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Efficacy of Plasmapheresis in Neutropenic Patients Suffering From Cytokine Storm Because of Severe Covid-19 Infection Publisher



Sadeghi A1 ; Sadeghi S2 ; Peikar MS1 ; Yazdi M3 ; Sharifi M1, 4 ; Ghafel S5 ; Khorvash F6 ; Ataei B2 ; Safavi MR7 ; Nasri E2
Authors
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Authors Affiliations
  1. 1. Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
  2. 2. Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
  3. 3. Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
  4. 4. Cancer Prevention Research Center, Seyed Al-Shohada Hospital, Isfahan, Iran
  5. 5. Mycology Reference Laboratory, Research Core Facilities Laboratory, Isfahan University of Medical Sciences, Isfahan, Iran
  6. 6. Acquired Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
  7. 7. Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Source: Blood Research Published:2023


Abstract

Background With the emergence of the coronavirus disease 2019 (COVID-19) and inability of healthcare systems to control the disease, various therapeutic theories with controversial responses have been proposed. Plasmapheresis was administered as a medication. However, the knowledge of its efficacy and indications is inadequate. This study evaluated the use of plasmapheresis in critically ill patients with cancer. Methods This randomized clinical trial was conducted on 86 patients with malignancies, including a control group (N=41) and an intervention group (N=45) with severe COVID-19 during 2020-21. Both groups were treated with routine medications for COVID-19 management according to national guidelines, and plasmapheresis was applied to the intervention group. C-reactive protein (CRP), D-dimer, ferritin, lactate dehydrogenase, hemoglobin, and white blood cell, polymorphonuclear, lymphocyte, and platelet levels were measured at admission and at the end of plasmapheresis. Other variables included neutrophil recovery, intensive care unit admission, intubation requirements, length of hospital stay, and hospitalization outcomes. Results CRP (P <0.001), D-dimer (P <0.001), ferritin (P =0.039), and hemoglobin (P =0.006) levels were significantly different between the groups after the intervention. Neutrophil recovery was remarkably higher in the case than in the control group (P <0.001). However, plasmapheresis did not affect the length of hospital stay (P=0.076), which could have significantly increased survival rates (P <0.001). Conclusion Based on the study findings, plasmapheresis led to a significant improvement in laboratory markers and survival rate in patients with severe COVID-19. These findings reinforce the value of plasmapheresis in cancer patients as a critical population suffering from neutropenia and insufficient immune responses. © 2023 Korean Society of Hematology.
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