Consent for Blood Transfusion - Guidance for Healthcare Practitioners in the UK

Key requirements in consent for transfusion

• Ensure shared decision-making discussion with the patient (or parent/guardian/advocate if applicable) takes place wherever possible, and that this is documented in the patient’s clinical record. Patients who have been given a blood transfusion and were not able to give informed and valid consent prior to the transfusion must be informed of the transfusion prior to discharge.

• Patients who receive a transfusion should have the details (including any related adverse events) clearly documented in their hospital discharge summary, ensuring both the patient and their family doctor/GP are aware.

• Transfusion should be considered when there is no appropriate alternative, and the benefit for the transfusion outweighs the risks. Many patients can safely tolerate not having a transfusion.

Informed consent discussion  [ This is a generic list covering the SaBTO guidance recommendations – you need to tailor your discussion to cover what is important to your individual patient ]

BENEFITS

Red cells:   Relieve symptoms of anaemia; Prevent complications of anaemia (tissue ischaemia, organ damage);                     Earlier mobilisation/quicker recovery after illness or surgery Platelets/plasma:   Stop or prevent bleeding

RISKS and actual or potential consequences

Wrong blood/wrong patient Febrile non-haemolytic reaction Allergic reaction Pulmonary complications: Transfusion-Associated Circulatory Overload (TACO) Transfusion-Related Acute Lung Injury (TRALI) Haemolytic Transfusion Reaction - acute or delayed Transfusion Transmitted Infection - bacterial, viral, other Antibody formation Iron overload Other complications The patient can no longer donate blood

ALTERNATIVES as relevant/appropriate to the clinical situation

Red cells:   Iron therapy (oral/IV); Other haematinic replacement (B12, folate); Erythropoietin; Cell salvage (surgery) Plasma:      Factor concentrates if applicable Platelets:    Tranexamic acid

INFORMED PATIENT

Give the patient written information, with sufficient time to read and consider and an opportunity to ask questions (if written information is not available then provide verbal information). There may be particular considerations to take into account for specific patient groups, such as paediatrics, multi-transfused, etc.

CONSENT (or REFUSAL)

Document your discussion and the outcome in the patient’s care records. If the patient is refusing the proposed treatment (transfusion), try to explore why this is; contact a transfusion expert if required. Make sure the patient understands the possible consequences of not having a transfusion, and ensure any Advanced Directive is applicable and valid.

Click here for printable PDF version of this checklist

For more detailed information about the risks of transfusion which may not necessarily need to be part of your consent discussion, see Handbook of Transfusion Medicine: Adverse effects of transfusion.

Before going on to authorise blood components, check whether the patient has any specific transfusion requirements.

All staff involved in consent for transfusion have a duty to give honest and accurate information and answer patient's concerns in full. 

For further information and guidance on consent for transfusion contact your local transfusion team, or see NHS Blood Assist.