Massive transfusion practices in Tunisia and protocol proposal

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Published Feb 10, 2022
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Vol. 100 No. 2 (2022): Issue feb 2022

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Mariem Cheikhrouhou
Sami Guermazi
Ihebe Labbene
Sonia Mahjoub

Abstract

Introduction: Massive transfusion (MT) is a life-saving therapy in situations of major hemorrhage awaiting radical haemostatic treatment.
Poor management and control of this therapy may, however, compromise the patient’s vital prognosis. The main aim of our study was to take
stock of massive transfusion practices in Tunisia. The secondary aim was to propose a massive transfusion protocol.

Methods: An analytical observational study based on a questionnaire was conducted. We targeted physicians brought in their clinical
practice to use MT.

Results: A total of 124 clinicians responded to the questionnaire. The majority (62%) were anesthesiologists or emergency physicians. More
than half of the participants were residents (51%). The use of MT based on a clinical or biological score was only found for a minority (13%).
The initial order was for the majority of participants (N=69) made up of red blood cell concentrates (RBC) and fresh frozen plasma (FFP).
The FFP: RBC ratio was1:2 for 51% of the participants. A higher ratio was adopted by the rest. Respectively 23.5% and 9.6% of participants
transfused platelets and fibrinogen concentrates without waiting for the result of biology. The use of tranexamic acid was systematically
advocated by 60.5% of clinicians. The majority (86.3%) adopted a restrictive transfusion strategy (target hemoglobin between 7 and 9 g/dl).
The latter was more adopted by the youngest physicians (92.1% of residents versus 55.6% of professors; p=0.008).

Conclusions: The professional practices of MT in Tunisia are heterogeneous. Given the lack of a clear institutionalized procedure which
frames this therapy, a MT protocol has thus been proposed.

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