Walter Sunny Dzik

Massachusetts General Hospital, Boston, Massachusetts, United States

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Publications (10)39.14 Total impact

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    ABSTRACT: Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare complication of blood transfusion. The clinicolaboratory features of TA-GVHD, and the relative contributions of recipient and component factors remain poorly understood. We conducted a systematic review of TA-GVHD reports. The Human Leukocyte Antigen (HLA) relationship between donor and recipient was classified as D=0 when no donor antigens were foreign to the recipient, versus D≥1 when ≥1 donor antigen disparity occurred. We identified 348 unique cases. Criteria for component irradiation were met in 48.9% cases(34.5% immune-compromised, 14.4% related-donor), though non-irradiated components were transfused in the vast majority of these(97.6%). Components were typically whole blood and red cells. When reported, component storage duration was ≤10 days in 94%, and 23(6.6%) were leukoreduced (10 bedside, 2 pre-storage, 11 unknown). Among 84 cases with HLA data available, the category of D=0 was present in 60(71%) patients at either HLA class I or II loci, and was more common among recipients without traditional indications for component irradiation. These data challenge the historic emphasis on host immune defects in the pathogenesis of TA-GVHD. The dominant mechanism of TA-GVHD in both immunocompetent and compromised hosts is exposure to viable donor lymphocytes not recognized as foreign by, but able to respond against, the recipient. Copyright © 2015 American Society of Hematology.
    Blood 04/2015; 126(3). DOI:10.1182/blood-2015-01-620872 · 10.43 Impact Factor
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    ABSTRACT: In November 2014, a 3-day conference devoted to transfusion medicine in sub-Saharan Africa was held in Kampala, Uganda. Faculty from academic institutions in Uganda provided a broad overview of issues pertinent to transfusion medicine in Africa. The conference consisted of lectures, demonstrations, and discussions followed by 5 small group workshops held at the Uganda Blood Transfusion Service Laboratories, the Ugandan Cancer Institute, and the Mulago National Referral Hospital. Highlighted topics included the challenges posed by increasing clinical demands for blood, the need for better patient identification at the time of transfusion, inadequate application of the antiglobulin reagent during pretransfusion testing, concern regarding proper recognition and evaluation of transfusion reactions, the expanded role for nurse leadership as a means to improve patient outcomes, and the need for an epidemiologic map of blood usage in Africa. Specialty areas of focus included the potential for broader application of transcranial Doppler and hydroxyurea therapy in sickle cell disease, African-specific guidelines for transfusion support of cancer patients, the challenges of transfusion support in trauma, and the importance of African-centered clinical research in pediatric and obstetric transfusion medicine. The course concluded by summarizing the benefits derived from an organized quality program that extended from the donor to the recipient. As an educational tool, the slide-audio presentation of the lectures will be made freely available at the International Society of Blood Transfusion Academy Web site: http://www.isbtweb.org/academy/. Copyright © 2015. Published by Elsevier Inc.
  • Walter Sunny Dzik · Meghan Delaney
    Transfusion 11/2014; 54(11):2791-4. DOI:10.1111/trf.12823 · 3.57 Impact Factor
  • Transfusion 11/2014; 54(11). DOI:10.1111/trf.12872 · 3.57 Impact Factor
  • Jeremy Ryan Andrew Peña · Walter Sunny Dzik
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    ABSTRACT: The scope of activity of the Blood Transfusion Service (BTS) makes it unique among the clinical laboratories. The combination of therapeutic and diagnostic roles necessitates a multi-faceted approach to utilization management in the BTS. We present our experience in utilization management in large academic medical center.
    Clinica chimica acta; international journal of clinical chemistry 09/2013; 427. DOI:10.1016/j.cca.2013.09.030 · 2.76 Impact Factor
  • Transfusion 06/2013; 53(6):1168. DOI:10.1111/j.1537-2995.2012.03926.x · 3.57 Impact Factor
  • Walter Sunny Dzik
    Transfusion medicine reviews 07/2012; 27(1). DOI:10.1016/j.tmrv.2012.06.001 · 4.54 Impact Factor
  • Walter Sunny Dzik
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    ABSTRACT: Anticoagulant drugs are taken by millions of patients throughout the world. Warfarin has been the most widely prescribed anticoagulant for decades. In recent years, new oral anticoagulants have been approved for use, are being positioned as alternatives to warfarin, and represent an enormous market opportunity for pharmaceutical companies. Requests for urgent reversal of anticoagulants are not uncommon especially in the setting of critical bleeding. This review summarizes information on reversal of warfarin by vitamin K, plasma, prothrombin complex concentrates, and recombinant VIIa. In addition, we emphasize the lack of current evidence supporting reversibility of the new oral direct thrombin inhibitors and Factor Xa inhibitors. This review is presented to assist transfusion medicine specialists, hematologists, and other clinicians who prescribe blood components for reversal of drug-induced anticoagulation.
    Transfusion 05/2012; 52 Suppl 1:45S-55S. DOI:10.1111/j.1537-2995.2012.03690.x · 3.57 Impact Factor
  • James P Aubuchon · Walter Sunny Dzik
    Transfusion 11/2009; 50(5):963-7. DOI:10.1111/j.1537-2995.2009.02457.x · 3.57 Impact Factor
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    ABSTRACT: Errors in the collection and labeling of blood samples for pretransfusion testing increase the risk of transfusion-associated patient morbidity and mortality. Statistical process control (SPC) is a recognized method to monitor the performance of a critical process. An easy-to-use SPC method was tested to determine its feasibility as a tool for monitoring quality in transfusion medicine. SPC control charts were adapted to a spreadsheet presentation. Data tabulating the frequency of mislabeled and miscollected blood samples from 10 hospitals in five countries from 2004 to 2006 were used to demonstrate the method. Control charts were produced to monitor process stability. The participating hospitals found the SPC spreadsheet very suitable to monitor the performance of the sample labeling and collection and applied SPC charts to suit their specific needs. One hospital monitored subcategories of sample error in detail. A large hospital monitored the number of wrong-blood-in-tube (WBIT) events. Four smaller-sized facilities, each following the same policy for sample collection, combined their data on WBIT samples into a single control chart. One hospital used the control chart to monitor the effect of an educational intervention. A simple SPC method is described that can monitor the process of sample collection and labeling in any hospital. SPC could be applied to other critical steps in the transfusion processes as a tool for biovigilance and could be used to develop regional or national performance standards for pretransfusion sample collection. A link is provided to download the spreadsheet for free.
    Transfusion 08/2008; 48(10):2143-51. DOI:10.1111/j.1537-2995.2008.01824.x · 3.57 Impact Factor