Informed Consent for Blood Transfusion
When blood transfusion is anticipated, discuss it with the patient before surgery during pre-assessment and document valid consent in the patient record. 1, 2
Timing and Setting of Consent Discussion
- Obtain consent preoperatively whenever possible, not at the bedside when the patient is acutely ill or under duress 2
- Conduct the discussion in the absence of factors that could unduly influence the patient's decision 2
- For elective surgery, early involvement of the patient in the consent dialogue is necessary for the process to be effective 3
Essential Elements to Discuss
Why the Transfusion is Needed
- Provide a clear explanation of why the transfusion is necessary for the patient's specific condition 2
- Explain the expected benefits and outcomes for their particular clinical situation 2
Risks of Transfusion
- Discuss individualized risks including:
Common pitfall: Research shows that 88% of patients do not recall discussion of specific transfusion risks even when consent was obtained, suggesting physicians often omit or inadequately explain these risks 4. Additionally, only 27.8% of patients report being informed of risks in practice 5.
Alternatives to Allogeneic Blood
- Present available alternatives where applicable:
Patient Rights and Restrictions
- Draw attention to the patient's right to refuse specific aspects of treatment, including blood transfusion, for religious or personal reasons 2
- Document the precise nature of any restrictions imposed by the patient 2
- Check whether patients have made advance decisions to refuse treatment 2
Documentation Requirements
Document the consent process clearly in the patient record, including: 2
- The patient's agreement to the intervention
- The discussions that led to that agreement
- The patient's questions and responses given
- Any specific restrictions or refusals
Documentation can be completed on: 2
- Standard consent form
- Anaesthetic record
- Separately in the patient's notes
Verification of Understanding
- Confirm the patient's capacity to provide informed consent before proceeding 2
- Verify the patient's understanding of the information provided about risks and benefits 2
- Ensure the discussion was understandable to the patient 2
Evidence note: Studies demonstrate that despite obtaining written consent, patients' recollection and understanding of risks and alternatives remain poor, with only 35% feeling better informed after the consent discussion 4. A standardized educational video improved understanding of risks (7.3/10), benefits (6.9/10), and alternatives (7.1/10) 6.
Post-Transfusion Requirements
- Inform patients before hospital discharge that they received blood components, as they will otherwise be unaware 1, 2
- Inform patients that receiving blood removes them from the donor pool 1
- Ensure the patient's general practitioner is informed that they received blood components 1, 2
Staff Training and Competency
- All staff involved in obtaining consent for blood transfusion must be properly trained and competency-assessed per local policy 2
- This is separate from but related to the requirement that all staff administering blood components must be trained and competency-assessed 1
Special Circumstances
Emergency Situations
- All hospitals should have a clear local policy for transfusion when the patient's identity is unknown or in emergency situations 2
- When possible, inform patients afterward that they received blood components 2
Special Patient Populations
- For transgender patients, report their status to the hospital's blood transfusion service with their consent to ensure appropriate blood products are administered 2