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Guidance for the procurement of COVID-19 convalescent plasma: differences between high- and low-middle-income
Evan M Bloch1, Ruchika Goel1,2, Silvano Wendel3
1Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Insights
Guidance for COVID-19 convalescent plasma (CCP) use is needed, especially in low- and middle-income countries (LMICs). Challenges differ between high-income countries (HICs) and LMICs, requiring tailored strategies for CCP adoption.
Area of Science:
- Transfusion Medicine
- Infectious Diseases
- Hematology
Background:
- COVID-19 convalescent plasma (CCP) has been utilized in high-income countries (HICs) with reported safety and efficacy.
- Limited data exist on CCP use and its challenges in low- and middle-income countries (LMICs).
Purpose of the Study:
- To develop guidance for the procurement and use of CCP.
- To address specific challenges faced by LMICs in adopting CCP therapy.
Main Methods:
- A multidisciplinary expert group developed guidance based on expert opinion, surveys, and evidence review.
- Subgroups focused on donor, product, and patient aspects, contrasting challenges between HICs and LMICs.
Main Results:
- HICs faced challenges with donor recruitment, qualification, and antibody testing standardization.
- LMICs encounter obstacles including transfusion deficits, suboptimal donor recruitment models, and limited laboratory capacity.
Conclusions:
- Widespread CCP adoption in HICs may increase with proven efficacy.
- LMICs require locally applicable strategies for successful CCP implementation.
Background And Objectives:
COVID-19 convalescent plasma (CCP) has been used, predominantly in high-income countries (HICs) to treat COVID-19; available data suggest the safety and efficacy of use. We sought to develop guidance for procurement and use of CCP, particularly in low- and middle-income countries (LMICs) for which data are lacking.
Materials And Methods:
A multidisciplinary, geographically representative group of individuals with expertise spanning transfusion medicine, infectious diseases and haematology was tasked with the development of a guidance document for CCP, drawing on expert opinion, survey of group members and review of available evidence. Three subgroups (i.e. donor, product and patient) were established based on self-identified expertise and interest. Here, the donor and product-related challenges are summarized and contrasted between HICs and LMICs with a view to guide related practices.
Results:
The challenges to advance CCP therapy are different between HICs and LMICs. Early challenges in HICs related to recruitment and qualification of sufficient donors to meet the growing demand. Antibody testing also posed a specific obstacle given lack of standardization, variable performance of the assays in use and uncertain interpretation of results. In LMICs, an extant transfusion deficit, suboptimal models of donor recruitment (e.g. reliance on replacement and paid donors), limited laboratory capacity for pre-donation qualification and operational considerations could impede wide adoption.
Conclusion:
There has been wide-scale adoption of CCP in many HICs, which could increase if clinical trials show efficacy of use. By contrast, LMICs, having received little attention, require locally applicable strategies for adoption of CCP.
