COVID-19 convalescent plasma therapy and immunodeficiency

Dear Editor, we would like to share ideas on the publication “COVID-19 convalescent plasma as long-term therapy in immunodeficient patients? [1].“Rnjak et al. concluded that “Therapeutic approach based on convalescent plasma transfusion transformed a prolonged, active COVID-19 infection into a manageable chronic disease [1].” The usefulness of plasma therapy in COVID-19 management is widely discussed. The immunodeficient cases might get advantage from convalescent plasma therapy. However, the risk should not be forgotten. Contamination in plasma is possible and it can cause a problem in an immunodeficient case. Hähnel et al. suggested that any blood during product for management of COVID-19 must undergo rigorous testing to ensure a high quality and safety [2]. Duan et al. noted that an important risk of plasma therapy is the transmission of the potential pathogen [3]. Standard protocols with pathogen inactivation technologies are important but it usually requires expensive infrastructures. Ferreira and Mostajo-Radji Noted that plasma-based COVID-19 treatment in low- and middle-income nations with little or no infrastructures could contribute a high risk of an HIV epidemic [4]. At present, there are limited data on pathogen contamination and most studies are on only HIV and hepatitis viruses [5]. Additionally, a recent report showed that plasma SARS CoV2 reduction, but not complete removal was observed after pathogen reduction process [6].

Comparing to plasma therapy, additional therapy by antiviral drug (such as favipiravir) and alternative drug such as hydroxychloroquine, are also available but the current evidences usually show a limited usefulness of those drugs and reevaluation of alternatives approaches for COVID-19 therapy is important. Based on a recent study using multicriteria decision-making techniques, plasma therapy seems to be superior to other alternative therapy. Nevertheless, there are still questions for plasma therapy. Using convaslescent therapy poses its risk and the risk might or might not increase in an immunodeficient subject [7]. Regarding risks and precautions in plasma therapy, Garraud et al. noted for a possible usefulness comparing to other alternative therapies [8]. Nevertheless, the reaction rate from plasma therapy still existed [5]. Garraud raised for an important consideration on standard safety guarantee and called for further clinical trials for verifying efficacy and safety of plasma therapy [9]. Risk-benefit analysis for using of convalescent therapy is still an interesting issue for further studies [6]. Risk of convalescent therapy is an important discussed bioethical issue at present [10].

Disclosure of interest

The authors declare they have no competing interest.