What information should be included in a consent form for blood products administration?

Blood Transfusion Consent Form Content

Your consent form for blood products must include a clear explanation of the procedure's nature and purpose, specific foreseeable risks with their consequences, available alternatives including no treatment, and documentation of the patient's understanding and agreement. 1

Core Elements That Must Be Included

Procedure Description and Indication

• Explain in lay terms what blood transfusion involves and why it is specifically needed for this patient's condition 2, 1
• State the expected benefits for their particular clinical situation, such as improving hemoglobin levels, oxygen-carrying capacity, or correcting specific blood component deficiencies 1
• Describe what would happen without the transfusion (the natural course without treatment) 3

Risks and Complications

• Discuss individualized risks based on the patient's specific circumstances, not just generic risks 1
• Include common reactions: fever, chills, allergic reactions, and transfusion reactions 1
• Include serious but rare risks: transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), infections, and anaphylaxis 1, 4
• Present risks from the patient's perspective—what they would consider relevant when making their decision 2

Alternatives to Allogeneic Blood

• List available alternatives such as cell salvage, autologous donation, or conservative management where applicable 1
• Explain the risks and benefits of choosing no treatment 1
• For surgical cases, discuss blood conservation strategies if relevant 1

Documentation Requirements

What Must Be Recorded

• Document the consent discussion clearly in the medical record, either on a standard consent form, anesthetic record, or separately in the patient's notes 1
• Record the patient's questions and your responses 1
• Note specific risks discussed, alternatives offered, and confirmation of the patient's understanding 1
• If the patient refuses blood products or qualifies their consent, document the precise nature of restrictions imposed and the explanation of risks that occurred 2

Special Consent Clause

• Include a clause on the consent form that specifies the patient's right to list procedures for which consent is not agreed 2
• This is particularly important for patients with religious objections (e.g., Jehovah's Witnesses) who may accept some blood products but not others 2

Process Requirements

Timing and Environment

• Obtain consent before the procedure whenever possible, during pre-assessment if transfusion is anticipated 1
• Allow sufficient time for discussion—immediately before the procedure is not acceptable for providing new information 2
• Conduct the discussion in the absence of factors that could unduly influence the patient's decision 1
• Ensure the patient has adequate time to come to a considered view after receiving information 2

Who Obtains Consent

• The physician responsible for the transfusion or an appropriately trained individual must obtain consent 1
• Ensure all staff obtaining consent are properly trained and competency-assessed 1
• Use professional interpreters if the patient does not speak English—never rely on family members or friends to translate 2

Capacity Assessment

• Confirm the patient has capacity to provide informed consent before proceeding 1
• Verify the patient understands the information provided about risks and benefits 1
• If patients insist they don't want information, explain that this may invalidate their consent, document this discussion, and provide opportunity to change their mind 2

Critical Pitfalls to Avoid

Information Withholding

• Never withhold information just because it might make the patient anxious or deter them from a beneficial procedure—information may only be withheld if it poses a serious threat to the patient's health 2
• Any information that might lead a patient to cancel or defer should be considered significant 2

Emergency Situations

• Have a clear hospital policy for transfusion when patient identity is unknown or in emergency situations 1
• When possible, inform patients afterward that they received blood components 1
• In emergencies when treatment is immediately necessary, attempt to comply with the wishes of a patient who has capacity 2

Advance Directives

• Check whether the patient has made a relevant advance decision to refuse blood transfusion (many Jehovah's Witnesses carry these) 2
• An advance decision to refuse life-sustaining treatment must be in writing, witnessed, and make clear it applies even if life is at risk 2
• These are legally binding if valid and applicable 2

Post-Transfusion Requirements

• Inform the patient's general practitioner that they received blood components 1
• Document all blood products administered and volumes in the patient's case notes 1