AABB Panel Issues Interim Recommendations for COVID-19 Convalescent Plasma Use

February 15, 2021

A new series of interim recommendations on the use of COVID-19 convalescent plasma (CCP), developed by an AABB-convened panel, has been published in Transfusion journal. Evidence from recently published randomized controlled trials (RCTs) and large observational studies suggests that CCP is most efficacious when high-titer units are given early in the course of disease. FDA’s Feb. 4 update to the emergency use authorization for CCP and the corresponding update to recommendations in the Feb. 11 guidance reflect these data. 

Demand for CCP has outpaced supply, however, resulting in the need for more judicious use so that transfusions are limited to patients for whom CCP is likely to be effective. Based on the available literature, the working group developed the following five interim recommendations to guide use of this scarce resource: 

  • Interim Recommendation 1: When making risk benefit decisions, one should consider the risk of CCP as comparable to standard (SARS-CoV-2 non-immune) plasma.
  • Interim Recommendation 2: CCP is optimally effective when transfused as close to symptom onset as possible. CCP is unlikely to provide benefit for patients with late-stage disease or on mechanical ventilation.
  • Interim Recommendation 3: The effectiveness of CCP is related to the antibody quantity within a unit; high-titer CCP is superior to low-titer CCP. A single high-titer unit should be sufficient for most patients. 
  • Interim Recommendation 4:  If group B or group AB CCP is unavailable, transfusion of group A or group O CCP with low anti-A/B titer may be acceptable for group B and group AB patients.
  • Interim Recommendation 5: Additional RCT data are needed to fully assess CCP efficacy and to identify which specific patient populations and unit characteristics might confer the greatest benefit. 

The working group based these interim recommendations on a general analysis of the peer-reviewed data currently available. While additional studies on the efficacy of CCP are ongoing, the interim recommendations aim to address the present need for clinical guidance and serve as a valuable tool to guide current practice.

“Data indicate that high-titer CCP can arrest progression to severe disease in mildly ill patients when administered early, but supply of this critical resource is limited,” said Claudia S. Cohn, MD, PhD, chief medical officer of AABB. “These recommendations will help clinicians prioritize CCP for patients who are most likely to benefit until vaccines are widely available.”

AABB will continue to evaluate and revise these recommendations to reflect the latest peer-reviewed data and regulatory requirements as they are available. Additional resources – including AABB’s Toolkit for COVID-19 Convalescent Plasma under Emergency Use Authorization – are available on AABB's coronavirus resources web page.