From the Guidelines
When obtaining consent for blood transfusion in a bleeding patient, essential details must include the reason for transfusion, the specific blood products being administered, and the expected benefits, as well as potential risks and alternatives to transfusion, as outlined in the AAGBI guidelines 1.
Key Components of Informed Consent
The consent process should cover the following key points:
- Reason for transfusion, including the cause of active bleeding
- Specific blood products being administered, such as red blood cells, platelets, plasma, or cryoprecipitate
- Expected benefits, including stabilizing hemodynamics, improving oxygen-carrying capacity, and correcting coagulopathy
- Potential risks, including allergic reactions, fever, transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), infection transmission, and hemolytic reactions
- Alternatives to transfusion, if available, such as cell salvage, hemostatic agents, or accepting a lower hemoglobin in stable patients
Patient-Centered Approach
The consent process should be patient-centered, taking into account the individual patient's needs, values, and preferences, as emphasized in the guideline for obtaining valid consent for gastrointestinal endoscopy procedures 1. This includes providing clear, accurate information about the proposed treatment, alternative available treatments, and the option of having no treatment, presented in a way that patients can understand.
Emergent Situations
In truly life-threatening emergencies where the patient cannot provide consent and no surrogate is available, it is essential to document the necessity for proceeding without formal consent under the principle of implied consent, as stated in the AAGBI guidelines 1. This approach balances the urgent need for treatment with ethical obligations to inform patients about this potentially life-saving intervention.
From the Research
Essential Details for Consent
When obtaining consent for blood transfusion in a bleeding patient, the following essential details should be included:
- Benefits of the transfusion, as patients need to be fully informed to make an informed decision 2
- Risks associated with the transfusion, such as acute and delayed adverse reactions, including acute hemolytic transfusion reaction, febrile nonhemolytic transfusion reaction, allergic and anaphylactic reactions, and transfusion-related acute lung injury 3, 4
- Potential complications, such as transfusion-related infection or sepsis, and transfusion-associated circulatory overload 4
- Alternatives to blood transfusion, if available
- The patient's rights and responsibilities, including the right to refuse the transfusion
Patient Education and Satisfaction
Studies have shown that patients often do not receive sufficient information about blood transfusions, and many would like to have more details about the risks and benefits 5
- Healthcare professionals should provide patients with clear and concise information about the transfusion, including the potential risks and benefits
- Patients should be given the opportunity to ask questions and express their concerns
- The majority of patients are satisfied with the information they receive, but some may still feel that they do not have enough information to make an informed decision 5
Healthcare Professional Responsibilities
Healthcare professionals have a responsibility to provide patients with accurate and timely information about blood transfusions, including the potential risks and benefits 2, 5
- They should also be aware of the latest evidence-based guidelines and algorithms for transfusion, as well as new laboratory testing and electronic verification systems 3
- Healthcare professionals should be familiar with the different types of blood products and their indications for transfusion, as well as the potential reactions and complications of these transfusions 6