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Convalescent Plasma Transfusion: A Life
Saving Therapy for Covid-19 Patients
Shmmon Ahmad1>*, Shivani Thakur2>, Abdul Hafeez1>, Satish Kumar Sharma1>, Samera Ali Siddique1> and Isha Talwar1>
1 Glocal School of Pharmacy, Glocal University Saharanpur, India
2School of Pharmacy, Maharaja Agrasen University Solan, India
Submission: July 17, 2020; Published: July 24, 2020
*Corresponding author: Shmmon Ahmad, Glocal School of Pharmacy, Glocal University Saharanpur, India
How to cite this article: Shmmon A, Shivani T, Abdul H, Satish K S, Samera A S, et al. Convalescent Plasma Transfusion: A Life Saving Therapy for
Covid-19 Patients. Palliat Med Care Int J. 2020; 3(4): 555619.
At present, there is no specific antiviral agent that have been found to be effective in the treatment of COVID-19. The disease in past few months was controlled by various measures, such as travel restriction and patient isolation but for a long duration these are not a permanent solution. As patients fight the virus, their bodies develop antibodies that will stay in their blood waiting for the same virus to attack again and fight against it. When those antibodies are administered to another infected person, they attack the outside virus and block the virus from penetrating human cells. Antibodies are extracted from blood plasma, and they can be used to possibly prevent or treat disease in another infected person. Convalescent plasma therapy involves transfusing certain components from the blood of recovered patients into people who are seriously infected. The therapy might prove to be a boon to patients suffering from COVID 19.
Coronavirus is a large family of viruses that may cause disease in humans and animals [1,2]. The pandemic caused by COVID-19, affected more than thirteen million people around the world. No specific treatment is completely effective against the novel coronavirus (SARS-CoV-2) and no vaccine is available yet to prevent the infection [3,4].
When no proven specific vaccine or drug is available for emerging infections Historically , Convalescent plasma immunotherapy has been used as a possible therapeutic option . Some clinical researchers and doctors have started using plasma from the recovered patient of COVID-19 to treat others who have developed the disease . The convalescent plasma administration, collected from the previously infected patient to passively-transfer antibodies. Convalescent plasma has previously been used to protect or treat humans, against viral illnesses such as polio, measles, influenza, rabies, hepatitis B, Ebola, and other pathogens .
In 2014, While there was no proven treatment available for Ebola (EVD), the WHO recommended the use of Ebola convalescent plasma (CP) transfusion as an empirical treatment with promising
results in a small group of EVD cases . To evaluate the efficacy of
convalescent plasma therapy, during the SARS outbreak in 2002, various studies good outcome was defined. It was concluded that people treated with convalescent plasma therapy resulted in earlier recoveries and had a higher chance of being discharged from hospital compared to regular drug-treated patients .
An exploratory meta-analysis of 32 studies assessed the clinical benefit of the administration of convalescent plasma, hyperimmune immunoglobulin, or serum in the treatment of severe acute respiratory infections. It is found that the mortality rate was significantly reduced with no serious adverse effects .
Researchers or clinical scientists are testing the use of donated blood as a treatment for people with severe COVID-19 . People who have recovered from COVID-19 have antibodies, developed by the individual against the disease. Scientists call this convalescent plasma. Researchers hope that convalescent plasma can be given to people with severe coronavirus infectious disease to boost their ability to fight the virus. Convalescent plasma could provide short-term immunity against the COVID-19 by providing antibodies (secreted by immune cell lymphocytes) that neutralize the novel coronavirus and prevent further damage. .
In Convalescent Plasma Therapy, the blood is withdrawn
from the patient who has recently recovered from COVID-19 .
Then the serum is separated to analyse the presence of virus
neutralising antibodies. These antibodies are extracted and then
administered to a a patient infected with Coronavirus. As per the
Houston Methodologist, the donation process of Plasma takes
around 1 hour just like blood donation. The donors of plasma
are hooked up with a small device that removes the plasma and
returns erythrocytes back to their bodies. The plasma rich in
antibodies is extracted from a patient who has recently recovered
from Coronavirus disease and infused into an infected patient.
When the body gets infected with external pathogens, the body
immediately starts releasing antibodies .
Researchers are expecting that convalescent plasma can be
given to people suffering from severe COVID-19 to boost their
ability to fight the virus. It also might help keep people who are
moderately ill from becoming more ill and experiencing COVID-19
complications (Figure 1).
The U.S. Food and Drug Administration has outlined the
requirements that individuals must meet to donate blood for this
research. Before donated blood can be used, it must be tested for
safety. It then goes through a process to separate blood cells so that
all that’s left is plasma with antibodies [10,13]. The immediate goal
of clinical trials is to determine whether the convalescent plasma
approach can improve the chance of recovery for people with
the most severe disease and secondary goals are to test whether
convalescent plasma can help keep people who are moderately
sick from getting sicker [14,10].
Passive immunization therapy has been successfully used
to treat infectious diseases back to the 1890s. An individual
who is sick with infectious diseases and recovers has blood
drawn and screened for particular microorganism neutralizing
antibodies . Following identification of those with high titers
of neutralizing antibody, convalescent plasma containing these
neutralizing antibodies can be administered in individuals with
specified clinical disease to reduce symptoms and mortality.
Hence, Convalescent Plasma Transfusion (CPT) has been the
subject of increasing attention, especially in the wake of largescale
epidemics. It has recently been suggested by the Food and
Drug Administration (FDA) that administration and study of
investigational CPT may provide a clinical effect for the treatment
of COVID-19 during the public health emergency .
The current treatment of COVID-19 caused by novel
coronavirus SARS-CoV-2 has been limited to general supportive
care, with provisions of critical care as no approved therapies or
vaccines are available . One of the hopeful treatments that
has emerged is convalescent plasma (CP), or immune plasma. CP,
which is plasma that is collected from an infected individual, such
as by COVID-19 (i.e., human anti–SARS-CoV-2 plasma), is then
transfused into infected patients as postexposure prophylaxis.
3 Unlike immunoglobulin (IgG)-derived antibodies such as
plasma-derived monoclonal antibodies, CP is a passive antibody therapy that showed some success as a neutralizing antibody
against other coronavirus epidemics, SARS-1 and the Middle East
respiratory syndrome (MERS), in the first two decades of the
2000s. CP-derived antibodies can neutralize a virus by preventing
replication (e.g., by complement activation or phagocytosis) or by
binding without interfering with replication .
Convalescent plasma transfusion (CPT) therapy in COVID-19
patients appears safe, clinically effective, and reduces mortality.
Well-designed large multicentre clinical trial studies should be
conducted urgently to establish the efficacy of CPT to COVID-19
patients . There was sufficient data that prove COVID-19
Patients can be treated With Convalescent Plasma . Since late
March, some U.S. patients have received a promising experimental
treatment for the new coronavirus. All were critically ill and in
hospitals. They didn’t get a new drug. Instead, doctors infused
their blood with antibodies. These immune proteins were taken
from the blood of people who had already recovered from
A group of US academic researchers has sparked a nationwide
effort to encourage people who have recovered from COVID-19
to donate plasma, which will be used to treat patients across the
country. The convalescent plasma program was instigated by
physicians and investigators from 40 institutions, including the
Mayo Clinic, Johns Hopkins University, Washington University,
Einstein Medical Center and the Icahn School of Medicine at Mount
Sinai, among many others working closely with the US Food and
Drug Administration (FDA) and industry partners. The UK’s
National Health Service launched in April a program across its 23
main blood centers to collect convalescent plasma for testing in
planned clinical trials. At the same time, a consortium of industry
players Takeda, CSL Behring, Biotest, Bio Products Laboratory,
LFB, Octapharma, and Microsoft have come together to develop an
unbranded polyclonal antibody product: hyperimmune globulin
(H-Ig) purified from the pooled plasma of donors who have
recovered from COVID-19 .
The treatment is known as convalescent plasma. Plasma is a
yellowish liquid in blood. It carries antibodies. The body’s immune
system makes those antibodies special proteins in response to a
virus or vaccine. Those proteins can bind to a virus and help to
remove the infectious particles. It takes time for the body to make
antibodies, around a week or two. But once they are available, the
immune system can quickly respond to a particular virus the next
time it confronts it. Antibodies are part of what is known as the
body’s “active immunity.” For some viruses and vaccines, active
immunity can last decades even the rest of your life .
In opposite, the new plasma therapy uses other person
antibodies to fight infection. The immunity it offers may last for
only weeks to a few months. But physician and scientist Jeffrey
Henderson (Washington University School of Medicine) say it’s
just possible that these proteins can prevent infection or treat
infection in another patient [19,21].
Convalescent plasma is an experimental therapy for
COVID-19. The U.S. Food and Drug Administration, or FDA,
recently authorized it for emergency use. The United States now
leading the world in confirmed cases of COVID-19 and no proven
treatments known researchers are racing to set up clinical trials
to test Convalescent plasma . If the therapy works, the FDA
might approve its wider use to treat infections with SARS-CoV-2,
the virus that causes COVID-19. A vaccine is still needed to protect
people from the infection. But such a vaccine for SARS-CoV-2 is
at least a year away or more. Until then, scientists are searching
for ways to treat the infection. John Roback. pathologist (Emory
University School of Medicine in Atlanta) say, donated antibodies
are one such treatment, he performs research on bloodtransfusion
COVID-19 convalescent plasma can be used for either
treatment of infection or treatment of disease. And plasma therapy
is old techniques because it is used in many other conditions.
Blood donors must have had documented SARS-CoV-2 infection,
the right time to using plasma therapy is within the first 14 days
of the symptoms. In a mode of action, the benefit of convalescent
plasma administration is that it can prevent infection and
subsequent disease in those who are at high risk for diseases, such
as underlying chronic medical conditions, health care providers,
and those with exposure to confirmed cases of COVID-19 .
Blood and plasma have been used many other conditions and may
be caused minor risk which is involved in transfusion of blood.
Being overweight is a major risk factor for people infected with
coronavirus so we can say the obesity is a major COVID-19 risk
factor. This risk is caused by age, pre-existing illness, or obesity.
The virus can hit young people’s particularly obese young peoples.
Another risk may be an allergic reaction. . A passive antibody
used to prevent COVID-19 infection. Such as patients exposed to
hepatitis B are treated with hepatitis B immune globulin (HBIG)
and patients exposed to rabies virus treated with human rabies
immune globulin (HRIG). Besides, the passive antibody is used for
the prevention of severe respiratory syncytial virus (RSV) disease
in high-risk infants .
The utilization of plasma has increased over the last two
decades, and Plasma transfusion is not without risk, Plasma
transfusion has a greater risk than other blood components.
Risks of passive use of convalescent plasma can be divided into
two categories, known & theoretical. The risks associated with
plasma transfusion is pathogenesis, diagnosis, and management.
The common risk associated with fresh frozen plasma include are:
a) Allergic or anaphylactic reactions.
b) Transfusion-related acute lung injury
c) Transfusion-associated circulatory overload
Other less common risks include
a) RBC alloimmunization,
b) Haemolytic transfusion reactions.
c) Transmission of infections,
d) Febrile non-haemolytic transfusion reactions,
With modern blood banking techniques and the risks of
inadvertently transferring known infectious agents or transfusion
reactions are low because of screening for blood-borne
pathogens and match the blood type of donors and recipients
. Convalescent Plasma therapy provides some benefits over
COVID-19. In a plasma, therapy immunity can be transferred from
a healthy person to an infected person with the help of blood
plasma. The idea behind this therapy is that antibodies produced
by the patients who have had survived the virus will boost the
immune system. And it also provides a medium for red blood cells
and platelets to circulates through the body .
To use convalescent plasma administration for COVID-19 the
following conditions must be considered;
1) Availability of assays, including virological assays to
measure viral neutralization and serological assays, to detect
SARS-CoV-2 in plasma,
2) Virology laboratory support to perform these assays
3) Availability of a population of donors who have
recovered from the disease and can donate convalescent plasma;
4) Blood banking facilities to process the plasma donations;
5) Treatment and therapeutic protocols, which should
ideally include randomized clinical trials to assess the efficacy of
any intervention and measure immune responses;
6) Regulatory compliance, including institutional review
board approval, which may vary depending on location. Ideally,
the use of convalescent plasma would involve multiple points
follow randomized control protocols, and have a single point as
a governing body. Each of these conditions should be available in
developed areas affected by COVID-19. At least one pharmaceutical
company, Takeda, is gearing up to generate antibody preparations
against SARS2-CoV-2 from COVID-19 convalescent sera [23,27].
We included 5 studies reporting CPT to COVID-19 patients.
The main findings from available data are as follows:
1. Convalescent plasma may reduce mortality in critically
2. Increase in neutralizing antibody and disappearance of
SARS-CoV-2 RNA was observed in almost all the patients after CPT
3. Beneficial effect on clinical symptoms after
administration of convalescent plasma . General methods,
which include existing broad-spectrum antiviral drugs. Use of
these individual and combined form to treat with coronaviruses,
including neuraminidase inhibitors such as oseltamivir, paramivir,
zanamivir, etc. Commonly used antiviral drugs, other drugs
possibly effective for 2019-nCoV include remdesivir, lopinavir/
ritonavir lopinavir/ritonavir, Neuraminidase inhibitors,
peptide (EK1), RNA synthesis inhibitors (such as TDF, 3TC),
anti- inflammatory drugs, Chinese traditional medicine, such as
Lianhuaqingwen Capsule, and Shu Feng Jie Du Capsules could be
the drug treatment options for 2019-nCoV. However, the safety
and efficacy of these drugs for novel Coronavirus still under
clinical experiments [28-30].
Liamas produce antibodies that block SARS-COV-2 from
infecting cells this could help in developing treatment against
COVID-19. Liamas produce a special type of antibodies when
exposed to viruses. These antibodies are very small as compare to
human antibodies and are known as single-domain antibodies or
nanobodies. Researchers isolated two nanobodies from ilamas and
engineered a new type antibody. That binds to the spike protein
on the coronavirus that causes COVID-19 . German biotech is
testing its coronavirus vaccine candidate on human volunteers.
BioNTech, a German pharmaceutical company launched its
vaccine on human trials. The company is collaborating with Pfizer,
a US-based pharmaceutical, on the vaccine called BNT162. After
it had received regulatory approval from the US authorities 12
volunteers are currently participating in a clinical trial in Germany
since April 2020 . Clinical trials to evaluate the safety and
efficacy of human Anti- SARS-CoV-2 (Severe Acute Respiratory
Syndrome Coronavirus 2). These trials have been performed to
evaluate the efficacy of convalescent plasma. At least five clinical
trials have been proposed to evaluate human anti-SARS-CoV-2
plasma for the prevention and treatment of COVID-19 .
The majority of patients who recover from COVID-19 illness
develop circulating neutralizing antibodies to various SARS-CoV-2
proteins in 15-20 days. Transfer of patient’s plasma should be
preventing further replication, neutralize the virus, and halting
ongoing tissue damage. This theory would be predicted to work
excellent in patients with less severe infection, or prophylactically
in highly susceptible individuals such as exposed health care
workers or family caregivers of SARS-CoV-2 patients. The
COVID-19 may with mild, moderate, or severe illness. Among
the severe clinical manifestations, there are ARDS, sepsis, septic
shock, and severe pneumonia. The clinical course of the disease
seems to predict a favourable trend in the majority of patients. For
suspected cases, rapid antigen detection, and other investigations
should be adopted for evaluating common respiratory pathogens and non-infectious condition . COVID-19 patients who had
established humoral immunity against the virus, contains a large
quantity of neutralizing antibodies capable of neutralizing SARSCoV-
2 and eradicating the pathogen from blood circulation and
pulmonary tissues. All investigated patients achieved plasma
SARS-CoV-2 RNA negativity after CP transfusion, accompanied
by an increase of oxygen saturation and lymphocyte counts, and
the improvement of liver function and CRP . The clinical
symptoms were significantly overcome along with an increase
in oxyhaemoglobin saturation. The Convalescent plasma therapy
was well good and effective could potentially improve the clinical
outcomes through severe COVID-19.
The convalescent plasma theory is an interim approach
during the development of vaccines, hyperimmune globulin, and
drug therapies. Human plasma from recovered novel coronavirus
patients is to be a safe and potentially effective therapy for
COVID-19 treatment. Hypothesize study suggests that the use of
convalescent plasma will improve the clinical outcomes in patients
with moderate Coronavirus infection. However, it is critically
important to perform well-controlled clinical trials to confirm
efficacy, Current estimates suggest a single donor collection could
be used to treat 2-3 patients. Clinical researchers or Pharmacists
can separate plasma, from the blood components that contain
such antibodies, and administer it to people whose bodies are
currently fighting an infectious disease novel coronavirus. This
theory helps their immune systems reject the pathogen virus
To launch new Convalescent plasma therapy for the treatment
of COVID-19 large pharmaceutical companies are racing to develop
purification procedures to produce concentrated neutralizing
antibodies from convalescent sera and immunizing in large
animals such as Cow, Horse, and sheep with SARS-CoV-2 proteins
to create antiserum. As well as biotech companies are trialling
to develop cocktails of monoclonal antibodies active against the
SARS-CoV-2 virus, but for finalized it take more months.