Massive transfusion practices in Tunisia and protocol proposal

Area of Science:

• Emergency Medicine
• Hematology
• Critical Care

Background:

• Massive transfusion (MT) is critical for major hemorrhage but requires careful management to avoid adverse outcomes.
• Practices surrounding MT in Tunisia were previously uncharacterized.
• This study aimed to assess current MT practices and propose a standardized protocol.

Purpose of the Study:

• To evaluate the current state of massive transfusion practices in Tunisia.
• To identify variations in MT protocols and component usage among Tunisian clinicians.
• To develop a comprehensive MT protocol for Tunisian healthcare settings.

Main Methods:

• An analytical observational study utilizing a questionnaire distributed to physicians involved in MT.
• 124 clinicians, primarily anesthesiologists and emergency physicians, participated.
• Data collected focused on transfusion triggers, component ratios, and adjunctive therapies.

Main Results:

• Significant heterogeneity in MT practices was observed, with limited use of clinical or biological scores for transfusion decisions (13%).
• Red blood cell concentrates (RBC) and fresh frozen plasma (FFP) were the primary initial orders, with a 1:2 FFP:RBC ratio used by 51%.
• Restrictive transfusion strategies (hemoglobin 7-9 g/dL) were common (86.3%), particularly among junior physicians.

Conclusions:

• Tunisian MT practices are diverse and lack institutional standardization.
• A proposed MT protocol is presented to address the identified heterogeneity and improve patient care.
• Standardization of MT protocols is crucial for optimizing outcomes in major hemorrhage management.