Convalescent blood transfusion may reduce Ebola-related mortality
Using a model constructed of epidemiological estimates for Ebola virus in Liberia, researchers have found that convalescent transfusion therapy could reduce mortality among patients hospitalized with the virus.
However, the blood from convalescent donors will be in short supply, highlighting a need to increase donor recruitment and/or switch to plasma donations compared with whole blood donations, according to Alexander Gutfraind, PhD.
“A major caveat for our study is that the efficacy of convalescent transfusions is still not established and is currently undergoing clinical trials in West Africa,” Gutfraind, a research assistant professor at the University of Illinois at Chicago School of Public Health, told Infectious Disease News. “Treated individuals tend to do so much better than untreated, but it might be because the former tend to be hospitalized and receive supportive care, including rehydration. In September 2014, WHO prioritized evaluation of transfusion therapy as a possible rapid intervention measure.”
Gutfraind and Lauren Ancel Meyers, PhD, professor at the University of Texas at Austin, used a CDC Ebola transmission model and recent epidemiological data to determine the impact of widespread use of transfusion therapy in Liberia. Their findings were published in the Journal of Infectious Diseases.
They constructed their models on the assumption that transfusions reduce the Ebola fatality rate from 67% to 13%. They estimated that if the hospitalization rate for Ebola is 10%, and transfusion therapy was scaled up beginning Dec. 1, the whole blood transfusions would avert 851 (0.73%) deaths and plasma transfusions would spare 3,586 (3.1%) deaths. The most recent data suggest that the hospitalization rate is 30%, and the incidence of Ebola is leveling off. Using this data, whole blood transfusions would avert 65 (0.37%) deaths and plasma infusions would save 151 (0.9%) lives.
With a 10% hospitalization rate, the model estimates that 1,594 of 14,883 hospitalized patients would receive transfusions if mass whole blood donations were received, but 6,683 patients would receive transfusions if mass plasma donations were received.
“Although donations of plasma allow more donations to be made per survivor and thus allow more people to be treated, they require expensive blood processing equipment not readily available in developing countries,” Gutfraind said. “The use of transfusion treatment is fairly unique to Ebola. Although some other infections, such as respiratory syncytial virus, could be treated using blood from survivors, there are usually alternatives, like vaccines and pharmaceuticals, which are more effective.”
Gutfraind said this model could help plan transfusion interventions in future Ebola outbreak by helping public health officials determine how many lives can be saved with whole blood vs. plasma transfusion therapy, which hospitals should be prioritized to receive the necessary equipment, and how many personnel and supplies will be needed. – by Emily Shafer
Disclosure: Gutfraind and Meyers report no relevant financial disclosures.