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More clinical trials needed before media boasts about blood transfusions as COVID-19 treatment

Could administration of convalescent plasma transfusion be beneficial in the treatment of critically ill patients with coronavirus disease 2019 (COVID-19)?

Blood transfusions as a cure for COVID-19 has been gaining a lot of media attention due to reported cases of this working for patients. The idea is to take blood from an individual who has recovered fully from COVID-19 and transfuse it into a sick patient. The blood of the recovered patient contains the memory cells and antibodies that were successful at fighting COVID-19 and will hopefully speed up the recovery of the sick patient.

The use of convalescent plasma was the recommended treatment during outbreaks of Ebola virus in 2014, and a protocol for treatment of MERS coronavirus with convalescent plasma was established in 2015. This approach with other viral infections such as SARS-CoV, H5N1 avian influenza, and H1N1 influenza also suggested that transfusion of convalescent plasma was effective (Kraft, 2015).

Small-scale randomized clinical studies have shown that patients do improve and recover at a faster time (Shen et al., 2020). There are some aspects of blood transfusion treatment to consider before the mass media broadcasts it as the breakthrough cure, though.

  • Patients will only be considered for blood transfusion if they are in critical condition: “Severe pneumonia with rapid progression and continuously high viral load despite antiviral treatment; Pao2/Fio2 <300; and mechanical ventilation (Wang et al., 2020).” Most people who catch COVID-19 will not need hospitalization and even less develop severe symptoms.

  • The blood type must be a match and donated blood must be easily accessible which is difficult due to travel bans and overall strain on the healthcare system.

  • All the patients receiving a blood transfusion are also on anti-viral medication so it is hard to determine whether the blood antibodies or drugs are the source of recovery.

  • Currently, there is not enough clinical trials to confirm that blood transfusions are truly effecitve.

These preliminary findings raise the possibility that blood transfusion may be helpful in the treatment of critically ill patients with COVID-19, but this approach requires evaluation in randomized clinical trials and time before we can put confidence into saying this is a treatment.

Chen L, Xiong J, Bao L, Shi Y. Convalescent plasma as a potential therapy for COVID-19. Lancet Infect Dis. 2020;S1473-3099(20)30141-9.

Kraft CS, Hewlett AL, Koepsell S, et al; Nebraska Biocontainment Unit and the Emory Serious Communicable Diseases Unit. The use of TKM-100802 and convalescent plasma in 2 patients with Ebola virus disease in the United States. Clin Infect Dis. 2015;61(4):496-502.

Shen C, Wang Z, Zhao F, et al. Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma. JAMA. Published online March 27, 2020. doi:10.1001/jama.2020.4783

Wang C, Li W, Drabek D, et al A human monoclonal antibody blocking SARS-CoV-2 infection. bioRxiv. Preprint posted online March 12, 2020. doi:10.1101/2020.03.11.987958

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