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Christine Cserti-Gazdewich

Christine Cserti-Gazdewich
University of Toronto / University Health Network

MD FRCPC

About

165
Publications
12,782
Reads
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2,550
Citations
Citations since 2017
60 Research Items
1613 Citations
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Introduction
Transfusion Medicine & Hematology (focus: immunohematology, compatibility, hemovigilance)
Additional affiliations
October 2006 - present
University Health Network
Position
  • Professor (Assistant)
July 2005 - September 2006
Harvard University
Position
  • Fellow

Publications

Publications (165)
Article
Full-text available
Background: Cardiorespiratory transfusion reactions drive most transfusion-related morbidity and mortality. Transfusion-associated circulatory overload and transfusion-related acute lung injury have established causes, important impacts, mitigation options, and revised definitions, while non-conforming CRTRs fall into a category known as transfusio...
Article
Background Sickle cell trait (SCT) testing of red blood cell (RBC) units is sometimes performed to identify and divert units containing hemoglobin S (HbS). Recipients strategically guarded against this exposure include fetuses, neonates, and children with sickle cell disease (SCD). The clinical necessity of this practice is unclear. Study Design a...
Article
In the current dogma, immune hemolysis is considered an exclusively humorally-mediated state. However, in some cases, serological investigations are negative and without alternative explanations. In such a subset of unexplained seronegative hemolysis (SNH), we investigated for potentially attributable cellular mechanisms. Release of chromium-51(Cr5...
Article
Full-text available
Background Iron deficiency anemia (IDA) accounts for the majority of anemia cases across the globe and can lead to impairments in both physical and cognitive functioning. Oral iron supplementation is the first line of treatment to improve the hemoglobin level for IDA patients. However, gaps still exist in understanding the appropriate dosing regime...
Article
Introduction Myocarditis is an inflammatory disease of cardiac muscle caused by a variety of infectious and non-infectious conditions. Viral infection is the most frequent cause of myocarditis; however, herpes simplex virus 1 (HSV-1) infection causing myocarditis has been rarely described. We present a case of a young woman with HSV-1 viremia and f...
Article
Donor organ allocation is dependent on ABO matching, restricting the opportunity for some patients to receive a life-saving transplant. The enzymes FpGalNAc deacetylase and FpGalactosaminidase, used in combination, have been described to effectively convert group A (ABO-A) red blood cells (RBCs) to group O (ABO-O). Here, we study the safety and pre...
Article
BACKGROUND: RBC transfusions play a role in organ- and life-preservation for patients with sickle cell disease (SCD). These in turn are subject to higher-fidelity matches to offset the particularly high condition-specific odds of seroconversion events. Adverse outcomes may be as severe as hyperhemolysis, and/or undertransfusion from the scarcity of...
Article
Full-text available
The efficacy of convalescent plasma for coronavirus disease 2019 (COVID-19) is unclear. Although most randomized controlled trials have shown negative results, uncontrolled studies have suggested that the antibody content could influence patient outcomes. We conducted an open-label, randomized controlled trial of convalescent plasma for adults with...
Article
Transfusion associated circulatory overload (TACO) is one of the leading causes of transfusion related morbidity and mortality. TACO is the result of hydrostatic pulmonary edema following transfusion. However, up to 50% of all TACO cases appear after transfusion of a single unit, suggesting other factors, aside from volume, play a role in its patho...
Article
Prior to death patients commonly experience impaired consciousness for a significant period of time, frequently preventing family and others from final interactions with the patient. Some of these episodes of cognitive impairment may be treatable, with treatment not offered owing to the perception of ultimate futility, or expense, or both. One of t...
Article
Background/objectives: Transfusion reactions (TRs) may cause or contribute to death. Cardiopulmonary TRs are distressing, and collectively account for most transfusion fatalities, though the degree to which they alter survival more broadly is unclear. Deaths (and their timing) after TRs may provide further insights. Materials/methods: Adult (tri...
Article
Background: Platelets are the most commonly discarded blood product in Canada, with the most common cause of in-date product loss being improper storage. Transport containers to maintain temperature and extend acceptable return time may represent a method to reduce wastage. The objective of this study was to evaluate the impact of a validated Plat...
Article
Background Intravenous Immune Globulin (IVIG) is used to treat numerous immune‐mediated and inflammatory conditions. There is growing awareness of hemolysis, occasionally severe, as a side‐effect of this therapy. While most cases are associated with anti‐A and/or anti‐B isoagglutinins, the frequency and mechanism of hemolysis remain poorly characte...
Article
Background Transfusion of red blood cells (RBC) is a common procedure, which when prescribed inappropriately can result in adverse patient outcomes. This study sought to determine the impact of a multi‐faceted intervention on unnecessary RBC transfusions at hospitals with a baseline appropriateness below 90%. Study Design and Methods A prospective...
Article
Introduction: Due to their short shelf-life, platelet concentrates are particularly susceptible to the product shortages which may result from shortfalls in donor collections or disruptions to the manufacturing and supply chain. Mechanisms to address shortages are particularly important in light of the ongoing COVID-19 pandemic. Canadian Blood Serv...
Article
Full-text available
Background and Objectives Transfusion‐associated circulatory overload (TACO) is the leading cause of transfusion‐related morbidity and mortality. A recently completed pilot trial randomized patients to pre‐transfusion furosemide versus placebo but had a slower than expected enrollment rate. We sought to determine whether the lack of recruitment was...
Article
Background Hemolysis following the administration of intravenous immunoglobulin (IVIG) is an important adverse event (AE). While the monocyte monolayer assay (MMA) has been used to predict in vivo hemolysis when serologically incompatible blood may be transfused, it has also been shown to correlate with IVIG‐associated hemolysis. In this study, the...
Article
Background: Alloimmunization can impact both the fetus and neonate. Study objectives: (a) calculate the incidence of clinically significant RBC isoimmunization during pregnancy, (b) review maternal management and neonatal outcomes, (c) assess the value of prenatal and postnatal serological testing in predicting neonatal outcomes. Study design a...
Article
Background and objectives: The key first step for a safe blood transfusion is patient registration for identification and linking to past medical and transfusion history. In Canada, any deviation from standard operating procedures in transfusion is an error voluntarily reportable to a national database (Transfusion Error Surveillance System [TESS]...
Article
Rate of Sickle Hemoglobin Recovery in Sickle Cell Disease Patients Undergoing Red Blood Cell (RBC) Exchange Transfusion is Associated with Age of Patients and Number of RBC Units Transfused Introduction: Automated and manual red blood cell exchange (RBCX) transfusions are useful in the primary and secondary prevention of sickle cell disease (SCD) c...
Article
BACKGROUND: The blood transfusion chain is complex and error-prone. The key first step is patient registration for identification and linking to past medical and transfusion history. In Canada, transfusion-related errors are voluntarily reported to a national web-based database (Transfusion Error Surveillance System [TESS]). This project focuses sp...
Article
Background & objectives: Serologic testing after transfusion reactions (TRs) aims to find accountable immune haemolytic incompatibility. Our hospital policies recommend serologic testing in all TR, except for low-risk fevers (subclinical temperature <39°C) or uncomplicated allergic reactions. Assessing compliance with these guidelines and serologi...
Article
BACKGROUND The optimal method of providing transfusion medicine (TM) education has not been determined. Transfusion Camp was established in 2012 at the University of Toronto as a centrally delivered TM education program for postgraduate trainees. The impact of Transfusion Camp on knowledge, attitudes, and self‐reported behavior was evaluated. METH...
Article
Transfusion-related acute lung injury is a leading cause of death associated with the use of blood products. Transfusion-related acute lung injury is a diagnosis of exclusion which can be difficult to identify during surgery amid the various physiologic and pathophysiologic changes associated with the perioperative period. As anesthesiologists supe...
Article
BACKGROUND Transfusion‐associated circulatory overload (TACO) is a leading cause of transfusion‐attributable morbidity. It is unclear whether diuretics are safe and effective in preventing this reaction. MATERIALS AND METHODS In a pilot controlled feasibility trial, inpatients 65 years or older ordered a single unit of red blood cells were randomi...
Article
Full-text available
Background Evolutionary pressure by Plasmodium falciparum malaria is known to have favoured a large number of human gene adaptations, but there is surprisingly little investigation of the effect of malaria on human mitochondrial sequence variation. Plasmodium falciparum infection can cause severe malaria anaemia (SMA) with insufficient tissue oxyge...
Article
The transfusion support of hematological malignancies considers 2 dimensions: the quantity of what we order (in terms of triggers, doses, targets, and intervals), and the special qualities thereof (with respect to depths of matching and appropriate product modifications). Meanwhile, transfusion-related enhancements in the quantity and quality of li...
Article
Introduction: In patients undergoing ABO-incompatible stem cell transplants, recipient isoagglutinins with specificity for donor antigens are expected to slowly become undetectable during the post-transplant period, presumably secondary to the loss of recipient plasma cells via either conditioning chemotherapy or graft-versus-host-disease. Converse...
Article
Introduction: Serologic testing of post-transfusion reaction specimens aims to ascertain potentially accountable immune hemolytic incompatibility. With the exception of low-risk fevers or uncomplicated allergic reactions (ie- reactions with a likelihood of incompatibility that is deemed too low to justify testing), all transfusion reactions undergo...
Article
Autoantibody-opsonized platelets in immune thrombocytopenia (ITP) are thought to be destroyed primarily by macrophage Fc gamma receptor (FcγR)-mediated phagocytosis in the spleen. Blockade of splenic macrophage FcγRs has been proposed as a therapeutic mechanism for ITP intervention. Unfortunately, the contribution of specific FcγRs to disease in IT...
Article
BACKGROUND Evans syndrome is a rare autoimmune disorder that is defined by the simultaneous or sequential presence of two or more cytopenias without an obvious underlying precipitating cause. Evans syndrome usually follows a chronic relapsing and remitting course and is quite rare, making it difficult to evaluate in clinical studies. CASE REPORT A...
Article
In endemic areas, the burden of malaria and anaemia converge together upon children, with severe malarial anaemia (SMA) accounting disproportionately for demands on limited blood supplies. The attributable morbidity and mortality from SMA remain high, and improved outcomes hinge in part on the timeliness, sufficiency and safety of transfusion suppo...
Article
BACKGROUND Transfusion‐associated circulatory overload (TACO) is a leading cause of serious reactions. In regard to TACO, little is known regarding biomarkers as a predictor, their most informative timing, or thresholds of significance or differentiation from other reactions. STUDY DESIGN AND METHODS In this study of inpatients at risk for TACO (a...
Article
Full-text available
Background and objectives: Approaches to preventing transfusion-associated circulatory overload (TACO) include the use of diuretics. The purpose of this study was to determine how commonly diuretics are prescribed in patients receiving a red-blood-cell (RBC) transfusion. Materials and methods: This was a retrospective study of 200 adult inpatien...
Article
Background: Blood transfusions and fractionated products are not without risk and may lead to acute and long-term adverse events. The objective of this study was to evaluate the appropriateness of usage of frozen plasma (FP), cryoprecipitate (CRYO), and recombinant factor VIIa (rVIIa) in a pediatric setting. Methods: All orders for FP, CRYO, and...
Article
Heparin induced thrombocytopenia (HIT) is associated with significant morbidity and mortality. Critically ill patients are commonly thrombocytopenic and exposed to heparin. Although HIT should be considered, it is not usually the cause of thrombocytopenia in the medical-surgical ICU population. A systematic approach to the critically ill patient wi...
Article
Background and objectives: Platelet (PLT) transfusions must be used appropriately, as they are in chronic short supply, costly and risky to patients. The goals of this audit were to: (1) validate preset adjudication criteria through an audit of appropriateness at four large academic hospitals; (2) identify variability in appropriateness across med...
Article
BACKGROUND In Canada, transfusion‐related errors are voluntarily reported to a tracking system with the goal to systematically improve transfusion safety. This report provides an analysis of sample collection (SC) and sample handling (SH) errors from this national error‐tracking system. STUDY DESIGN AND METHODS Errors from 2006 to 2015 from 23 par...
Article
Background: Febrile nonhemolytic transfusion reactions (FNHTRs) are characterized by a post-transfusion temperature rise (of???1?C, to???38?C) or chills/rigors unrelated to the underlying condition. FNHTRs are provoked by inflammatory cytokines in the product or by host antileukocyte antibodies against residual donor leukocytes. FNHTRs are among t...
Article
Background: Contamination of platelet concentrates (PCs) with Staphylococcus aureus is one of the most significant ongoing transfusion safety risks in developed countries. Case report: This report describes a transfusion reaction in an elderly patient diagnosed with acute myeloid leukemia, transfused with a 4-day-old buffy coat PC through a cent...
Article
Background: Fever is described in transfusion-associated circulatory overload (TACO), reflecting either comprehensive haemovigilance or an inflammatory pathobiology (such as congestion-associated atheroma disruptions). Methods: Hospital haemovigilance data (1/1/2010-31/12/2012) were reviewed for TACO cases (frequency and mode of referral). TACO...
Article
Introduction Anti-erythroid antibodies are the classical marks of serologic and hemolytic transfusion reactions. These reactions can occur acutely or in a delayed timeframe, while the sensitizing antibody may derive from the host or be passively acquired. In those with concurrent hemolysis, the red blood cell (RBC) breakdown may be severe enough to...
Article
Background: Paroxysmal cold hemoglobinuria (PCH) is a rare form of autoimmune hemolytic anemia caused by a biphasic (Donath-Landsteiner [DL]) immunoglobulin G autoantibody. Estimates of disease frequency after syphilis are lacking and the diagnostic yield of testing for PCH is uncertain. The objectives of this study were: 1) to describe DL testing...
Article
Objectives Debate continues on whether leukoreduction alone (LR) is sufficiently similar to leukoreduced cellular products drawn from cytomegalovirus (CMV)–seronegative (SN) donors to minimize the risk of transfusion-transmitted CMV (TT-CMV). We sought to determine the policy, inventory, and practice landscape of the province for TT-CMV mitigation....
Article
Full-text available
Importance Severe anemia, defined as a hemoglobin level of less than 5.0 g/dL, affects millions of children worldwide. The brain has a high basal demand for oxygen and is especially vulnerable to hypoxemia. Previous studies have documented neurocognitive impairment in children with severe anemia. Data on cerebral tissue oxygenation in children with...
Article
Background: Various versions of the monocyte monolayer assay (MMA) have been used to assess clinical significance of red blood cell (RBC) alloantibodies in transfusion for more than 35 years. However, the optimal conditions, including anticoagulant used for whole blood samples, temperature and duration of storage, and optimal pH for assessing the...
Article
Background: Evaluating the appropriateness of red blood cell (RBC) transfusion requires labor-intensive medical chart audits and expert adjudication. We sought to determine the appropriateness of RBC transfusions at 10 hospitals using retrospective chart review and to determine whether simple metrics (proportion of single-unit transfusions, RBCs/1...
Article
Background: Extracorporeal photopheresis (ECP) culls pathogenic T lymphocytes, be these the clones of cutaneous T-cell lymphoma, or mediators of chronic graft-versus-host disease (GVHD) after allogeneic bone marrow transplantation (BMT-GVHD). Whether or not ECP may have an effect in the rarer instances of solid organ transplantation-associated GVH...
Article
Methods: Ugandan children (ages 6-60 months) with severe anemia and lactic acidosis were randomly assigned to receive RBCs stored 1-10 days versus 25-35 days. B-type natriuretic peptide (BNP), vital signs, renal function test results, and plasma hemoglobin were measured. Most children had either malaria or sickle cell disease and were thus at risk...
Article
Full-text available
Malaria is associated with haemolysis and the release of plasma haem. Plasma haem can cause endothelial injury and organ dysfunction, and is normally scavenged by haemopexin to limit toxicity. It was hypothesized that dysregulation of the haem-haemopexin pathway contributes to severe and fatal malaria infections. Plasma levels of haemin (oxidized h...
Article
Full-text available
Importance Although millions of transfusions are given annually worldwide, the effect of red blood cell (RBC) unit storage duration on oxygen delivery is uncertain.Objective To determine if longer-storage RBC units are not inferior to shorter-storage RBC units for tissue oxygenation as measured by reduction in blood lactate levels and improvement...
Article
Introduction: The extent to which febrile transfusion reactions (FTRs) are investigated is the extent to which bacterial contamination (BaCon) may be ascertained; FTR rates in turn vary with policies concerned with their recognition and approach. Microbiology and serology aim to rule out contamination or incompatibility, both potentially fatal. BaC...
Article
Introduction Pembrolizumab is a humanized monoclonal antibody that disrupts programmed cell death 1 (PD-1) receptor signaling and unmasks native cytotoxic T-cell activity against tumor cells. Early clinical trials show that pembrolizumab induces a prolonged and sometimes dramatic antitumor response in advanced melanoma, renal cell carcinoma, and no...
Article
BACKGROUND: Acquired hemophilia A (AHA) results from auto-antibodies that neutralize factor VIII (FVIII) coagulant function. AHA is rare, usually occurring late in life, and occasionally post-partum. It is most often idiopathic, but can be associated with malignancy, autoimmunity, or drugs. In contrast to congenital hemophilia, AHA generally manife...
Article
Introduction In robust hospital transfusion services, transfusion reaction reporting triggers a structured response to the assessment, diagnosis, and clinical management of the individual. At a population level, the feedback loop of hemovigilance permits the perception of signals applicable to donors, material production, patterns of use, infusion...
Article
Each year approximately 100 million units of blood are transfused worldwide. Current regulations allow RBCs to be stored in approved solutions for up to five or six weeks. Regulatory agencies use cell survival studies and in vitro markers of hemolysis, rather than measures of oxygen delivery, to establish the maximal duration of blood storage. Duri...
Article
Full-text available
Background: Direct oral anticoagulants (DOACs) are now standard of care for the management of thromboembolic risk. A prevalent issue of concern is how to manage direct oral anticoagulant (DOAC)-associated bleeding for which there is no specific antidote available for clinical use. We conducted a retrospective case series to describe the Toronto, C...
Article
Full-text available
Epidemiologic studies have suggested an association between hepatitis C virus (HCV) infection and antigendriven lymphoproliferative disorders, in particular marginal zone lymphomas. Antiviral therapy has been shown to exert an anti-lymphoma effect in these indolent B-cell lymphoproliferations, with survival gains observed. However, these protocols...
Article
Background: After introduction of a closed-system cell processor, the effect of this product change on safety, efficacy, and utilization of washed red blood cells (RBCs) was assessed. Study design and methods: This study was a pre-/postimplementation observational study. Efficacy data were collected from sequentially transfused washed RBCs recei...
Article
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 don...
Article
Direct antiglobulin test-negative (DAT(-)) autoimmune hemolytic anemia, characterized by hemolysis without detectable immunoglobulin or complement on patient red blood cells (RBCs), poses a diagnostic challenge. To select therapy, classification of the hemolysis as immune- or non-immune-mediated is important. We developed a method using Western imm...