Praxis Medical Insights

The American Society of Anesthesiologists recommends that informed consent for blood transfusion should be obtained and documented before the procedure whenever possible 1, 2
The discussion should take place in the absence of factors that could unduly influence the patient's decision, as suggested by the American Journal of Kidney Diseases 3
Where blood transfusion is anticipated before surgery, this should be discussed during pre-assessment and valid consent documented, according to Anaesthesia 4, 5
The patient should be provided with an explanation of why the transfusion is needed and the specific benefits for their condition, as recommended by the American Society of Anesthesiologists 6, 7
Individualized risks, benefits, and expected outcomes of the transfusion should be discussed, including potential risks of transfusion such as transfusion reactions, infections, and other adverse events, as suggested by the American Journal of Kidney Diseases and Anaesthesia 2, 3, 6
Available alternatives to allogeneic blood transfusion, such as cell salvage and autologous donation, should be discussed where applicable, as recommended by the British Journal of Anaesthesia and Anaesthesia 4, 8

Documentation Requirements

The consent process must be clearly documented, including the patient's agreement to the intervention and the discussions that led to that agreement, as required by Anaesthesia 1
Documentation should include the patient's questions and the responses given, and can be done on a standard consent form, on the anaesthetic record, or separately in the patient's notes, as suggested by Anaesthesia 1

In emergency situations, all hospitals should have a clear policy for transfusion of patients whose identity is unknown or in emergency situations, as recommended by Anaesthesia 2, 7
When possible, inform patients afterward that they have received blood components, as suggested by Anaesthesia 4, 5
Confirm the patient's capacity to provide informed consent before proceeding, and verify the patient's understanding of the information provided about risks and benefits, as recommended by the American Journal of Kidney Diseases 3

Ensure all staff involved in obtaining consent for blood transfusion are properly trained and competency-assessed, as required by Anaesthesia 5
Inform the patient's general practitioner that they have received blood components, as suggested by Anaesthesia 4, 5

The British Journal of Anaesthesia recommends presenting available alternatives to allogeneic blood transfusion, including cell salvage and autologous donation options 9

The British Journal of Anaesthesia suggests recording all blood transfusion procedures and volumes of blood reinfused in the patient's case notes 10

The Anaesthesia journal notes that some patients may qualify their general consent to treatment by refusing specific aspects of that treatment for religious or other personal reasons, and their specific preferences should be documented 11
For patients with advance decisions, the Anaesthesia journal recommends checking whether they have made relevant advance decisions to refuse treatment 11
The Anaesthesia journal also suggests reporting the transgender status of patients to the hospital's blood transfusion service with their consent to ensure appropriate blood products are administered 12
The American Journal of Respiratory and Critical Care Medicine recommends clearly disclosing organizational affiliation and role in the donation process when seeking consent 13

The Anaesthesia journal recommends documenting the precise nature of any restrictions imposed by the patient and the explanation of risks that took place 11
The Anaesthesia journal also suggests drawing attention to the clause on the consent form that specifies the patient's right to list procedures for which consent is not agreed 11