What are the key points to consider when obtaining consent for blood transfusion?

Key Points for Obtaining Consent for Blood Transfusion

Informed consent for blood transfusion should be obtained and documented before the procedure whenever possible, with discussions taking place in the absence of factors that could unduly influence the patient's decision. 1

Essential Elements of Informed Consent

• The consent process should occur before the procedure whenever possible, ideally during pre-assessment when blood transfusion is anticipated 1
• The discussion must include a clear explanation of why the transfusion is needed and the specific benefits for the patient's condition 1
• Individualized risks, benefits, and expected outcomes must be discussed, including potential adverse events such as transfusion reactions and infections 1, 2
• Available alternatives to allogeneic blood transfusion should be presented where applicable, including cell salvage and autologous donation options 1, 3
• Ensure the patient has capacity to provide informed consent and verify their understanding of the information provided 1

Documentation Requirements

• The consent process must be clearly documented, including the patient's agreement to the intervention and the discussions that led to that agreement 1
• Documentation should include the patient's questions and the responses given 1
• This can be done on a standard consent form, on the anesthetic record, or separately in the patient's notes 1
• All blood transfusion procedures and volumes of blood reinfused must be recorded in the patient's case notes 3

Religious and Personal Considerations

• Some patients may qualify their general consent to treatment by refusing specific aspects of that treatment for religious or other personal reasons 3
• For Jehovah's Witnesses, document their specific preferences as interpretations may vary - some refuse all blood products while others may accept autologous or cell-salvaged blood 3
• When a patient gives qualified consent, record in the hospital notes that the patient has been informed of the likely consequences of their decision 3
• Document the precise nature of any restrictions imposed by the patient and the explanation of risks that took place 3

Special Circumstances

• In emergency situations, follow hospital policy for transfusion of patients whose identity is unknown 1
• When possible, inform patients afterward that they have received blood components 1
• For patients with advance decisions ("living wills"), check whether they have made relevant advance decisions to refuse treatment 3
• For transgender patients, report their transgender status to the hospital's blood transfusion service with their consent to ensure appropriate blood products are administered 3

Common Pitfalls to Avoid

• Failing to discuss important risks such as transfusion-related acute lung injury, which research shows is frequently omitted from consent discussions 2
• Discussing benefits that are not true benefits of transfusion 2
• Obtaining hurried or incomplete consent that patients poorly understand 4
• Not providing patients with available educational resources about transfusion benefits, risks, and alternatives 2
• Failing to clearly disclose organizational affiliation and role in the donation process when seeking consent 3

Practical Implementation

• Ensure all staff involved in obtaining consent for blood transfusion are properly trained and competency-assessed 1
• Consider using standardized educational tools like videos to improve patient understanding of risks, benefits, and alternatives 5
• Inform the patient's general practitioner that they have received blood components 1
• When documenting qualified consent, draw attention to the clause on the consent form that specifies the patient's right to list procedures for which consent is not agreed 3