Table 1.
Characteristics of case reports of children treated with convalescent plasma.
| Author (year) |
Design | Country | Case study | Comorbidity | Clinical condition | Diagnostic approach | Treatment | Reason for CP* treatment | Outcome | Comments |
|---|---|---|---|---|---|---|---|---|---|---|
| Jin H., et al. (Sep 2020) [20] | Case report | USA | Case 1−10-year-old male; excluded: Case 2−24-year-old man; Case 3−40-year-old man |
Hereditary spherocytosis + X-linked agammaglobulinemia (XLA) | Initial symptoms: 10 dys before hospitalization; chest X-ray: right middle and lower lobe infiltrates | At admission: negative naso-pharyngeal swab RT-PCR;*** day 19: positive bronchoalveolar lavage RT-PCR*** |
10-day course of remdesivir; 2 units 200 mL unmixed ABO-compatible CP* (days 22 and 23) |
Minimal improvement on supportive therapies | Recovered after receiving CP* (6 dys). | CPT may help neutralize virus, shorten duration of illness, also in later stages of COVID-19 |
| Figlerowicz M, et al. (July 2020) [21] | Case report | Poland | 6-year-old girl | Aplastic anemia with severe pancytopenia | Hepatomegaly and bilaterally enlarged kidneys; COVID-19-associated severe aplastic anemia |
RT-PCR*** test on nasopharyngeal swab. | IVIG, lopinavir-ritonavir (10 mg + 2.5 mg twice daily). At 5 wks: CP* with antibodies against IgG titer 1:700 once in a 200 mL/dose |
Poor effect of treatment: IVIG, lopinavir-ritonavir + steroid | Negative SARS-CoV-2 RNA in nasopharyngeal swabs (3 wks); hematologic parameters (pancytopenia) did not improve; no adverse events |
In patients with pancytopenia, transfusion of CP* could be an option |
| Shankar AU, et al. (2020) [22] | Case report | India | 4-year-old girl | Acute lymphoblastic leukemia | Chest X-ray: bilateral fluffy opacities; hypoxia with increasing oxygen requirement to 7 L/min with face mask | RT-PCR*** for SARS-COV-2 RNA from nasopharyngeal swab | CP* 15 mL/kg on day 8 and 9. Lopinavir-ritonavir and remdesivir dexamethasone (0.2 mg/kg) and IVIG (1 g/kg) |
Children with cancer (high-risk population); severe COVID-19 associated pneumonia |
Remarkable improvement with reduction in respiratory rate, work of breathing and oxygen requirement (10 dys) No transfusion reaction |
Positive outcome following use of IVIG, steroids and CP* alone |
| Schwartz SP, et al. (Oct 2020) [17] | Case report (n = 4) | USA | 1) 15-year-old obese Hispanic male; 2) 16-year-old obese Asian male; 3) 5-year-old Hispanic female; 4) 12-year-old obese Hispanic female |
None | Acute respiratory failure requiring high-flow nasal cannula (HFNC) at admission | Anti-SARS-CoV-2 antibodies targeted to RBD** of SARS-CoV-2 spike protein | CP* units transfused: Case 1) no. 2 (RBD** binding titer 1:160; same donor); Remdesivir. IV anakinra. Case 2) no. 2, 10 mL/kg (titer unknown). remdesivir. Case 3) no. 2 (separate donors; titer 1:1,280). remdesivir Case 4) no. 2 (titer: Unit 1 = 1: 2,560, Unit 2 = 1:640). remdesivir. IV methylprednisolone |
CPT* as a treatment strategy for severe disease | Discharged home after CP*: 7 dys; 5 dys; 23 dys; 10 dys, respectively. Off oxygen support. 4) binding titer: unit 1 = 1:2,560, unit 2 = 1:640 No adverse events |
CPT* is feasible therapy for critically ill pediatric patients |
| Rodriguez Z, et al. (Sep 2020) [23] | Case report | USA | 9-week-old female | Trisomy 21; congenital heart disease | Cardiopulmonary failure secondary to unrepaired congenital heart disease exacerbated by COVID-19 | SARS-CoV-2 nucleic acid testing of nasopharyngeal swab | Remdesivir (5 mg/kg) 2 aliquots of CP* from 2 donors (10 mL/kg per aliquot; donor no. 1 had IgG titer 1:12724 and neutralizing titer 1:126; donor no. 2 had IgG titer 1:816 and neutralizing titer 1:50) from 2 COVID-19 recovered donors |
Deteriorating clinical status because lack of response to remdesivir (5 mg/kg per day) on hospital day 15 and 2.5 mg/kg per day on hospital days 16−25). | Uneventful complete recovery (47 dys) | CP* may be safe and effective treatment option in SARS-CoV-2 infection refractory to remdesivir. |
| Diorio C, et al (Sep 2020) [18] | Case report | USA | N = 4 patients, 14–18 years old; CD4, CD15, CD17, CD25# | None | Intubation and ventilation; two required extracorporeal membrane oxygenation |
RT-PCR*** testing of respiratory tract mucosa | Patient CD4 received CP* 2 mL/kg Patients CD15, CD17, CD25 received CP* 4 mL/kg (RBD**-specific antibody titer levels <1:160) |
Life-threatening COVID-19-associated respiratory disease | Donor for patient CD25# had higher SARS-CoV-2 RBD** antibody titers (>1:6000) than donor for other patients; no adverse event | CP* may be of greatest benefit early in illness |
| Greene AG, et al (Jun 2020) [19] | Case report | USA | 11-year-old female | None | Toxic shock-like syndrome; LV systolic function mildly decreased based on decreased shortening fraction | RT-PCR*** positive for SARS-CoV-2 | Furosemide, enoxaparin, tocilizumab, CP*, remdesivir, steroids, IVIG | Signs of distributive shock, multi-organ injury, systemic inflammation associated with COVID-19 | Improved dramatically (24 h) | Close follow-up for children presenting with fever lasting 3 dys |
| Balashov D, et al. (Nov 2020) [24] | Case report | Russia | 9-month-old girl | Juvenile myelomonocytic leukemia; hematopoietic stem cell transplantation | Polysegmental bilateral viral pneumonia with 60 % damage of lung tissue | RT-PCR***, throat swab positive for SARS-CoV-2 on day 99 after hematopoietic stem cell transplantation | Tocilizumab (10 mg/kg), CP* (10 mL/kg; 3 doses; titers 1:160, 1:160 and 1:80) | Secondary immunodeficiency | Full resolution of lung lesions; complete elimination SARS-CoV-2 4 mths after first detection CT* well tolerated |
SARS-CoV-2 CP* in combination with other therapeutic approaches possible curative options |
Legend: *CP denotes convalescent plasma; **RBD receptor-binding domain; ***RT-PCR real-time reverse transcription-polymerase chain reaction; #antibody titers expressed as reciprocal serum dilution against SARS-CoV-2 antigens in four children.