• Victor Altmayer, Samir Saheb, Benjamin Rohaut, Clémence Marois, Albert Cao, Antonio Gallo, Loïc Le Guennec, Nicolas Weiss, and Sophie Demeret.
• Département de Neurologie, Unité de Médecine Intensive Réanimation Neurologique, APHP.Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France.
• J Clin Apher. 2021 Feb 1; 36 (1): 179-182.

AbstractHere we describe the effect of therapeutic plasma exchange with 5% albumin as sole replacement solution for the management of Covid-19. A 74-year-old man was admitted for severe Covid-19 acute respiratory distress syndrome. Based on the growing body of evidence that cytokine release syndrome, and especially interleukin-6, plays a key role in critically ill Covid-19 patients, we decided to implement therapeutic plasma exchange as a rescue therapy. The patient's clinical status rapidly improved, and biological records showed convincing results of decrease in interleukin-6 and inflammatory parameters under treatment. This case presents a proof-of-concept for the use of therapeutic plasma exchange with 5% albumin as sole replacement solution in a critically ill Covid-19 patient with cytokine release syndrome. This could constitute a major benefit in terms of security compared to long-lasting immunosuppressive monoclonal antibodies, or to therapeutic plasma exchange with plasma as replacement fluid. Hence, we think that a further evaluation of risk-benefit balance of this therapy in severe cases of Covid-19 should rapidly be undertaken.© 2020 Wiley Periodicals LLC.

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