Multi-institutional experience with COVID-19 convalescent plasma in children

Cyril Jacquot, Department of Laboratory Medicine, Children's National Hospital, District of Columbia, Washington, USA.
Oren Gordon, Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland, USA.
Daniel Noland, Children's Health Dallas/UTSW, Dallas, Texas, USA.
Jeffrey R. Donowitz, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia, USA.
Emily Levy, Mayo Clinic, Rochester, Minnesota, USA.
Sanjay Jain, Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland, USA.
Zachary Willis, UNC Chapel Hill, Chapel Hill, North Carolina, USA.
Casey Rimland, UNC Chapel Hill, Chapel Hill, North Carolina, USA.
Michele Loi, Children's Hospital Colorado, Aurora, Colorado, USA.
Antonio Arrieta, Division of Infectious Diseases, Children's Hospital of Orange County, Orange, California, USA.
Kyle Annen, Children's Hospital Colorado, Aurora, Colorado, USA.
Noelle Drapeau, Mayo Clinic, Rochester, Minnesota, USA.
Stephanie Osborne, Division of Infectious Diseases, Children's Hospital of Orange County, Orange, California, USA.
Monica I. Ardura, Pediatric Infectious Diseases & Host Defense Program, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA.
Satyam Arora, Postgraduate Institute of Child Health, Delhi, India.
Elise Zivick, Medical University of South Carolina, Charleston, South Carolina, USA.
Meghan Delaney, Department of Laboratory Medicine, Children's National Hospital, District of Columbia, Washington, USA.

Document Type

Journal Article

Publication Date

3-25-2023

Journal

Transfusion

DOI

10.1111/trf.17318

Keywords

COVID-19 convalescent plasma; pediatric transfusion; transfusion safety

Abstract

BACKGROUND AND OBJECTIVES: Convalescent COVID-19 plasma (CCP) was developed and used worldwide as a treatment option by supplying passive immunity. Adult studies suggest administering high-titer CCP early in the disease course of patients who are expected to be antibody-negative; however, pediatric experience is limited. We created a multi-institutional registry to characterize pediatric patients (<18 years) who received CCP and to assess the safety of this intervention. METHODS: A REDCap survey was distributed. The registry collected de-identified data including demographic information (age, gender, and underlying conditions), COVID-19 disease features and concurrent treatments, CCP transfusion and safety events, and therapy response. RESULTS: Ninety-five children received CCP: 90 inpatients and 5 outpatients, with a median age of 10.2 years (range 0-17.9). They were predominantly Latino/Hispanic and White. The most frequent underlying medical conditions were chronic respiratory disease, immunosuppression, obesity, and genetic syndromes. CCP was primarily given as a treatment (95%) rather than prophylaxis (5%). Median total plasma dose administered and transfusion rates were 5.0 ml/kg and 2.6 ml/kg/h, respectively. The transfusions were well-tolerated, with 3 in 115 transfusions reporting mild reactions. No serious adverse events were reported. Severity scores decreased significantly 7 days after CCP transfusion or at discharge. Eighty-five patients (94.4%) survived to hospital discharge. All five outpatients survived to 60 days. CONCLUSIONS: CCP was found to be safe and well-tolerated in children. CCP was frequently given concurrently with other COVID-19-directed treatments with improvement in clinical severity scores ≥7 days after CCP, but efficacy could not be evaluated in this study.

Department

Pathology

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