April 6, 2020

COVID-19 convalescent plasma website for US providers and patients launched, characteristics of peripheral lymphocyte subset alteration in COVID-19 pneumonia, using lung ultrasound for management of patients with COVID-19

By Denise Baez

NEW YORK -- April 6, 2020 -- Today’s DG Alert covers the launch of the National Convalescent Plasma Project, characteristics of peripheral lymphocyte subset alteration in coronavirus disease 2019 (COVID-19), and using lung ultrasound for the identification of patients with COVID-19 with lung involvement.

The National Convalescent Plasma Project has launched a website for patients who have recovered from COVID-19 and want to donate plasma, and for healthcare providers who are considering this treatment for their patients. 

Nigel Paneth, Michigan State University, East Lansing, Michigan, and colleagues from Johns Hopkins University, Baltimore, Maryland, and the Mayo Clinic, Rochester, Minnesota, led the development of the National Convalescent Plasma Project, which includes 170 physician-scientists from 50 universities and hospitals across the nation studying the use of convalescent plasma for the treatment and prevention of COVID-19.

“We need to inform healthcare providers about the use of convalescent plasma and also reach recovered patients with an urgent plea to donate plasma,” said Paneth. “Additionally, doctors will use the site to input data on how their patients respond to the plasma treatment. The hope is that we can move this potentially life-saving therapy to controlled clinical trials and then to wider use if effectiveness is demonstrated as quickly as possible.”

He said that as of April 1, 2020, more than 1,100 plasma donors have registered and they are coordinating with the Red Cross and other agencies to collect and distribute plasma. They are also working directly with the US Food and Drug Administration to obtain clearance to use convalescent plasma in trials, and in certain situations, outside of a trial framework. 

According to a study published in The Journal of Infectious Diseases, peripheral lymphocyte subset alteration was associated with the clinical characteristics and treatment efficacy of COVID-19.

Fan Wang, MD, Zhongnan Hospital of Wuhan University, Wuhan, China, and colleagues measured levels of peripheral lymphocyte subsets in 60 patients hospitalised with COVID-19, and found that total lymphocytes, CD4+ T cells, CD8+ T cells, B cells, and natural killer (NK) cells decreased in patients with COVID-19, but severe cases had lower levels than milder cases. 

After treatment, 37 (67%) patients reached clinical response, with an increase of CD8+ T cells and B cells; however, no significant change of any subset was detected in patients who did not respond to treatment. In multivariate analysis, post-treatment decrease of CD8+ T cells and B cells and increase of CD4+/CD8+ ratio were indicated as independent predictors for COVID-19 severity and treatment efficacy. 

Lastly, a study published in Echocardiography showed how lung ultrasound can be used as a bedside tool for identification of lung involvement, along with pulmonary severity, in patients with suspected or documented COVID‐19, thus reducing the use of chest x-rays and CTs. 

Luigi Vetrugno, MD, University of Udine, Udine, Italy, and colleagues described their use of lung ultrasound from January 2020 until present day as a tool for COVID-19 diagnosis and monitoring of lung involvement severity. 

“One may perform a topographic analysis of the underlying lung regions daily without moving the patient,” the authors wrote. “A scan of the 3 different areas of the thorax -- anterior, lateral, and posterior -- and then superior and inferior segments are performed. Thus, 6 specific regions for each lung are defined and categorized by 1 of 4 different aeration patterns. A point scoring system is employed by region and ultrasound pattern as: A = 0 points, B1 = 1 point, B2 = 2 points, C = 3 points. Thus, a [lung ultrasound score] of 0 is normal and 36 would be the worst. The [lung ultrasound score] can be used to follow the clinical patient trajectory in which an increased score means decreased lung aeration, while on the contrary, a decrease in score means an increase in lung aeration limiting the need of [chest x-rays and CT scans].”

The authors noted that an experienced sonographer can do this examination within 5 minutes. For those who are not experienced, a brief training and about 25 supervised exams seem to be sufficient to achieve a basic ability to perform the lung ultrasound. 

SOURCE: Michigan State University, The Journal of Infectious Diseases, and Echocardiography
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