Research
Tanya L. Zakrison, MHSc MD FRCSC FACS MPH
Dr. Tanya L. Zakrison is a Trauma & Acute Care Surgeon and a surgical critical care intensivist who works at the Ryder Trauma Center, at Jackson Memorial Hospital. She has been an Assistant Professor of Surgery at the University of Miami since 2012. Dr. Zakrison has collaborated with her mentor, Dr. Alessia Fornoni, since early 2016. They both share an interest in the negative sequelae of Sickle Cell Disease on various organ systems and affected patients. While Dr. Fornoni is a world expert in the renal effects of Sickle Cell Disease, namely causing Focal Segmental Glomerulosclerosis, Dr. Zakrison’s research interests similarly lie in the effects of Sickle Cell Trait on trauma patients. Specifically, she is interested in exploring changes in the coagulation system in trauma patients presenting in hemorrhagic shock. To date, this has been very hard to study retrospectively in trauma as Dr. Zakrison’s preliminary work has demonstrated that Sickle Cell Trait is poorly captured in trauma registries by ICD-10 codes. Clinical outcomes in this vulnerable population in trauma thus become impossible to measure, and therefore difficult to draw meaningful conclusions that may change practice management guidelines.
Sickle Cell Trait is a very common blood dyscrasia present in 8-10% of African American patients, 1% of white Hispanic patients and 0.5% of white patients of European descent, living in the south of the United States. Close to 95% of patients with Sickle Cell Trait are unaware of their status as disease manifestations occur only during times of significant physiologic stress, if at all. Such manifestations include Acute Kidney Injury, rhabdomyolysis, delayed splenic rupture, venothromboembolic events and even sudden death. These manifestations have occurred in individuals during times of extreme exertion or exercise. Both African American and Hispanic patients are disproportionately affected by trauma throughout the United States, including firearm-related, interpersonal violence causing high injury severity scores. Sickle Cell Trait, to date, has not been studied in trauma patients who present with the physiologic stress of significant blood loss, leading to hemorrhagic shock. Dr. Zakrison is specifically interested in studying changes that may occur in the coagulation profiles of such patients, using thromboelastography. Thromboelastography is a tool that measures the viscoelastic properties of blood clots to determine if any clotting abnormalities exist, and if so, at which part of the clotting cascade. This tool is used in trauma patients to identify early coagulation defects by identifying patients that are coagulopathic (unable to form adequate clot), hypercoagulable (forming too much clot) or hyperfibrinolytic (having clot that is broken down too quickly). All three of these states lead to preventable morbidity and mortality. Dr. Zakrison, under Dr. Fornoni’s mentorship, is currently applying for NIH funding, through the Heart, Lung and Blood Institute, to study these phenomena carefully to close this gap in the literature.