Following the first wave of COVID-19 infections in spring 2020, treatment optimization studies did not provide conclusive evidence of clinical efficacy in patients with severe pneumonia.1 Since mid-June, numerous outbreaks of the SARS-CoV-2 disease have hit some areas of Spain. In Aragon, infections continue to increase and account for 33% of COVID-19 hospitalizations throughout the country.2 Currently there is still no vaccine available and the interest in achieving passive immunization in the population has placed convalescent plasma and hyperimmune globulin as valid options when it comes to achieving this goal.3 Convalescent or hyperimmune plasma is extracted from patients infected by COVID-19 who have overcome the disease and have generated antibodies in sufficient titers against this pathogen which, when infused into the recipient, promote binding with the virus and facilitate its phagocytosis. Hyperimmune plasma transfusion allows for faster immunization in infected individuals and thus shorten the disease or reduce its symptoms, so it should be administered in the first days of progression.3 Like all other blood products, hyperimmune plasma can be responsible for transfusion reactions, including allergic and anaphylactic reactions, haemolysis, circulatory overload, and transfusion-related acute lung injuries. Based on published data, the incidence of serious adverse reactions to date is low (<1%).4
We report the case of two young male patients admitted to the intensive care unit (ICU) for severe bilateral pneumonia after COVID-19 infection who had a transfusion reaction after the administration of hyperimmune plasma against COVID-19.
Case 1. 48-year-old male from Colombia with symptoms compatible with COVID-19 infection and positive PCR. He went to the emergency department due to respiratory distress and was admitted to the ward, where he developed respiratory deterioration, for which he was transferred to the ICU. Treatment was initially started with remdesivir 200 mg and then 100 mg every 24 h and dexamethasone 20 mg every 24 h. Two bags of hyperimmune plasma were administered, after which he presented an urticarial reaction on the face and trunk along with increased dyspnoea and desaturation, requiring an increase in oxygen concentration and flow. Treatment with dexchlorpheniramine 5 mg every 8 h was started and the lesions disappeared after 24 h. The patient showed good subsequent progression, high-flow oxygen therapy (HFOT) was withdrawn, and he was discharged to the ward.
Case 2. 45-year-old male from Cameroon. He went to the emergency department due to clinical worsening in the context of SARS-CoV-2 infection. He was admitted to the ward, where he showed a poor progression requiring admission to the ICU. Treatment started with HFOT and dexamethasone 20 mg every 24 h, remdesivir (200 mg load dose and 100 mg every 24 h later) and hyperimmune plasma, developing itchy hives in the body that subsided with 10 mg of IV dexchlorpheniramine. The course was favourable, and he was discharged.
Hyperimmune plasma treatment is a promising option in the treatment of severe COVID-19 pneumonia. The allergic reaction after its administration is uncommon, and the possible relationship with the different antigenic loads of the administered plasma and the severity of the immune reaction is so far unknown.
Please cite this article as: Edroso Jarne PE, Lozano Gómez H, Abansés Moreno P. Reacción transfusional a plasma hiperinmune en pacientes con infección grave por COVID-19. Med Clin (Barc). 2021;156:306.
