggests CCP transfusion in addition to the usual standard of care for hospitalized patients with COVID-19 and preexisting immunosuppression (weak recommendation, low-certainty evidence).
RECOMMENDATION 5 (PROPHYLAXIS): The AABB suggests against prophylactic CCP transfusion for uninfected persons with close contact exposure to a person with COVID-19 (weak recommendation, low-certainty evidence).
CCP is most effective when transfused with high neutralizing titers to infected patients early after symptom onset.
新冠肺炎恢复期血浆（CCP）已成为治疗 COVID-19 的一种潜在方法。然而，目前关于它的荟萃分析数据和建议有限。血液和生物疗法促进协会（AABB）制定了 CCP 合理使用的临床实践指南。
这些指南基于 2019 年 1 月 1 日至 2022 年 1 月 26 日期间对 CCP 进行的 2 项随机对照试验（RCT）的实时系统评价。共有 33 项 RCT 评估了 21916 名参与者。结果使用 GRADE（推荐评估、制定与评价）方法进行总结。专家组使用 GRADE 框架审查数据，制定建议。
推荐 1（门诊）：对于有进展为疾病高风险的 COVID-19 门诊患者，AABB 建议在常规标准治疗之外输注 CCP（弱推荐，中等确定性证据）。
推荐 2（住院）：AABB 建议对于未选择的中重度疾病住院患者，不要输注 CCP（强推荐，高确定性证据）。该建议不适用于免疫抑制患者或缺乏针对 SARS-CoV-2 抗体的患者。
推荐 3（住院）：对于无入院时检测到 SARS-CoV-2 抗体的 COVID-19 住院患者，AABB 建议在常规标准治疗之外输注 CCP（弱推荐，低确定性证据）。
推荐 4（住院）：对于 COVID-19 住院患者和存在预先存在的免疫抑制，AABB 建议在常规标准治疗之外输注 CCP（弱推荐，低确定性证据）。
推荐 5（预防）：对于与 COVID-19 感染者密切接触但未感染的人，AABB 建议不要预防性输注 CCP（弱推荐，低确定性证据）。
CCP 在症状出现后早期感染患者中输注时，中和效价高，效果最佳。
