Authors: Keith P, Day M, Perkins L, Moyer L, Hewitt K, Wells A

PMID: 32241301 PMCID: PMC7117947 DOI: 10.1186/s13054-020-2836-4


The novel coronavirus (“SARS-CoV-2”) outbreak has created a sense of panic globally and has the medical community rapidly searching for answers. An estimated 100,000 individuals have already been infected with nearly 3300 deaths attributed to the disease (termed COVID-19) [1]. The search for effective treatment is underway with multiple investigations ongoing across the world. Chinese authorities have reported success treating infected patients with donated plasma from survivors of the illness, the proposed benefit being protective antibodies formed by the survivors [2]. Plasma transfusion and blood purification are not novel therapies, and we propose therapeutic plasma exchange as a possible treatment for fulminant COVID-19.

With COVID-19, the degree of illness varies, ranging from asymptomatic to fulminant and fatal. The World Health Organization estimates that serious illness may occur in as many as 13.8% of cases and 6.1% are critical [3]. When fulminant, patients may develop sepsis, acute respiratory distress syndrome (ARDS), and/or multiple organ failure which are not unique to coronavirus. While treatment of the virus itself is certainly desired, treatment of the systemic response is likely to be the more important aspect of care and should be aggressively sought. This host response to infection has been well described and involves a complex interaction of cytokine storm, inflammation, endothelial dysfunction, and pathologic coagulation [4–8]. The pathway is common to multiple inciting events and has been the target of treatment for years, with therapeutic plasma exchange uniquely offering benefit on multiple levels by removing inflammatory cytokines, stabilizing endothelial membranes, and resetting the hypercoagulable state [4, 8, 9]. An in-depth review is beyond the scope of this editorial, but the reader is encouraged to review the referenced articles. Figure 1 briefly illustrates the pathway.

Keywords: COVID-19, SARS-CoV-2, therapeutic plasma exchange