The Use of Ebola Convalescent Plasma to Treat Ebola Virus Disease in Resource-Constrained Settings: A Perspective From the Field

van Griensven, Johan; De Weiggheleire, Anja; Delamou, Alexandre; Smith, Peter G.; Edwards, Tansy; Vandekerckhove, Philippe; Bah, Elhadj Ibrahima; Colebunders, Robert; Herve, Isola; Lazaygues, Catherine; Haba, Nyankoye; Lynen, Lutgarde

The infection control environment of Ebola treatment centers brings with it difficult operational challenges, both for care of patients and, in particular, for the implementation of clinical research. Short and intermittent patient contact by staff in protective clothing, with potentially confused patients, is the norm. Therefore, mistakes are more likely to occur, such as in patient identification, labeling of blood tubes, and request forms during sample collection and packaging. Moreover, introducing the procedure for blood group typing into already overloaded EVD diagnostic laboratories might engender additional errors. This can potentially increase the risks of adverse reactions due to preanalytical, analytical, or postanalytical errors. These errors could potentially lead to severe reactions if ABO-incompatible plasma with high titers of hemolysins were administered. The ability to monitor patients for and to react to severe, acute adverse reactions is clearly limited by the environment of many Ebola treatment centers. Some (severe) transfusion reactions might erroneously be attributed to EVD [29, 30] . For instance, respiratory difficulties, often seen during EVD, might be due to transfusion-related acute lung injury. Patient management options for adverse events may also be limited.