Table 2.
Summary of included studies(case reports or case series) on CP for COVID-19 patients.
| Author | Country | Study design | Study population | CPT dose | titers | Time of administration | Status during CPT | Outcomes | Sever events and treatment complications |
|---|---|---|---|---|---|---|---|---|---|
| Salazar E et al. [43] | USA | Case series(n = 25) | Age (23–67),14F:11 M,16 patients had one or more underlying chronic conditions:DM2(n = 10), HTN(n = 9),HLD(n = 5),GERD(n = 4) |
300 ml single dose | Ranged from 0 to 1350 for the RBD and ECD domains. | Median time from symptoms onset to CPT was 10 days (IQR,7.5 to 12.5 days) | ARDS(n = 11);ARDS,CRRT(n = 1);ARDS,CRRT, ECMO (VV)(n = 1);None(n = 12) |
At 7 days after transfusion, 9 of 25 patients (36%) had improvement. By 14 days after transfusion, 19 patients (76%) had improved or been discharged. | No AEs |
| Ye et al. [44] | China | Case series(n = 6) | Age (28–75),3M:3F, Bronchitis(n = 1) and Sjogren syndrome(n = 1) |
200–250 ml two consecutive transfusions | – | Average interval between symptom onset and CPT is 34.8 days (range from 22 to 48 days) | Clinical deteration | Clinical symptoms improved | No severe AEs |
| Shen et al. [45] | China | Case series(n = 5) | Age(36–65),2F:3M,HTN;mitral insufficiency(n = 1) | 200 ml two consecutive transfusions | NAbs＞40 | Average interval between symptom onset and CPT is 20.8 days (range from 14 to 24 days) | All 5 critical severe ARDS on MV, ECMO (n = 1) | Viral loads decreased,NAbs increased and clinical symptoms improved. | No severe adverse reactions |
| Zhang et al. [46] | China | Case series(n = 4) | Age (31–73),2F:2M,HTN(n = 2,&CRF n = 1),COPD (n = 1),pregnant(35 week and 2 days of gestation) | 200–400 ml in one or two consecutive transfusions. A patient received 2400 ml divided in eight consecutive transfusions | – | Average interval between admission and CPT is 16.2 days (range from 11 to 22 days) | Critically ill invasive MV | Clinical symptoms and lung imaging improved. All patients discharged. | No severe adverse reactions |
| Anh et al. [47] | South Korea | Case series(n = 2) | Age(67,71),1M:1F,HTN(n = 1) | 250 ml two consecutive transfusions. | Optional density ratio for IgG:0.532&0.586 | Interval between symptom onset and CPT was 22 days and 6 days | Severe ARDS, MV | Favourable clinical outcome in critically ill patients with ARDS. | No adverse reactions |
| Kong,et al [48] | China | Case report | A 100-year-old male | 200 ml,100 ml | IgG titer of >1:640 | More than 60 days | High-flow oxygen; a 30-year record of HTN, abdominal aortic aneurysm,cerebral infarction, prostate HLD, and complete loss of cognitive function for the preceding 3 years. | Laboratory indicators and clinical symptoms recoveried, discharged from hospital. | No adverse reactions |
| Anderson,et al. [49] | United States | Case report | A 35-year-old critically ill obstetric patient(22 weeks and 2 days of gestation). | One unit | – | 14 days | Worsening dyspnea and hypoxia. acute respiratory distress syndrome.high-flow non-invasive positive-pressure ventilation | After the combination of remdesivir.Clinical recovery and discharge from hospital. | No adverse reactions |
| Çınar,et al. [50] | Turkey | Case report | A 55-year-old male with a history of myelodysplastic syndrome complicated by disseminated systemic tuberculosis and associated kidney disease. | 200 ml,twice | Titer of anti-SARS-CoV-2 IgG was 6.6(<0.8 negative,≥0.8 to < 1.1 borderline,≥1.1 positive) |
Interval between admission and CPT is 5 days | ICU,oxygen supplementation of 2 L/min with nasal cannula. | Clinical recovery and discharge from hospital. | No adverse reactions |
| Abdullah HM et al [51] | Iraq | Case series(n = 2) | 46y/M; 56y/M | 200 ml | – | case1:10 days; case2: not reported |
Severe illness | Clinical recovery and discharge from hospital | No AEs |
| Peng H et al [52] | China | Case report | 66y/F | 200 ml,twice | Greater than 1:160. | 10 days | Severe illness | On the fourth day after CPT, the absolute lymphocyte count returned to normal. After 2 weeks, she recovered and discharged. | No AEs |
| Al Helali AA et al [53] | Abu Dhabi, UAE | Case report | 55y/M | 300 ml | – | 9 days | Severe illness | There was a significant radiological and clinical improvement in a few days’ post CPT. | No significant AEs were observed. |
| Jafari R et al [54] | Iran | Case report | 26y/F, pregnant(36 w) | – | – | 12 days | – | Her clinical course during hospitalization improved, particularly during the second week. | No AEs |
| Im JH et al [55] | Korea | Case report | 68y/M | 250 ml,twice | 1:32 | 16 days | Critical illness | The patient showed clear improvement in respiratory distress and fever symptoms for 3 days after CPT. However, 4 days after CPT, he presented respiratory distress again. It was difficult to assess the effects of CP clearly. | 4 days after the CPT, the patient presented respiratory distress. |
| Figlerowicz M ey al [56] | Poland | Case report | 6y/F | 200 ml | 1:700 | – | Severe and severe aplastic anemia | The patient’s SARS-CoV-2 RNA in nasopharyngeal swabs was tested seven times in next three weeks. All these results were negative. | No AEs |
| Xu TM et al [57] | China | Case report | 65y/M | – | – | – | Severe illness | On day 4 after CPT, the lactic acid and CRP levels remained high. The arterial oxyhemoglobin saturation decreased to 86%, and mv was administered. | No AEs |
| Karataş A et al [58] | Turkey | Case report | 61y/M | – | 13.3 (≥1.1 positive) | – | Mixed cellularity classical Hodgkin lymphoma, autologous stem cell transplantation (ASCT, 6 months ago) | After the CPT, his fever resolved after 3 days.He was discharged from the hospital on the 78th day of hospitalization. | No AEs |
| Naeem S et al [59] | USA | Case series(n = 3) | 65y/F;35y/F;36y/F | Case1: 1 unit case2: 2 units case3: 3 unit | Case1:antibody Levels in plasma (index):8.68. case2:antibody index:5.70,8.15 case3:antibody index:5.67. | – | 3 kidney transplant (KT) recipients | They all successful recovery from COVID-19. | No AEs |
| Zeng H et al [60] | China | Case series(n = 8) | F:4;M:4;median age 65.0 | 5/8 cases received two doses of 100–200 ml of CP within 24 h (totally 300 or 400 ml), 3 cases received one dose of 200 ml | 1:320–1:2560(Anti-S-RBD specific IgG ELISA titer) | – | Critical or severe illness;5 patients had coexisting chronic diseases. | After CPT, patients’ oxygen support status and chest CT improved, and viral load was decreased. | No AEs |
| Wang M et al [61] | China | Case series(n = 5) | 56y/M;66y/F;46y/F;51y/F;61y/M | 200 ml of CP was transfused at a time,3 received 400 ml and remaining 2 received 1200 ml | above 1:640 | Median and IQR: 34, 44 days | All patients were critically ill and had underlying chronic comorbidities, including HTN and DM.2 Septic shock;1Coagulopathy;1Septicemia | 2 patients were cured and subsequently discharged, 3 patients succumbed due to multiple organ failure. | None of the patients developed adverse reactions following the infusion of CPT. |
| Shankar R et al [62] | India | Case report | 4y/F | She received CP 15 ml/kg on Days 8 and 9 of illness. | – | 8 days | Standard-risk B Lineage Acute Lymphoblastic Leukemia in remission and on interim maintenance therapy | She showed remarkable improvement by day 10. And She was discharged after remaining asymptomatic for 5 days. | No transfusion reaction |
| Jiang J et al [63] | China | Case report | 70y/F | 200 ml,twice | SARS-CoV-2–specific ELISA antibody titer higher than 1:1000. | 26 days | Renal transplant patient receiving immunotherapy, combined with chronic bronchitis, HTN, and HLD | The patient was discharged and the use of plasma was helpful for SARS-CoV-2 clearance and patient recovery. | No AEs |
| Zhang LB et al [64] | China | Case series(n = 2) | 69y/F, 50y/F | Case1:400 ml, once. case2:200 ml | – | 30 days, 10 days | Case1: recurrent gastrointestinal complaints of anorexia and mild diarrhea. case2: intermittent course of diarrhea, positive fecal occult blood; SLE, LI, and DM. |
Case1:3 days after CPT, the patient’s condition was much improved, and was discharged. case2:7 days after CPT, she showed complete recovery and was discharged. | No AEs |
| Diorio C et al [65] | USA | Case series(n = 4) | 14–18 years | 200–220 ml | 2patients received CP with RBD-specific antibody titer (<1:160), and full-length IgG S titers(>1:1000). 1 patient received CP with RBD-specific antibody titer levels >1:6000 | 8–15 days | Critical illness | 1 patient showed transient clinical improvement, decannulating from ECMO, however, died from cardiac.2patients remain in hospital and have had the placement of tracheostomies. 1patients has been discharged from the hospital after being critically ill and on ECMO. | No AEs |
Abbreviations: M, male; F, female. CPT, convalescent plasma transfusion; CP, convalescent plasma; DM2, diabetes mellitus type 2; HTN, hypertension; GERD, gastrointestinal reflux disease; HLD, hyperlipidemia; RBD, receptor binding domain; ECD, ectodomain; ARDS, acute respiratory distress syndrome; CRRT, cardiac rapid response team; ECMO (VV), extracorporeal mechanical oxygenation(venovenous);AZM, azithromycin; HCQ, hydroxychloroquine; LPVr, lopinavir/ritonavir; RBV, ribavirin; ARB,arbidol; DRV, darunavir; IFN,interferon; NAbs, Neutralizing antibodies; HFNO, High‐flow nasal oxygen therapy; LFNO, low‐flow nasal cannula oxygenation; ICU, Intensive care unit; COPD, chronic obstructive pulmonary disease; CRF, chronic renal failure; SLE, systemic lupus erythematosus; LI, lacunar infarction; AEs, adverse events; IQR:Inter quartile range; MV: mechanical ventilation;