Background and objectives: Cytokine release syndrome in COVID-19 is due to a pathological inflammatory response of raised cytokines. Removal of these cytokines by therapeutic plasma exchange (TPE) prior to end-organ damage may improve clinical outcomes. This manuscript is intended to serve as a preliminary guidance document for application of TPE in patients with severe COVID-19. Material and methods: The available literature pertaining to the role of TPE for treatment of COVID-19 patients was reviewed to guide optimal management. It included indication, contraindication, optimal timing of initiation and termination of TPE, vascular access and anticoagulants, numbers and mode of procedures, outcome measures and adverse events. Results: Out of a total of 78 articles, only 65 were directly related to the topic. From these 65, only 32 were acceptable as primary source, while 33 were used as supporting references. TPE in critically ill COVID-19 patients may be classified under ASFA category III grade 2B. The early initiation of TPE for 1–1·5 patient’s plasma volume with fresh frozen plasma, or 4–5% albumin or COVID-19 convalescent plasma as replacement fluids before multiorgan failure, has better chances of recovery. The number of procedures can vary from three to nine depending on patient response. Conclusion: TPE in COVID-19 patients may help by removing toxic cytokines, viral particles and/or by correcting coagulopathy or restoring endothelial membrane. Severity score (SOFA & APACHE II) and cytokine levels (IL-6, C-reactive protein) can be used to execute TPE therapy and to monitor response in COVID-19 patients.
Bibliographical noteFunding Information:
We would like to acknowledge the all ISBT convalescent plasma working party members and special thanks to Vernon J Louw, Division of Clinical Haematology, Department of Medicine, University of Cape Town, South Africa; Adaeze Oreh, National Blood Transfusion Service, Department of Hospital Services, Federal Ministry of Health, Abuja, Nigeria; Evan M Bloch, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Dana Devine, Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada; Jinho Shin, Medical Officer, World Health Organization, Manila, Phillippines; Vincenzo De Angelis, Italian National Blood Centre, Roam, Italy; Richard Schafer, Institute for Transfusion Medicine and Immunohematology, Goethe University Hospital, Frankfurt am Main, Germany; Ruchika Goel, Division of Hematology/Oncology, Simmons Cancer Institute at SIU School of Medicine and Mississippi Valley Regional Blood Center, Springfield, Illinois, USA; Arwa Al Riyami, Department of Hematology, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman; and Silvano Wendel, Hospital Sirio Libanes, Sao Paulo, Brazil for reviewing the manuscript and give valuable comments.
© 2021 International Society of Blood Transfusion