Susan Nahirniak

Susan Nahirniak
University of Alberta | UAlberta · Department of Laboratory Medicine and Pathology

MD, FRCPC

About

73
Publications
8,202
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1,587
Citations
Citations since 2017
32 Research Items
939 Citations
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2017201820192020202120222023050100150200250
2017201820192020202120222023050100150200250
2017201820192020202120222023050100150200250

Publications

Publications (73)
Article
Full-text available
Objective Out-of-hospital blood transfusion (OHBT) is becoming increasingly common across the prehospital environment, yet there is significant variability in OHBT practices. The Canadian Prehospital and Transport Transfusion (CAN-PATT) network was established to collaborate, standardize, and evaluate the effectiveness of out-of-hospital blood tran...
Article
Full-text available
Background and objectives: Platelet transfusions are used across multiple patient populations to prevent and correct bleeding. This scoping review aimed to map the currently available systematic reviews (SRs) and evidence-based guidelines in the field of platelet transfusion. Materials and methods: A systematic literature search was conducted in...
Article
Purpose Ventricular assist devices (VADs) have improved survival to heart transplant (HTx). However, VADs have been associated with the development of human leukocyte antigen antibodies (HLA-Ab) which may limit the donor pool and increase risk for worse outcomes post-HTx. Since HLA-Ab development after VAD insertion is poorly understood, the aim of...
Article
Full-text available
Haemolytic disease of the newborn (HDN) can be associated with significant morbidity. Prompt treatment with intensive phototherapy (PT) and exchange transfusions (ETs) can dramatically improve outcomes. ET is invasive and associated with risks. Intravenous immunoglobulin (IVIG) may be an alternative therapy to prevent use of ET. An international pa...
Article
Full-text available
Background and Objectives: The coronavirus disease 2019 (COVID-19) pandemic has impacted blood systems worldwide. Challenges included maintaining blood supplies and initiating the collection and use of COVID-19 convalescent plasma (CCP). Sharing information on the challenges can help improve blood collection and utilization. Materials and Methods:...
Article
Full-text available
Background and objectives: The coronavirus disease 2019 (COVID-19) pandemic has impacted blood systems worldwide. Challenges included maintaining blood supplies and initiating the collection and use of COVID-19 convalescent plasma (CCP). Sharing information on the challenges can help improve blood collection and utilization. Materials and methods...
Article
Background and Objectives The coronavirus disease 2019 (COVID-19) pandemic has impacted blood systems worldwide. Challenges included maintaining blood supplies and initiating the collection and use of COVID-19 convalescent plasma (CCP). Sharing information on the challenges can help improve blood collection and utilization. Materials and Methods...
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
Purpose ABO-incompatible (ABOi) heart transplantation (HTx) has become a standard approach for infants with low isohemagglutinin titers (ISO). ABOi HTx may also be safe for older pediatric patients with altered immune response, however, thresholds are yet to be defined. Methods Data on management, clinical course and ISO were analyzed from two pat...
Article
Background Guidelines for platelet (PLT) transfusion are an important source of information for clinicians. Although guidelines intend to increase consistency and quality of care, variation in methodology and recommendations may exist that could impact the value of a guideline. We aimed to determine the quality of existing PLT transfusion guideline...
Article
Background Irradiation of red blood cells (RBCs) inactivates residual donor T lymphocytes to prevent transfusion‐associated graft‐vs‐host disease (TA‐GVHD) but can have adverse effects on recipients and inventory management. Reported incidence of TA‐GVHD is lower when leukoreduced RBCs and older blood products are transfused; therefore, the impact...
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
Severe acute respiratory distress syndrome (ARDS) can complicate novel pandemic coronavirus disease (COVID-19). Extracorporeal life support (ECLS) represents the final possible rescue strategy. Variations in practice, combined with a paucity of rigorous guidelines, may complicate blood product resource availability and allocation during a pandemic....
Article
Solid organ transplant (SOT) recipients who are cytomegalovirus (CMV) seronegative (R‐) and receive seronegative donor (D‐) organs have a small but currently unquantified risk of both transfusion‐transmitted CMV (TT‐CMV) and community‐acquired CMV (CA‐CMV). We retrospectively studied the incidence and clinical symptoms of TT‐CMV (infection <1 year...
Article
Background: Ventricular assist device (VAD) therapy has become an important tool for end-stage heart failure. VAD therapy has increased survival but is associated with complications including the development of human leukocyte antigen (HLA) antibodies. We sought to determine the incidence of HLA antibody development post-VAD insertion, across the...
Article
In the Original Article by Schulman et al. "Prothrombin Complex Concentrate for Major Bleeding on Factor Xa Inhibitors: A Prospective Cohort Study" (Thromb Haemost 2018;118:842-851) after publication of the article it has come to the corresponding author's attention that the author affiliations were mixed up. The amended author affiliations are as...
Article
Background: Blood loss and transfusion remain a significant concern in liver resection (LR). Patient blood management (PBM) programs reduce use of transfusions and improve outcomes and costs, but are not standardized for LR. This study sought to create an expert consensus statement on PBM for LR using modified Delphi methodology. Methods: An exp...
Article
Objectives: To determine the clinical benefit of using colloids versus crystalloids for volume resuscitation in children admitted after cardiac surgery. Design: Retrospective pre-/postintervention cohort study. Setting: Stollery Children's Hospital tertiary care pediatric cardiac ICU. Patients: Children admitted to the pediatric cardiac ICU...
Article
Many transfusion guidelines are available, but little appraisal of their quality has been undertaken. The quality of guidelines may potentially influence adoption. Our aim was to determine the quality of evidence-based transfusion guidelines (EBG) for red cells and plasma, using the Appraisal of Guidelines for Research and Evaluation (AGREE II) ins...
Article
Oral factor Xa inhibitors are increasingly used for anticoagulation, but there is no approved reversal agent. Prothrombin complex concentrate (PCC) for the management of Xa-inhibitor–associated bleeding has been described in small case series and one cohort study. Patients on apixaban or rivaroxaban, suffering a major bleed, were treated at nine Ca...
Article
Hospital Transfusion Medicine Committees (TMCs) are multidisciplinary committees that provide oversight of a variety of clinical activities as they pertain to transfusion medicine and patient care in hospital environments. Across the globe, there are many different standards that provide guidance on the goals, structure and function of hospital tra...
Article
Background No direct and thorough accounting of costs related to packed red blood cells (PRBCs) has occurred in recent Canadian history. Our study sought to determine the cost accrued for a unit of PRBC within a Canadian hospital related to the inventory management, storage, testing, issuing and administration of the product. Methods An eight‐step...
Article
Conclusions: Rh is a complex blood group system with diverse genotypes that may encode weak and partial D variants. Standard serologic analysis may identify clinically significant D variants as D+; nevertheless, individuals with these D variants should be managed as D- patients to prevent antibody formation to absent D epitopes. Variant identifica...
Article
The reversal of dabigatran-associated major bleeding can now be achieved with the antidote idarucizumab. We evaluated activated prothrombin complex concentrate (aPCC) as an alternative for this purpose. Patients treated with dabigatran and suffering a major bleed were treated as per existing hospital protocol with aPCC. They were subsequently recru...
Article
On May 3, 2016, the City of Fort McMurray, Alberta ordered the evacuation of 80,000 people due to the threats from a large-scale forest fire. During the evacuation of the regional hospital, red cell concentrates (RCCs) were transported with critically ill patients to a remote field hospital site or retained at the evacuated blood bank. As there was...
Article
Most guidelines suggest that only the bone marrow aspirate (BMA) is necessary to assess residual disease following intensive chemotherapy for Acute Myeloid Leukemia (AML) with the bone marrow trephine biopsy (BMTB) recommended in cases of a poor quality BMA. We performed a retrospective study evaluating this in a cohort of patients receiving intens...
Article
BACKGROUND Patients with chronic bone marrow failure syndromes often become dependent on recurrent red blood cell (RBC) transfusions (txn). Given the lack of standard RBC txn guidelines in this population, txn practices can be quite variable. Our aim is to study the pattern of RBC txns in chronically transfused patients with bone marrow failure syn...
Article
Background: Four-factor prothrombin complex concentrates (PCCs) are human plasma-derived products containing coagulation factors II, VII, IX and X as well as proteins C and S. They are licensed in many countries for treatment of bleeding or urgent periprocedural prophylaxis in patients with acquired deficiency of prothrombin complex coagulation fa...
Article
Aim Patients refractory to platelet transfusion are tested for class I HLA antibody (Ab). CDC-AHG has been used due to cost, turnaround time (TAT) and clinically appropriate sensitivity for this indication. This study compares CDC-AHG, standard single antigen bead (SAB) testing and C1q-AHG SAB testing to determine if more efficient and clinically r...
Article
Full-text available
Purpose: Hereditary Hemorrhagic Telangiectasia (HHT) is an autosomal dominant disorder affecting vasculature in different organ systems; seen at a rate of approximately 1:5000 in North America. Complications, with significant increases in health service utilization, arise from bleeding and shunts, and are particularly problematic in the lung and l...
Article
Background and Objectives Determining whether anti-D represents active or passive alloimmunization after RhIg administration is challenging. The objectives were to use antibody reaction strength to differentiate patients who may have become RhD alloimmunized during pregnancy from those manifesting passive anti-D and to investigate which methods wor...
Article
Background: The diagnosis of acute myeloid leukemia (AML), response to treatment and disease recurrence are most commonly assessed with bone marrow studies. Recommendations from leading experts (Bain, 2001) and guidelines of the European LeukemiaNET (Dohner, 2010) and the National Comprehensive Cancer network (O’Donnell, 2012) suggest that only the...
Article
Patients with hypoproliferative thrombocytopenia are at an increased risk for hemorrhage and alloimmunization to platelets. Updated guidance for optimizing platelet transfusion therapy is needed as data from recent pivotal trials have the potential to change practice. This guideline, developed by a large international panel using a systematic searc...
Article
Background Transfusion-related acute lung injury (TRALI) is a severe transfusion reaction that manifests as acute respiratory compromise within 6 hours of the infusion of blood products. Intravenous immune globulin (IVIG) is prepared from large pools of human plasma and is commonly administered in the outpatient setting for the treatment of a wide...
Article
Complications while on dabigatran therapy, particularly bleeding and thrombosis, are occurring, and require laboratory assessment. The utility of routine coagulation assays has been previously evaluated in stable patients, but not those with acute complications. The purpose of this study was to determine how to employ routine coagulation assays to...
Article
Our clinical experience led us to reassess the effect of sole omega-3 lipid therapy on hemostasis. We compared thromboelastography platelet mapping in neonatal piglets given sole omega-3 lipid. We identified abnormalities in reaction time (P = .025) and the arachidonic acid pathway (P = .025). The potential for bleeding complications from parentera...
Article
Full-text available
Posttransfusion purpura (PTP) is an uncommon, but potentially fatal, transfusion reaction characterized by profound thrombocytopenia and bleeding. PTP is caused by alloimmunization to human platelet specific antigens following blood component transfusion. Although there is evidence of a wide serological spectrum of culprit antibodies implicated, An...
Article
Anticoagulant-associated intracranial hemorrhage (aaICH) presents with larger hematoma volumes, higher risk of hematoma expansion, and worse outcome than spontaneous intracranial hemorrhage. Prothrombin complex concentrates (PCCs) are indicated for urgent reversal of anticoagulation after aaICH. Given the lack of randomized controlled trial evidenc...
Article
Nearly 75% of critically ill patients develop anemia in the intensive care unit (ICU). Anemia can be treated with red blood cell (RBC) transfusions, although evidence suggests that lower hemoglobin levels are tolerated in the critically ill. Despite such recommendations, variation exists in clinical practice. A prospective cohort was assessed for a...
Article
Full-text available
To evaluate the effect of a preoperative protocol that triages patients awaiting total joint arthroplasty to one of four strategies designed to mitigate the risk of allogeneic blood transfusion (ABT) based on a priori transfusion risk on perioperative exposure to allogeneic blood. We compared the transfusion experiences of a historical control seri...
Article
Introduction: Thrombocytopenia is a frequent complication following solid organ transplant but previous reports suggest that the incidence of immune mediated thrombocytopenic purpura (ITP) following liver transplantation is low (0.7%). Although the mechanisms involved in post transplant thrombocytopenia are complex, the presence of alloantibody der...
Article
Canadian Blood Services' disposition reports suggested considerable variation in cryoprecipitate use and prompted this national audit. Thirty-one institutions were invited to participate in a 2-month audit. Patient information and relevant laboratory and transfusion data were collected. Cryoprecipitate transfusions were categorized as appropriate i...
Article
Pediatric patients may require small-volume transfusions necessitating splitting of red cell (RBC) units. This process usually involves temporary storage of aliquots in pediatric blood bags or, in some cases, plastic syringes, until they are transfused. While many studies have been published on the efficacy of storage in blood bags, there is little...
Article
Cryopreserved allograft tissue used in the Norwood procedure for infants with hypoplastic left heart syndrome causes profound immunologic sensitization, which may complicate future transplantation. Intravenous immunoglobulin has been shown to reduce sensitization after it has developed, allowing successful transplantation. The purpose of this pilot...
Article
Canada's per capita use of intravenous immune globulin (IVIG) grew by approximately 115% between 1998 and 2006, making Canada one of the world's highest per capita users of IVIG. It is believed that most of this growth is attributable to off-label usage. To help ensure IVIG use is in keeping with an evidence-based approach to the practice of medici...
Article
Many remote hospitals keep small on-site stocks of red blood cell (RBC) units for emergency use and to support patient care programs. In Canada, the blood supplier does not accept returned units into inventory. Discard rates can, therefore, be high. To transport near-outdate RBC units to a high-usage hospital site, which would reduce overall discar...
Article
Context.—Many remote hospitals keep small on-site stocks of red blood cell (RBC) units for emergency use and to support patient care programs. In Canada, the blood supplier does not accept returned units into inventory. Discard rates can, therefore, be high. Objective.—To transport near-outdate RBC units to a high-usage hospital site, which would r...
Article
The emergence of bovine spongiform encephalopathy (BSE) in British cattle has received significant media attention since its discovery in 1986. Transmission of this prion from cattle to humans has been documented, and the BSE prion is believed to be the causative agent for variant Creutzfeldt-Jakob disease (vCJD). Evidence of this spread is a signi...
Article
Febrile non-hemolytic transfusion reactions (FNHTRs) are a common complication of platelet concentrate (PC) and RBC transfusions, usually ascribed to cytokines released by WBCs and perhaps the platelets themselves during storage. Prestorage WBC reduction should abrogate the accumulation of these cytokines reducing the number of FNHTRs. A retrospect...
Article
Full-text available
We evaluated the lineage specificity of CD79a in acute leukemias using 3-color flow cytometry in 58 consecutive cases. A panel of cell-surface antigens, including myeloid-associated markers, B-cell-associated markers, and T-cell-associated markers, was used. All cases of acute myeloid leukemia were CD79a-, whereas all cases of B-lineage acute lymph...
Article
HIT is a well-defined clinicopathologic entity with significant morbidity and mortality. In prospective studies, HIT has occurred in approximately 3% of patients receiving heparin. Of these, 1/3 develop thrombosis; mortality is 25-35%. In most hospitals diagnosis is based on clinical criteria that may be unreliable. Our hospital is a 600 bed acute...

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