Convalescent plasma safety
References
Niveditha Devasenapathy, Zhikang Ye, Mark Loeb, et al. Efficacy and safety of convalescent plasma for severe COVID-19 based on evidence in other severe respiratory viral infections: a systematic review and meta-analysis. CMAJ 2020;10.1503/cmaj.200642.
4 Contemporary Risk Factors and Outcomes of Transfusion-Associated Circulatory Overload. Roubinian NH, Hendrickson JE, Triulzi DJ, Gottschall JL, Michalkiewicz M, Chowdhury D, Kor DJ, Looney MR, Matthay MA, Kleinman SH, Brambilla D, Murphy EL; National
Plasma transfusion is associated with postoperative infectious complications following esophageal resection surgery: a retrospective cohort study. Subramanian A, Berbari EF, Brown MJ, Allen MS, Alsara A, Kor DJ. J Cardiothorac Vasc Anesth. 2012 Aug;26(4
A major issue of convalescent plasma safety is that most studies have only included events that occur within a few hours of infusion as potentially plasma infusion related. Examples include hemolysis, acute lung injury, volume overload, anaphylaxis, urticaria, etc. However, the observational literature suggests that allogeneic plasma infusion may contribute to such less acute, but no less serious adverse events as nosocomial infection due to immunomodulation, subacute lung injury, myocardial injury, thrombosis and multi-organ failure. Some of these events may take days to be detectable. Thus I think there are still significant questions about the safety of allogeneic plasma in this and other settings. Large randomized trials of the sort planned in the USA through the Hopkins directed CTSI network will be needed to provide a definitive assessment of convalescent plasma efficacy and safety.