Experience of using convalescent plasma for severe acute respiratory syndrome among healthcare workers in a Taiwan hospital.
OBJECTIVE
To describe the immunological responses and clinical outcome of coronavirus (SARS) infected healthcare workers (HCW) who had been administered with convalescent plasma as a treatment.


METHODS
Convalescent plasma (500 mL) was obtained from each of three SARS patients and transfused into the three infected HCW. Donors were blood type O and seronegative for hepatitis B and C, HIV, syphilis and human T-cell lymphotropic virus types I and II (HTLV-I and -II). Serum antibody (IgG) titre was >640. Apharesis was performed with a CS 3000 plus cell separator followed by the forming of the convalescent phase plasma. As part of the routine check with donated plasma, the convalescent plasma was confirmed free of residual SARS-CoV by RT-PCR. Serial serum samples obtained from the recipients of the convalescent plasma were collected to undertake real-time quantitative RT-PCR for SARS-CoV for direct measurement of viral concentration. Specific immunoglobulin IgM and IgG concentrations were titrated using an antigen microarray developed in-house.


RESULTS
Viral load dropped from 495 x 10(3), 76 x 10(3) or 650 x 10(3) copies/mL to zero or 1 copy/mL one day after transfusion. Anti-SARS-CoV IgM and IgG also increased in a time-dependent manner following transfusion. All three patients survived. One HCW became pregnant subsequently, delivering 13 months after discharge. Positive anti-SARS-CoV IgG was detected in the newborn. Passive transfer of anti-SARS-CoV antibody from the mother was considered as a possibility.


CONCLUSIONS
All infected HCW whose condition had progressed severely and who had failed to respond to the available treatment, survived after transfusion with convalescent plasma.
Yeh
Kuo-Ming
KM
Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Cheng-Kung Road, Sec. 2, Neihu, Taipei, 114, Taiwan.
Chiueh
Tzong-Shi
TS
Siu
L K
LK
Lin
Jung-Chung
JC
Chan
Paul K S
PK
Peng
Ming-Yieh
MY
Wan
Hsiang-Lin
HL
Chen
Jenn-Han
JH
Hu
Bor-Shen
BS
Perng
Cherng-Lih
CL
Lu
Jang-Jih
JJ
Chang
Feng-Yee
FY
D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D005260:Female; D006282:Health Personnel; D006761:Hospitals; D006801:Humans; D007106:Immune Sera / Q000008:administration & dosage*; D007116:Immunization, Passive; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D009784:Occupational Diseases / Q000628:therapy*; D012367:RNA, Viral / Q000032:analysis; D020133:Reverse Transcriptase Polymerase Chain Reaction; D045473:Severe acute respiratory syndrome-related coronavirus / Q000235:genetics / Q000276:immunology; D045169:Severe Acute Respiratory Syndrome / Q000628:therapy*; D013624:Taiwan; D016896:Treatment Outcome; D019562:Viral Load
D000914:Antibodies, Viral; D007106:Immune Sera; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D012367:RNA, Viral