With limited therapies for patients with COVID-19 and a mortality rate of approximately 50% for patients in the ICU, demand is high for convalescent plasma from individuals who have recovered from COVID-19. Convalescent plasma has been requested for >18,000 patients through the expanded access program in the U.S., and almost 13,000 patients have been transfused to date. Key safety metrics from the first 5,000 patients with severe or life-threatening COVID-19 appear promising. Within the first 4 hours after transfusion, 36 (<1%) serious adverse events (SEAs) were reported including 15 (0.3%) deaths; only 4 deaths were possibly related to transfusion. Lung injury associated with COVID-19 could potentially increase the risk of transfusion-associated circulatory overload (TACO) and transfusion-related acute lung injury (TRALI); reassuringly, however, there were only 7 (0.14%) reports of TACO, 11 (0.22%) reports of TRALI, and 3 (0.06%) reports of severe allergic transfusion reactions. Furthermore, no evidence of antibody-dependent enhancement was observed. The seven-day mortality for patients transfused with convalescent plasma was 15% (602/5000). As further studies discern the efficacy of convalescent plasma, continued vigilance for safety should continue, especially for specific high-risk sub-groups.
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