In the latest episode of Blooducation Baristas podcast, I had the privilege of hosting Dr. Arturo Casadevall, a renowned expert in infectious diseases, to discuss the evolving landscape of convalescent plasma therapy. This conversation sheds light on the history, current applications, and future potential of convalescent plasma, particularly in the context of recent FDA guidance and the lessons learned from the COVID-19 pandemic.
Listen to it here.
Understanding Convalescent Plasma
I had no idea what “convalescent” meant when COVID-19 convalescent plasma (CCP) was first proposed as a treatment for critically ill hospitalized patients in early March 2020. At that point, we had nothing to offer these patients. I was just eight months from completing my transfusion medicine fellowship and then serving as Associate Medical Director of the Transfusion Service at SSM Health St. Louis University Hospital and Cardinal Glennon Children’s Hospital.
As a resident and fellow, I thought I had learned all the indications for plasma transfusions. In fact, I had recently studied the inappropriate use of single-unit plasma transfusions to correct coagulopathies in our hospital. While I understood that pooled plasma was used to manufacture IVIG, I had never learned about its application in treating specific infections in acute situations.
In those early days, I opened my Technical Manual—this was before the era of asking ChatGPT quick questions—and discovered that the term "convalescent" wasn’t even listed in the index.
So, I turned to Google.
Ah-ha!
“Convalescent – adjective, (of a person) recovering from an illness or operation.” I finally connected the dots: convalescent plasma therapy uses plasma from recovered patients to treat those currently battling an infection.
This made sense, but had it been tried before? Historically, this method was utilized during the 1918 influenza pandemic and revisited during outbreaks of diseases like Ebola and COVID-19.
During this time, I frequently spoke with my mentor, Dr. Dennis Goldfinger, a retired transfusion medicine expert who was unfortunately facing health issues. Our conversations became more frequent as the pandemic unfolded. I asked him what he thought about the idea of CCP for treating COVID-19. He recalled his time at the NIH in the 1960s when it was used to treat chickenpox in children with positive outcomes. I can still hear his gravelly voice today: “Daniela, I think it’s a good idea, and it could work.” I miss him.
As we reflect on the rapid evolution of convalescent plasma therapy during the pandemic, it's crucial to discuss how this experience has shaped our understanding of scientific inquiry and public trust in medical practices. In this podcast, Dr. Casadevall echoes these historical uses and highlights the rapid mobilization and application of convalescent plasma during the early days of COVID-19, emphasizing its role as a bridge between microbiology and transfusion medicine.
The COVID-19 Experience
During the COVID-19 pandemic, convalescent plasma emerged as one of the initial therapeutic options. Dr. Casadevall shares the challenges faced during those early days, including the lack of standardized dosing and the urgent need for rapid testing and production. Despite these obstacles, the blood banking community managed to produce tens of thousands of units, significantly impacting patient outcomes. I remember how we mobilized this product in weeks. And we recruited patients that were recently discharged as donors. This video where I was interviewed is a reminder of those early days of those remarkable "COVID Angels" that donated plasma to help others with the infection.
FDA Guidance and Future Applications
The recent FDA guidance marks a significant step forward by allowing blood centers to formally apply for a biological license application for convalescent plasma. This development highlights the importance of establishing donor eligibility and standardizing qualifications for use. Dr. Casadevall underscores the need for continued vigilance and preparedness, especially with the looming threat of diseases like H5N1 bird flu.
Lessons Learned and Moving Forward
A key takeaway from the pandemic is the critical importance of early intervention and high-titer plasma. Dr. Casadevall advocates for using local plasma whenever possible to ensure the best match for current viral strains. He also discusses the transition from convalescent plasma to monoclonal antibodies, noting the challenges posed by viral mutations.
3 KEY TAKEAWAYS:
1.) Transfuse EARLY (in the disease or prophylactically)
2.) Transfuse HIGH TITER
3.) Transfuse LOCALLY (geographical distribution of virus matters)
The Fragility of Science and Public Trust
A recurring theme in the podcast is the fragility of science and the erosion of public trust in medical authorities. Dr. Casadevall reflects on the need for transparency and humility in scientific communication, particularly during public health emergencies. He emphasizes the importance of maintaining public confidence to ensure effective responses to future pandemics. Check out this fantastic article he co-authored that goes into depth on this topic.
Conclusion
The conversation with Dr. Casadevall offers valuable insights into the role of convalescent plasma in modern medicine. As we prepare for potential future outbreaks, the lessons learned from COVID-19 will be crucial in shaping our response strategies. The podcast serves as a reminder of the collaborative efforts required to combat infectious diseases and the vital role of science in safeguarding public health.
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