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Massive transfusion practices in Tunisia and protocol proposal.

Mariem Cheikhrouhou, Sami Guermazi, Ihebe Labbene

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    Massive transfusion (MT) practices in Tunisia are inconsistent, with varied approaches to blood product ratios and component use. A proposed protocol aims to standardize this life-saving therapy for better patient outcomes.

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    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.