Controversies in COVID-19 pandemic: the case of convalescent plasma

From Top Italian Scientists Journal
June 5, 2024
Controversies in COVID-19 pandemic: the case of convalescent plasma
Massimo Franchini, Daniele Focosi.
COVID-19; pandemic; therapy; convalescent plasma
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Massimo Franchini(a), Daniele Focosi(b).

(a) Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, Mantua, Italy;

(b) North-Western Tuscany Blood Bank, Pisa University Hospital, Italy.

Correspondence to: Massimo Franchini, MD; Department of Hematology and Transfusion Medicine; Carlo Poma Hospital, Mantova, Italy; E-mail: ; Phone: 0039-0376-201234 ; FAX: 0039-0376-220144


The SARS-CoV-2 pandemic has caused an unprecedented health and social crisis worldwide. In this paper we summarized the different therapeutic actions planned from the two sides of the Atlantic Ocean (USA and Europe) to fight the initial phase of COVID-19 pandemic, with an emphasis on passive immunotherapies such as convalescent plasma and anti-Spike monoclonal antibodies. The lessons derived from the critical analysis of that period could drive our treatment decisions for the next pandemics.


Conflict of Interest

The Authors declare that there is no conflict of interest.


  1. WHO. Coronavirus disease (COVID-19) pandemic. Accessed on February 5, 2024.
  2. Yuan, Y., Jiao, B., Qu, L., Yang, D., & Liu, R. The development of COVID-19 treatment. Frontiers in Immunology. 2023; 14, 1125246.
  3. Casadevall, A., & Pirofski LA. The convalescent sera option for containing COVID-19. Journal of Clinical Investigation. 2020; 130(4), 1545-1548.
  4. Senefeld, J.W., Franchini, M., Mengoli, C., Cruciani, M., Zani, M., Gorman, E.K., Focosi, D., Casadevall, A., & Joyner, M.J. COVID-19 Convalescent Plasma for the Treatment of Immunocompromised Patients: A Systematic Review and Meta-analysis. JAMA Network Open. 2023; 6(1), e2250647.
  5. Senefeld, J.W., Gorman, E.K., Johnson, P.W., Moir, M.E., Klassen, S.A., Carter, R.E., Paneth, N.S., Sullivan, D.J., Morkeberg, O.H., Wright, R.S., Fairweather, D., Bruno, K.A., Shoham, S., Bloch, E.M., Focosi, D., Henderson, J.P., Juskewitch, J.E., Pirofski, L.A., Grossman, B.J., ., & Joyner, M.J. Rates Among Hospitalized Patients With COVID-19 Treated With Convalescent Plasma: A Systematic Review and Meta-Analysis. Mayo Clinic Proceedings Innovative Quality Outcomes. 2023; 7(5), 499-513. 10.1016/j.mayocpiqo.2023.09.001
  6. Bloch, E.M., Focosi, D., Shoham, S., Senefeld, J., Tobian, A.A.R., Baden, L.R., Tiberghien, P., Sullivan, D.J., Cohn, C., Dioverti, V., Henderson, J.P., So-Osman, C., Juskewitch, J.E., Razonable, R.R., Franchini, M., Goel, R., Grossman, B.J., Casadevall, A., Joyner, M.J., …, & Gebo, K.A. Guidance on the Use of Convalescent Plasma to Treat Immunocompromised Patients With Coronavirus Disease 2019. Clinical Infectious Diseases. 2023; 76(11), 2018-2024.
  7. Hassan, S., West, K.A., Conry-Cantilena, K., & De Giorgi, V. Regulatory challenges of convalescent plasma collection during the evolving stages of COVID-19 pandemic in the United States. Transfusion. 2022; 62(2), 483-492.
  8. Joyner, M.J., Bruno, K.A., Klassen, S.A., Kunze, K.L., Johnson, P.W., Lesser, E.R., Wiggins, C.C., Senefeld, J.W., Klompas, A.M., Hodge, D.O., Shepherd, J.R.A., Rea, R.F., Whelan, E.R., Clayburn, A.J., Spiegel, M.R., Baker, S.E., Larson, K.F., Ripoll, J.G., Andersen, K.J., … & Wright RS. Safety Update: COVID-19 Convalescent Plasma in 20,000 Hospitalized Patients. Mayo Clinic Proceedings. 2020; 95(9), 1888-1897.
  9. Casadevall, A., Dragotakes, Q., Johnson, P.W., Senefeld, J.W., Klassen, S.A., Wright, R.S., Joyner, M.J., Paneth, N., & Carter, R.E. Convalescent plasma use in the USA was inversely correlated with COVID-19 mortality. Elife. 2021; 10, e69866. htpps://
  10. Franchini, M., Marano, G., Velati, C., Pati, I., Pupella, S., & Liumbruno G.M. Operational protocol for donation of anti-COVID-19 convalescent plasma in Italy. Vox Sang. 2021; 116(1), 136-137.
  11. Focosi, D., & Franchini, M. COVID-19 convalescent plasma therapy: hit fast, hit hard! Vox Sanguinis. 2021; 116(9), 935-942.
  12. Franchini, M., Focosi, D., Casadevall, A., Joyner, M.J., & Perotti, C. Convalescent plasma for COVID-19. TSUNAMI is not the final word. European Journal of Internal Medicine. 2022; 97, 116-118.
  13. Franchini. M., Cruciani, M., Casadevall, A., Joyner, M.J., Senefeld, J.W., Sullivan, D.J., Zani, M., & Focosi, D. Safety of COVID-19 convalescent plasma: A definitive systematic review and meta-analysis of randomized controlled trials. Transfusion. 2023 Dec 29.
  14. Sullivan, D.J., Focosi, D., Hanley, D.F., Cruciani, M., Franchini, M., Ou, J., Casadevall, A., & Paneth, N. Outpatient randomized controlled trials to reduce COVID-19 hospitalization: Systematic review and meta-analysis. Journal of Medical Virology. 2023, 95(12), e29310.
  15. Focosi, D., Meschi, S., Coen, S., Iorio, M.C., Franchini, M., Lanza, M., & Maggi, F. Serum anti-Spike immunoglobulin G levels in random blood donors in Italy: High-titre convalescent plasma is easier than ever to procure. Vox Sanguinis. 2023, 118(9), 794-797.
  16. Sullivan, D.J., Franchini, M., Joyner, M.J., Casadevall, A., & Focosi, D. Analysis of anti-SARS-CoV-2 Omicron-neutralizing antibody titers in different vaccinated and unvaccinated convalescent plasma sources. Nature Communications. 2022; 13(1), 6478.