In Colorado, on November 5, 2020, the number of patients hospitalized with confirmed COVID-19 surpassed the peak of 888 patients in April, 2020. The number of hospitalized patients is rising.
Scientific evidence suggests that the transfusion of convalescent plasma from COVID-19 recovered donors to hospitalized patients with COVID-19 improves survival.
Bottom line: COLORADO NEEDS PLASMA FROM PEOPLE WHO HAVE RECOVERED FROM COVID-19, which means no fever and no shortness of breath at rest. We need plasma donation during 14 and 60 days of your recovery, since your antibody levels are the highest and most effective in fighting the illness in a hospitalized COVID-19 patient. We also know that the sooner the hospitalized patient receives plasma, the better chance of survival.
People who convalesce (recover) from COVID-19 make antibodies against COVID-19 in their plasma component of blood. The only antibody type that is currently available for immediate use in COVID-19 is found in convalescent plasma. As more people contract COVID-19 and recover, the number of potential convalescent plasma donors will continue to increase. Giving this plasma to people who are seriously ill with COVID-19 disease may improve their chance of survival.
On August 23, 2020, the United States Food and Drug Administration issued an emergency use authorization (EUA) for COVID-19 convalescent plasma for the treatment of hospitalized patients with COVID-19. This means that the FDA supports the use of convalescent plasma to improve survival in patients hospitalized with COVID-19. It also means that doctors can order convalescent plasma for their hospitalized patients.
To donate, you must:
- Be 18 years or older.
- Have recovered from a COVID-19 illness, which means no fever and shortness of breath for at least 14 days. You may also be eligible to donate if you have had a positive COVID-19 antibody test.
- Donate between 14 days and 60 days of your recovery period. This is because your antibodies to fight COVID-19 are at the highest levels, giving the recipient the best chance of survival. Some blood centers allow you to donate beyond 60 days of your recovery.
- As with any blood donation, you must pass the standard blood donation screening process at the blood bank of your choice.
Please note: If you have recently been sick with COVID-19, please DO NOT go to a Blood Collection Center until you have recovered, which means no fever and no shortness of breath for 14 days.
- You need confirmation of a positive COVID-19 test, by nasal swab or blood test. This can be a positive test for the active virus or a positive test for antibodies in your bloodstream.
- Keep a copy of your positive test result as proof for the Blood Collection Centers.
- Contact a Blood Collection Center to see if you quality, using the contact information below.
Vitalant Blood Centers, from Cheyenne to Colorado Springs to Santa Fe, New Mexico:
St. Mary’s Hospital of Grand Junction:
Children’s Hospital Colorado, Aurora:
- If you have a potential donor who had a confirmed COVID-19 positive test result, and is interested in donation, they will need assistance in confirming and providing documentation of that result.
- Your donor needs to be recovered from COVID-19, which means no fever and no shortness of breath for 14 days. The ideal time frame to donate is 14 to 60 days after the illness, since the antibody levels are highest during that time. Some centers allow donation after 60 days of recovery. Your donor does not need another COVID-19 test.
You and your donor’s plasma collection site of choice may require a different screening and ordering methodology.
If you are a physician caring for a patient with COVID-19 disease in the hospital, this is a general guide to help you obtain plasma for your patient.
There are two main pathways available to you for ordering and administering plasma as suggested by the FDA Recommendations. Please check with your hospital, as one of these two pathways may be the suggested course of action:
Inquire whether your hospital is participating in a clinical trial, as your patient may be eligible to participate.
Emergence Use Authorization (EUA) granted by the FDA
The FDA has approved convalescent plasma, an unapproved product, under Emergency Use Authorization as of August 23, 2020 for hospitalized patients with COVID-19.
The process to order convalescent plasma may vary between hospitals, but this is the general workflow:
- Before you proceed, review the FDA’s Convalescent Plasma Provider Fact Sheet.
- Present the patient with the FDA’s Convalescent Plasma Recipient Fact Sheet.
- Obtain the patient’s assent for convalescent plasma and document the assent in the medical record.
- Obtain the patient’s consent to blood products, indicating transfusion of convalescent plasma.
- Order ABO typing so the blood bank has a validated ABO type on the patient.
- Place the transfusion order in your hospital’s ordering system. Your hospital will likely have additional ordering processes in place specific to your blood bank supplier.
- Plasma unit is transfused at bedside and administered according to local hospital procedures.
The provider can choose 1 unit or 2 units of convalescent plasma. If choosing two units they must be ordered at the same time and the second administered within 12 hours of the start of the first. The issuing of two units will be dependent on the availability of supply of units of the appropriate blood type at the blood donor centers. The decision to use 1 or 2 units is at the discretion of the treating physician. There is no data that confirms a benefit of two units over one unit. Each unit is generally 200 mL. Factors that may be considered by the physician are the severity of illness, the patient’s body mass and the patient’s ability to tolerate the extra volume.
Prioritization given limited supply:
Convalescent plasma is a blood product of undetermined benefit based on limited clinical experience and may be in short supply at times depending on local epidemiology of disease. It is likely that the number of eligible patients for outstrips the number of available, matched units. We propose the following guidance for prioritizing its use.
- First priority is patient safety: Over 73,000 in units have been transfused to over 103,000 patients to date in the US (https://www.uscovidplasma.org). Nonetheless, providers and patients/families should carefully weigh the potential risks and benefits prior to decision to treat.
- Known risks of blood products include:
- inadvertent infection with another infectious pathogen
- general reactions such as transfusion-associated circulatory overload (TACO), and transfusion-associated acute lung injury (TRALI) in patients with already severe lung damage.
- Additional concerns include:
- contribution to fluid overload
- potential worsening of immune-mediated tissue damage
- theoretical antibody-dependent enhancement of infection and blunting of development of endogenous immunity to the virus
Several reports of COVID convalescent plasma have been made publicly available:
Initial FDA announcement, August 23, 2020: https://www.fda.gov/media/141480/download
Updated FDA announcement, September 23, 2020: https://www.fda.gov/media/142386/downloadThese studies generally found an improved survival benefit when patients were treated with high-antibody donor plasma early in the course of disease. Given the limited data available to guide decision-making, providers should consider prioritizing:
- Severe (hospitalized) Covid 19 with evidence of acute decompensation such as
- increasing oxygen requirements
- requiring move to ICU whether intubated or not
- requiring 100% oxygen +/- high PEEPs representing someone in severe ARDS
- Severe(hospitalized) Covid 19 with risk for decompensation such as
- increasing or persistently elevated inflammatory markers - Ferritin, CRP, elevated AST and ALT, lymphopenia (new or worsening)
- Clinical factors placing patients at high risk (DM, immunosuppression, obesity, COPD, etc)
- Patients who have already had a prolonged ICU course (>10 days) may already have developed an immune response and/or may not benefit from this therapy due to cytokine mediated response.
- Severe (hospitalized) Covid 19 with evidence of acute decompensation such as
- The use of an emergency use blood product in short supply is a clinical decision that is left to the treating clinician in conjunction with the patient and family members. Convalescent plasma allocation is not governed by Crisis Standards of Care in CO or MT.
Colorado COVID-19 Convalescent Plasma Project Consortium
Updated on November 9, 2020
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