What should be discussed with patients when obtaining informed consent for blood transfusion?

Key Elements of Informed Consent for Blood Transfusion

When obtaining informed consent for blood transfusion, healthcare providers should discuss the benefits, risks, and alternatives to transfusion, ensuring patients understand what they are consenting to and documenting this discussion appropriately. 1

Essential Information to Discuss with Patients

• Explanation of why the transfusion is needed and the specific benefits for their condition 1
• Individualized benefits of transfusion relevant to the patient's clinical situation 2, 1
• Potential risks and complications of blood transfusion, including: 2, 1
  • Common side effects: fever, allergic reactions, fluid overload 2, 3
  • Serious adverse events: transfusion reactions, transfusion-related acute lung injury (TRALI), hemolysis 2, 3
  • Extremely rare but serious risks: transfusion-transmitted infections, death 2, 3
• Available alternatives to allogeneic blood transfusion where applicable: 1
  • Cell salvage techniques
  • Autologous donation options
  • Pharmacological alternatives (e.g., tranexamic acid) 2

Special Considerations for Religious or Personal Restrictions

• Patients may qualify their consent by refusing specific aspects of treatment 2
• For example, Jehovah's Witnesses may refuse homologous blood transfusion but some may accept:
  • Autologous or cell-salvaged blood
  • Cardiopulmonary bypass with non-hematogenous primes
  • Organ transplantation 2
• Document any restrictions clearly, including that the patient has been informed of potential consequences 2

Documentation Requirements

• Clearly record the consent discussion in the patient's medical record 2, 1
• Documentation should include: 1
  • Patient's agreement to the intervention
  • Specific risks and benefits discussed
  • Patient's questions and the responses given
  • Any qualified consent or restrictions imposed by the patient 2
• Follow local protocols for documentation (standard consent form, anesthetic record, or in patient notes) 2

Timing and Setting for Consent

• Obtain consent before the procedure whenever possible 1
• For anticipated transfusions, discuss during pre-assessment 2, 1
• Ensure discussion takes place in an environment free from undue influence 1
• Use professional interpreters (not family members) for patients who don't speak the local language 2

Practical Implementation

• Provide written information in appropriate languages and formats (including Braille or large print when needed) 2
• Verify patient's understanding of the information provided 1, 4
• Inform patients afterward that they have received blood components, as they may otherwise be unaware 2
• Inform the patient's general practitioner that they have received blood components 2

Emergency Situations

• Follow local hospital policy for transfusion of unidentified patients or in emergency situations 2
• In emergencies when treatment is immediately necessary, attempt to comply with known patient wishes if they have capacity 2
• Document clearly if consent could not be obtained due to emergency circumstances 2

Common Pitfalls to Avoid

• Failing to discuss important risks such as TRALI or focusing only on infectious risks 4, 5
• Overstating benefits that may not be true benefits for the specific patient 4
• Inadequate documentation of the consent process 1, 6
• Relying on family members as translators instead of professional interpreters 2
• Not informing patients they've received blood components after transfusion 2

Remember that studies have shown patients often have incomplete understanding of transfusion risks and benefits, highlighting the importance of clear communication and verification of understanding 4, 6.