Long Covid and Apheresis – Where are we Standing?, 2022, Steenblock et al

[Andy]

A continual increase in cases of Long Covid constitutes a medical and socioeconomic challenge to health systems around the globe. While the true extent of this problem cannot yet be fully evaluated, recent data suggests that up to 20% of people with confirmed with SARS-CoV-2 suffer from clinically relevant symptoms of Long Covid several weeks to months after the acute phase. The clinical presentation is highly variable with the main symptoms being chronic fatigue, dyspnea and cognitive symptoms. Extracorporeal apheresis has been suggested to alleviate symptoms of Long Covid. Thus, numerous patients are currently treated with apheresis. However, at present there is no data from randomized controlled trials available to confirm the efficacy. Therefore, physicians rely on the experience of practitioners and centers performing this treatment. Here, we summarize clinical experience on extracorporeal apheresis in patients with Long Covid from centers across Germany.

Paywall, https://www.thieme-connect.de/products/ejournals/abstract/10.1055/a-1945-9694

 

[SNT Gatchaman]

Discusses the potential patho-mechanisms for long COVID and the different types of apheresis.

There are several types of apheresis mainly based on three physical mechanisms: filtration, precipitation and adsorption, whereby lipids, immunoglobulins, inflammatory agents and further molecules are removed from the blood. Apheresis can be roughly divided into whole blood and plasma based methods, in which the cell-rich fraction must first be separated from the plasma.

We've discussed the HELP apheresis type, which was said anecdotally to be helping a year ago, but hasn't demonstrated long term efficacy in published form (or even particularly much in social media form). Some patients do continue to describe significant improvement, if not cure.

The authors conclude:

Despite promising experiences with several forms of apheresis in the treatment of Long Covid, either alone or in combination with other therapies, confirmatory data on its efficacy from large well- designed interventional studies is still lacking. A randomized sham-controlled trial is therefore needed and should include a defined patient group with Long Covid (at least 12 weeks after positive PCR) with fatigue and other symptoms.

All patients should undergo structured evaluation of fatigue severity using a questionnaire and a visual analogue scale of tiredness [Gah!], as well as a detailed clinical evaluation of the other symptoms before and after the treatment.

Finally, this is key. What is it actually doing?

Also, blood samples should be collected before and after the treatment in order to measure blood count, routine biochemical parameters, rheological parameters, markers of oxidative stress, immunoglobulins A, M and G, autoantibodies against α and β adrenergic, muscarinic cholinergic receptors, ACE2, MASR, AT1R, ETAR, ETBR, PAR1, bradykinin receptor and CXCR3 in the plasma and Real-Time-Deformability-Cytometry of patients’ blood should optimally be performed.