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Duarte GDC, Simoni V, Ribeiro GN, Haddad R, Moschen M, Toledo RSM, Ottoboni MAP, Mendrone-Junior A, Langhi DM. Development and implementation of a COVID-19 convalescent plasma program in a middle-income economy. Hematol Transfus Cell Ther 2022; 44:206-212. [PMID: 35071990 PMCID: PMC8767797 DOI: 10.1016/j.htct.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 01/04/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Convalescent Plasma therapy is one of the therapeutic strategies that has been used for patients with the Covid-19 disease. Implementing a program with national extension to supply hospitals with this blood component is a great challenge mainly in a middle-income economy. Objectives Our objective was to develop and implement a Covid-19 Convalescent Plasma Program which met established quality standards and was adapted to a reality of limited resources. Methods A multicentric convalescent plasma collection program was developed and implemented, based on four main sequential procedures: selective donor recruitment, pre-donation antibody screening (Anti-SARS-CoV-2- Chemiluminescence IgG Abbott), convalescent plasma collection by apheresis or whole-blood processing and distribution to the hospitals according to local demand. Results From the 572 candidates submitted to the pre-donation antibody screening, only 270 (47%) were considered eligible for plasma donation according to the established criteria. Higher levels of total antibody were associated with the donor age being above 45 years old (p = 0.002), hospital admission (p = 0.018), and a shorter interval between the diagnosis of the SARS-CoV-2 infection and plasma donation (p < 0.001). There was no association between the ABO and Rh blood groups and their antibody levels. Of the 468 donations made, 61% were from the collection of whole-blood and 39%, from apheresis. The Covid-19 Convalescent Plasma units obtained were distributed to 21 different cities throughout the country by air or ground transportation. Conclusion The implementation of a Covid-19 Convalescent Plasma program in a continental country with relatively scarce resources is feasible with alternative strategies to promote lower cost procedures, while complying with local regulations and meeting quality standards.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Dante Mario Langhi
- HHemo, São Paulo, SP, Brazil; Fundação Pró-Sangue, Hemocentro de São Paulo, São Paulo, SP, Brazil
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Bégin P, Callum J, Jamula E, Cook R, Heddle NM, Tinmouth A, Zeller MP, Beaudoin-Bussières G, Amorim L, Bazin R, Loftsgard KC, Carl R, Chassé M, Cushing MM, Daneman N, Devine DV, Dumaresq J, Fergusson DA, Gabe C, Glesby MJ, Li N, Liu Y, McGeer A, Robitaille N, Sachais BS, Scales DC, Schwartz L, Shehata N, Turgeon AF, Wood H, Zarychanski R, Finzi A, Arnold DM. Convalescent plasma for hospitalized patients with COVID-19: an open-label, randomized controlled trial. Nat Med 2021; 27:2012-2024. [PMID: 34504336 PMCID: PMC8604729 DOI: 10.1038/s41591-021-01488-2] [Citation(s) in RCA: 176] [Impact Index Per Article: 58.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/02/2021] [Indexed: 12/24/2022]
Abstract
The efficacy of convalescent plasma for coronavirus disease 2019 (COVID-19) is unclear. Although most randomized controlled trials have shown negative results, uncontrolled studies have suggested that the antibody content could influence patient outcomes. We conducted an open-label, randomized controlled trial of convalescent plasma for adults with COVID-19 receiving oxygen within 12 d of respiratory symptom onset (NCT04348656). Patients were allocated 2:1 to 500 ml of convalescent plasma or standard of care. The composite primary outcome was intubation or death by 30 d. Exploratory analyses of the effect of convalescent plasma antibodies on the primary outcome was assessed by logistic regression. The trial was terminated at 78% of planned enrollment after meeting stopping criteria for futility. In total, 940 patients were randomized, and 921 patients were included in the intention-to-treat analysis. Intubation or death occurred in 199/614 (32.4%) patients in the convalescent plasma arm and 86/307 (28.0%) patients in the standard of care arm—relative risk (RR) = 1.16 (95% confidence interval (CI) 0.94–1.43, P = 0.18). Patients in the convalescent plasma arm had more serious adverse events (33.4% versus 26.4%; RR = 1.27, 95% CI 1.02–1.57, P = 0.034). The antibody content significantly modulated the therapeutic effect of convalescent plasma. In multivariate analysis, each standardized log increase in neutralization or antibody-dependent cellular cytotoxicity independently reduced the potential harmful effect of plasma (odds ratio (OR) = 0.74, 95% CI 0.57–0.95 and OR = 0.66, 95% CI 0.50–0.87, respectively), whereas IgG against the full transmembrane spike protein increased it (OR = 1.53, 95% CI 1.14–2.05). Convalescent plasma did not reduce the risk of intubation or death at 30 d in hospitalized patients with COVID-19. Transfusion of convalescent plasma with unfavorable antibody profiles could be associated with worse clinical outcomes compared to standard care. A randomized trial in patients hospitalized with COVID-19 showed no benefit and potentially increased harm associated with the use of convalescent plasma, with subgroup analyses suggesting that the antibody profile in donor plasma is critical in determining clinical outcomes.
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Affiliation(s)
- Philippe Bégin
- Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada. .,Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
| | - Jeannie Callum
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, Ontario, Canada. .,Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. .,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada. .,Canadian Blood Services, Ottawa, Ontario, Canada.
| | - Erin Jamula
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Richard Cook
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Nancy M Heddle
- Canadian Blood Services, Ottawa, Ontario, Canada.,McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Alan Tinmouth
- Canadian Blood Services, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Centre for Transfusion Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Michelle P Zeller
- Canadian Blood Services, Ottawa, Ontario, Canada.,McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Guillaume Beaudoin-Bussières
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Quebec, Canada.,CHUM Research Center, Montreal, Quebec, Canada
| | - Luiz Amorim
- Hemorio, Hospital and Regional Blood Center, Rio de Janeiro, Brazil
| | - Renée Bazin
- Héma-Québec, Medical Affairs and Innovation, Quebec City, Quebec, Canada
| | | | - Richard Carl
- Patient representative, Montreal, Quebec, Canada
| | - Michaël Chassé
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,Innovation Hub, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Melissa M Cushing
- Transfusion Medicine and Cellular Therapy, New York-Presbyterian, New York, NY, USA.,Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Nick Daneman
- Department of Medicine, Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Dana V Devine
- Canadian Blood Services, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeannot Dumaresq
- Département de médecine, CISSS de Chaudière-Appalaches, Lévis, Quebec, Canada.,Département de microbiologie-infectiologie et d'immunologie, Faculté de Médecine, Université Laval, Quebec City, Quebec, Canada
| | - Dean A Fergusson
- Canadian Blood Services, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Caroline Gabe
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Marshall J Glesby
- Division of Infectious Diseases, Weill Cornell Medical College, New York, NY, USA
| | - Na Li
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Department of Computing and Software, McMaster University, Hamilton, Ontario, Canada
| | - Yang Liu
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Allison McGeer
- Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nancy Robitaille
- Héma-Québec, Montreal, Quebec, Canada.,Division of Hematology and Oncology, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada.,Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Bruce S Sachais
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA.,New York Blood Center Enterprises, New York, NY, USA
| | - Damon C Scales
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Medicine, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Schwartz
- Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Nadine Shehata
- Canadian Blood Services, Ottawa, Ontario, Canada.,Departments of Medicine, Laboratory Medicine and Pathobiology, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of Hematology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Alexis F Turgeon
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada.,CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Heidi Wood
- Zoonotic Diseases and Special Pathogens, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Ryan Zarychanski
- Department of Internal Medicine, Sections of Hematology/Medical Oncology and Critical Care, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrés Finzi
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Quebec, Canada.,CHUM Research Center, Montreal, Quebec, Canada
| | | | - Donald M Arnold
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada. .,Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
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Muttamba W, Lusiba J, Namakula LO, Byakika-Kibwika P, Ssali F, Ddungu H, Mugenyi L, Kiwanuka N, Sekibira R, Kityo C, Keyune D, Acana S, Musinguzi A, Masasi A, Byamugisha J, Mpanju D, Musoki WJ, Tukamuhebwa HA, Nakwagala F, Bagaya BS, Kayongo A, Kimuli I, Nantanda R, Katagira W, Buregyeya E, Byanyima R, Byarugaba B, Siddharthan T, Mwebesa H, Charles O, Joloba ML, Bazeyo W, Kirenga B. Feasibility of collecting and processing of COVID-19 convalescent plasma for treatment of COVID-19 in Uganda. PLoS One 2021; 16:e0252306. [PMID: 34138909 PMCID: PMC8211202 DOI: 10.1371/journal.pone.0252306] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/06/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction Evidence that supports the use of COVID-19 convalescent plasma (CCP) for treatment of COVID-19 is increasingly emerging. However, very few African countries have undertaken the collection and processing of CCP. The aim of this study was to assess the feasibility of collecting and processing of CCP, in preparation for a randomized clinical trial of CCP for treatment of COVID-19 in Uganda. Methods In a cross-sectional study, persons with documented evidence of recovery from COVID-19 in Uganda were contacted and screened for blood donation via telephone calls. Those found eligible were asked to come to the blood donation centre for further screening and consent. Whole blood collection was undertaken from which plasma was processed. Plasma was tested for transfusion transmissible infections (TTIs) and anti-SARS CoV-2 antibody titers. SARS-CoV-2 testing was also done on nasopharyngeal swabs from the donors. Results 192 participants were contacted of whom 179 (93.2%) were eligible to donate. Of the 179 eligible, 23 (12.8%) were not willing to donate and reasons given included: having no time 7(30.4%), fear of being retained at the COVID-19 treatment center 10 (43.5%), fear of stigma in the community 1 (4.3%), phobia for donating blood 1 (4.3%), religious issues 1 (4.4%), lack of interest 2 (8.7%) and transport challenges 1 (4.3%). The median age was 30 years and females accounted for 3.7% of the donors. A total of 30 (18.5%) donors tested positive for different TTIs. Antibody titer testing demonstrated titers of more than 1:320 for all the 72 samples tested. Age greater than 46 years and female gender were associated with higher titers though not statistically significant. Conclusion CCP collection and processing is possible in Uganda. However, concerns about stigma and lack of time, interest or transport need to be addressed in order to maximize donations.
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Affiliation(s)
| | - John Lusiba
- Uganda Peoples Defense Forces Medical Services, Kampala, Uganda
- Uganda Heart Institute, Kampala, Uganda
| | | | | | | | | | | | - Noah Kiwanuka
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Cissy Kityo
- Joint Clinical Research Centre, Kampala, Uganda
| | | | - Susan Acana
- Uganda Blood Transfusion Services, Kampala, Uganda
| | | | - Ayub Masasi
- Mulago National Referral Hospital, Kampala, Uganda
| | - Joseph Byamugisha
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - David Mpanju
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Walter Jack Musoki
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Bernard Sentalo Bagaya
- Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Alex Kayongo
- Makerere University Lung Institute, Kampala, Uganda
| | - Ivan Kimuli
- Makerere University Lung Institute, Kampala, Uganda
| | | | | | - Esther Buregyeya
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Trishul Siddharthan
- Pulmonary and Critical Care, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Henry Mwebesa
- Ministry of Health, Republic of Uganda, Kampala, Uganda
| | - Olaro Charles
- Ministry of Health, Republic of Uganda, Kampala, Uganda
| | - Moses Lutaakome Joloba
- Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Bruce Kirenga
- Makerere University Lung Institute, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- * E-mail:
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