On-Going Projects

Project TitlePIDescriptionResearch ThemeStatus
Pre-transfusion furosemide in patients at high risk of TACO
Dr. Jacob PendergrastMulti-centre RCTSafetyPlanning
The Monocyte Monolater Assay - Enhancing Care for the 'Untransfusables' (MMA-ECU)Dr. Christine CsertRed Blood Cell unit (RBC) compatibility is founded on indirect anti-globulin testing (IAT), with two key fallibilities: “overcall” in high frequency alloantibodies (HFA), and “undercall” in hyperhemolysis syndrome (HHS). In HFA, undertransfusion and/or rare unit consumption may occur unnecessarily; while in (recurrence-prone) HHS, misleadingly compatible crossmatches cannot identify provocative RBCs. A more discriminating tool exists in the monocyte monolayer assay (MMA), which quantifies phagocytic indices (PI) for crosses between patient plasma, candidate RBCs, and (host vs control) monocytes. This has been locally optimized and validated, and applied in ad hoc cases as well as in a research cohort. Being labour-intensive, its adoption remains limited, and more evidence is required before its Canadian expansion. This study seeks to explore the monocyte monolayer assay for its potential to distinguish between units that are more or less likely to survive in the immune environment of the patient for more advanced precision in transfusion medicine.SafetyApproved
Transfusion-Associated Dyspnea: Prospective Observation and Laboratory Assessment (TAD-POL)
Dr. Christine CsertiTAD-POL (Transfusion-Associated Dyspnea: Prospective Observation and Laboratory Assessment): to better distinguish differing etiologies and associated pathophysiology, patients experiencing dyspneic transfusion reactions will undergo a standardized battery of clinical and laboratory tests via a peer-reviewed investigational protocol including NT-pro-BNP, histamine, cytokine profiling, leukoagglutinin assays and microparticle quantification.SafetyActively recruiting
Daily vs. Every Other Day Oral Iron Supplementation in Patients With Absolute Iron Deficiency Anemia (DEODO): a Multi-centered, Pilot Randomized Controlled Trial
Daily vs. Every Other Day Oral Iron Supplementation in Patients With Absolute Iron Deficiency Anemia
Dr. Yulia LinIron deficiency anemia is a global health problem and the most common cause of anemia worldwide. Patients with iron deficiency (ID) and IDA can present with a multitude of symptoms including fatigue, restless legs syndrome and pica. Oral iron supplementation is associated with increasing hemoglobin in multiple studies in women, pregnant women and elderly patients. However, the optimal dose and frequency of oral iron supplementation for treatment remains unclear. The current proposed study attempts to address this gap in the literature.
This is a pilot, pragmatic, non-inferiority, open label randomized controlled trial (RCT) in outpatients with iron deficiency anemia to evaluate the effectiveness of oral ferrous sulfate 300mg (60mg elemental iron) once daily versus every other day to improve hemoglobin at 12 weeks post-initiation. The rationale for this study includes: (1) IDA is a common and prevalent condition with potential adverse consequences if left untreated; (2) optimizing effectiveness of oral iron supplementation while minimizing side effects will improve treatment for patients. Because IDA is a global health problem, common in clinical practice and treatable, this study will have a significant practical impact on how clinicians treat outpatients with iron deficiency anemia and how patients tolerate therapy. For the patient, the expected benefit from taking part in this study is the potential to improve and treat iron deficiency anemia. These potential changes may lead to improved symptoms associated with iron deficiency anemia, such as cognitive and physical functioning, and fatigue.
UtilizationActively recruiting
Big Data-1Dr. Robert SkeateDemonstrate the impact of implementation of best practices in transfusion in the UofT QUEST hospitals through development of information technology systems linking the blood supplier, transfusion service, laboratory information systems and the discharge abstraction database. A pilot of this process has been conducted at Sunnybrook Health Sciences Centre, with a grant from the Ministry of Health, Ontario for $30,000. Computer provider order entry for transfusion has begun in a pilot phase at the hospital with full implementation planned for 2018-2019. With this infrastructure in place, we will be able to directly measure the impact of transfusion initiatives on individual clinical transfusion practice, including categorizing physicians who have and have not completed transfusion camp.UtilizationOngoing, manuscript in progress
TESS Error System – Registration ErrorsDr. Jeannie Callum & Dr. Christine CsertiTransfusion errors in Canada. The UofT QUEST investigators have received approval from the Public Health Agency of Canada to conduct an analysis to characterize the sample collection and handling errors that have occurred in Canada over the past 10 years (PI: Callum). Sunnybrook Health Sciences Centre is a sentinel site for transfusion error data collection as part of the Transfusion Error Surveillance System (TESS). In 2017, our research team has been requested to analyze the national data and submit to a peer reviewed journal. Our goal is to identify where, when and why these errors are occurring in hospitals and utilize this as a base to influence hospital policy and transfusion standards that relate to sample collection for transfusion compatibility testing. This will allow the UofT QUEST to identify frequent high risk errors and then develop and test innovative strategies to determine how best to prevent these errors. Indeed, Sunnybrook Health Sciences Centre is at the beginning of a phased rollout of bedside computer technology to facilitate error-free sample collection. If we can scientifically prove these innovative technologies improve safety we can lobby to ensure transfusion standards are modified to require accurate labelling strategies.SafetyManuscript submitted
The role of splenic macrophage Fc gamma receptors in two autoimmune conditions; immune thrombocytopenia and autoimmune hemolytic anemia (R2A2)
Dr. Alan Lazarus, Dr. Christine Cserti, Dr. Yulia LinIn immune thrombocytopenia (ITP) and autoimmune hemolytic anemia (AIHA) antibody and Fc gamma receptors are involved in cellular destruction. Immunoglobin G antibodies opsonizing either platelets or erythrocytes trigger macrophage phagocytosis primarily through interactions with activating Fcgamma receptors (FcgammaR). Macrophages have several different FcgammaRs available. These include high affinity FcgammaR1, and the low affinity FcgammaRIIa and FcgammaRIIIa. However, the role of specific activating FcgammaRs in ITP patients is not well defined. The proposed study will incubate antibody coated blood cells sampled from ITP or AHA patient sera with macrophages and define the specific FcgammaRs involved in platelet and red cell destruction. Identifying which Fc receptors mediate phagocytosis of platelets and red cells can establish a known signaling pathway for the development of drugs/pharmaceutical agents to block and disrupt the antibody mediated signal for cellular destruction. Fc receptor blockade has long been considered a viable strategy to treat antibody-mediated platelet destruction.
SafetyActively recruiting, model validation published in Haematologica
Fibrinogen vs Cryo Matched Cohort in Pediatrics/ microFIBRES/ miniFIBRESDr. Lani LiebermanAn observational study to evaluate the implementation of fibrinogen concentrate for pediatric cardiac surgery in a before-after study designUtilizationPlanning
Electronic audit of plasma useElectronic data (10 sites) extracted in collaboration with McMaster Centre for Transfusion Research of 1 year of transfusion, laboratory and discharge abstract database to evaluate the appropriate use of plasmaUtilizationCompleted, manuscript in progress
FARES-1Dr. Keyvan KarkoutiPilot RCT (n=120) comparing PCC to plasma for hemorrhage and coagulopathy to determine the optimal primary endpoint and feasibility for a larger definitive trialUtilizationActively recruiting
FIIRST-2Dr. Jeannie CallumDefinitive trial of 600 trauma patients at 8 centres in Canada randomized to plasma vs. PCC and fibrinogen concentratesUtilizationPlanning
STudy to ActivelY WARM Trauma Patients (STAY WARM): A Feasibility Pilot EvaluationDr. Luis da Luz & Dr. Jeannie CallumIn conjunction with FIIRST-2, we will randomize severe trauma patients to routine blankets vs. thermal military blankets to determine impact on temperature and transfusion outcomes. Pilot study underway at Sunnybrook.UtilizationActively recruiting
Utilization of albumin in pediatricsDr. Valerie ArsenaultRetrospective descriptive study - describe the use of albumin in neonatal intensive care units of 3 different tertiary care centers in Toronto.UtilizationActively recruiting
Pumping IronDr. Jeannie CallumQI project to provide patients with heart failure IV iron and track outcomes (re-admissions, transfusions, etc)UtilizationActively recruiting
RIPPLEDr. Heather Vandermeulen & Dr. Yulia LinQI project – replacing Iron and Preventing anemia in Pregnant women of Limited Economic MeansUtilizationActively recruiting
WBITDr. Nancy DunbarImprove our understanding of Wrong Blood in Tube (WBIT) risk factors and identify opportunities to improve safety.
SafetyActively recruiting
Viewing AnimationDr. Katerina PavenskiIVIG in high risk patients (non-O) receiving 2 g/kg doseEducationPlanning
Chemistry MicrofluidicsDr. Jeannie CallumCan get blood group result in 2 minutes – validated hematocrit, working on INR, PT, and FibrinogenUtilizationREB pending
Freeze Dried PlasmaDr. Jeannie CallumFresh frozen plasma vs. freeze dried plasma. Cardiac surgery trial (similar to FARES) – randomize patients to fresh vs. freeze dried plasma issues through Blood Bank.UtilizationPlanning
Studies to determine the mechanism of unexplained hemolysis in sickle cell, hyperhemolysis and DAT-negative AIHADr. Don BranchStudies to determine the mechanism of unexplained hemolysis in sickle cell, hyperhemolysis and DAT-negative AIHASafetyPlanning
Variations in Practice in Post-Partum Iron SupplementationDr. Ana Iancu & Dr. Yulia LinLook at post-partum iron supplementation.
UtilizationActively recruiting
High Risk Pregnancy Outcomes: A Prospective StudyDr. Lani LiebermanAssess feasibility of developing a data system to link data between transfusions related high risk pregnancy issues (e.g. NAIT, FNAIT) and neonatal outcomes. Step 2 would be to prospectively follow a cohort of mothers and neonates with these conditions.SafetyActively recruiting
National evaluation of platelet transport bags to reduce wastageUtilization
A Multifaceted Intervention to Optimize Red Blood Cell Transfusion Practice in Two Provinces (START)Utilization
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