ATLANTA, September 14, 2020 – A Children’s Healthcare of Atlanta patient has become the youngest patient to date to receive experimental convalescent plasma transfusions to treat the novel coronavirus. The nine-week-old baby girl was airlifted to Children’s Healthcare of Atlanta at Egleston for respiratory failure due to congenital heart defect and later received a positive COVID-19 test, further complicating her treatment plan which included heart surgery. Zahidee “Saidie” Rodriguez, MD, cardiologist at Children’s Heart Center, reports the successful case as lead author in a paper published in Blood Advances.
“The immune system is still developing at this young age, especially with regard to the ability to make antibodies,” said Dr. Rodriguez, assistant professor of pediatrics at Emory University School of Medicine. “In this case, it seems like convalescent plasma helped our patient through the COVID-19 infection and was very well tolerated. It’s encouraging to have that as an option to consider in cases where there is an urgent need to clear the infection.”
After recovery from a viral infection, antibodies may remain in blood plasma for months or even years. In convalescent plasma treatment, people with a new infection receive plasma from a recovered person in the hopes that it will improve their own immune response to fight the virus. This method was initially used during the 1918 Spanish Influenza pandemic but is now being investigated under an adult expanded access trial and emergency use authorization through the U.S. Food and Drug Administration (FDA) to treat COVID-19.
While evidence suggests giving COVID-19 patients plasma from COVID-19 survivors is generally safe, more research is still needed to determine whether such transfusions help recipients recover. Since studies examining this question do not include children, doctors rely on case reports, such as this one, for insights on the use of convalescent plasma in pediatric patients.
The patient spent nearly four months at Egleston for complications related to COVID-19 and atrioventricular canal (AVC) defect, which affects blood flow in the heart. Hospitalized initially with acute respiratory failure attributed to her heart condition, the patient improved after about a week, then began to decline rapidly. During this time, she tested positive for COVID-19.
Doctors determined the patient needed surgery to correct her heart defect, but the severity of the COVID-19 infection made it too risky. The patient’s condition continued to decline despite a 10-day course of remdesivir, an experimental antiviral drug that has been found effective against COVID-19 in adults. Shortly after she was placed on a ventilator, doctors decided to try convalescent plasma.
Given the complexity of the case, a multidisciplinary team of experts, including Cassandra Josephson, MD, hematologist at the Aflac Cancer and Blood Disorders Center of Children’s, collaborated to guide the infusion process, determine the correct dosage and monitor her response. The patient received two transfusions from two different donors who had recovered from COVID-19 after experiencing only mild symptoms and not requiring hospital stays. The patient’s immune system responded well to both infusions, showing high levels of COVID-19 antibodies after the first one and a more modest response to the second. The COVID-19 infection cleared after two months, and the patient was healthy enough to undergo heart surgery.
“Her clinical turning point came within days,” said Dr. Rodriguez. “We were very excited. We were all jumping for joy when it looked like she was getting better.”
While the outcome is encouraging, Dr. Rodriguez and her team caution that this is only one case and there remains much to learn about the possible benefits of convalescent plasma as a treatment for COVID-19, especially in babies whose immune systems are still developing. Ongoing research is needed to determine how effective convalescent plasma is, how it works, and what donor characteristics yield the best antibody response. For example, it is still unknown as to whether the severity of a person’s COVID-19 infection affects the level of antibodies present in their plasma.
By donating blood, survivors of COVID-19 can help to advance this research and potentially help future patients. “This therapy depends on people coming and donating,” said Dr. Rodriguez, who noted that donors must be over age 16 and symptom-free for 28 days before donating. “If you have had COVID-19, you might be able to save someone’s life by donating blood.”
Blood Advances is a peer-reviewed, online only, open access journal of the American Society of Hematology (ASH), the world’s largest professional society concerned with the causes and treatment of blood disorders. This release was written in coordination with ASH.