How to Obtain 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
Core Elements of the Consent Discussion
What Must Be Discussed
- Explain why the transfusion is needed and the specific benefits for the patient's condition 2
- Discuss individualized risks including transfusion reactions, infections (though rare with modern screening), transfusion-related acute lung injury (TRALI), and transfusion-associated circulatory overload (TACO) 2, 3
- Present alternatives to allogeneic blood transfusion such as cell salvage (for anticipated blood loss >500 ml) and autologous donation where applicable 2
- Provide expected outcomes of the transfusion for their specific clinical situation 2
Common pitfall: Research shows that patients often fail to recall specific risks and alternatives even when discussed 4, 5. To avoid this, use clear language, check understanding by asking patients to repeat back key points, and consider supplementing verbal discussion with written materials.
Timing and Setting
- Conduct the discussion before surgery in the pre-assessment clinic or during pre-operative evaluation, not rushed at the bedside immediately before transfusion 1
- Ensure the discussion occurs in the absence of factors that could unduly influence the patient's decision (e.g., not during acute distress or pain) 2
- Confirm the patient has capacity to provide informed consent before proceeding 2
Documentation Requirements
What to Document
- Record the patient's agreement to the intervention on a standard consent form, anaesthetic record, or separately in the patient's notes 2
- Document the discussions that led to that agreement, including risks, benefits, and alternatives covered 2
- Include the patient's questions and your responses 2
- Note any specific restrictions the patient imposes (e.g., religious objections to certain blood products) and document the explanation of risks provided 2
Legal requirement: 100% of blood components must be traceable, making proper documentation mandatory 1
Special Considerations
Religious or Personal Objections
- Respect patients who qualify their general consent by refusing specific aspects of treatment for religious or other personal reasons 2
- Draw attention to the clause on consent forms that specifies the patient's right to list procedures for which consent is not agreed 2
- Document the precise nature of any restrictions imposed by the patient 2
Emergency Situations
- Follow your hospital's clear local policy for transfusion of patients whose identity is unknown 1
- In emergencies where the patient cannot be identified, attach identification stating "unknown male/female" with a unique identification number 1
- When the patient's identity becomes known, attach new identification and collect a new transfusion sample with the known patient's details 1
Post-Transfusion Communication
- Inform patients before hospital discharge that they received blood components, as they will otherwise be unaware 1
- Explain that receiving blood removes them from the donor pool 1
- Inform the patient's general practitioner that they received blood components 1, 2
Training and Competency
- Ensure all staff obtaining consent are properly trained and competency-assessed per local policy 1, 2
Evidence note: While the 2016 AAGBI guidelines 1 provide the foundational framework, research consistently demonstrates that patients poorly recall transfusion risks and alternatives even when discussed 4, 5, 6. A 2023 study developed a standardized narrative through rigorous expert consensus that can serve as a teaching framework 7, though the core guideline requirements remain the priority for clinical practice.