Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible of the coronavirus disease 2019 (COVID-19) pandemic. Therapeutic options including antimalarials, antivirals, and vaccines are under study. Meanwhile the current pandemic has called attention over old therapeutic tools to treat infectious diseases. Convalescent plasma (CP) constitutes the first option in the current situation, since it has been successfully used in other coronaviruses outbreaks. Herein, we discuss the possible mechanisms of action of CP and their repercussion in COVID-19 pathogenesis, including direct neutralization of the virus, control of an overactive immune system (i.e., cytokine storm, Th1/Th17 ratio, complement activation) and immunomodulation of a hypercoagulable state. All these benefits of CP are expected to be better achieved if used in non-critically hospitalized patients, in the hope of reducing morbidity and mortality.
CP is a safe and potentially effective strategy for the treatment of emerging and re-emerging pathogens, especially in those scenarios without proved antiviral agents or vaccines. IVIg and CP shared similar mechanisms of action. The potential antiviral and immunomodulatory effects of CP are currently evaluated in COVID-19. According to the physiopathology of COVID-19 severe patients should be privileged over critical ones in order to reduce mortality and improve outcomes.
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