Guidance for healthcare practitioners in the UK

A patient should give valid consent before receiving a transfusion of blood components. Obtaining consent for any procedure involves discussing the benefits, risks and any available alternatives.

The Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO) guidance on patient consent for blood transfusion, updated in 2020, stipulates what information must be given to a patient who may be exposed to blood transfusion to help them make an informed decision about receiving a blood component transfusion.

Healthcare practitioners obtaining consent for transfusion must be appropriately trained to do so. Online courses specifically developed on consent for transfusion are accessible via e-learning. National, regional and local training and competency programmes on consent for transfusion may also be available. Contact your transfusion training lead for local arrangements regarding access to e-learning and provision of additional training and competency.

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

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

Key requirements in consent for transfusion

Shared decision making

Ensure a shared decision-making discussion takes place with the patient (or parent, guardian or advocate, if applicable) 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.

Discharge summary

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 GP are aware.

Discussion of appropriate alternatives

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

Having an informed consent discussion

The following is a generic checklist covering the recommendations within the SaBTO guidance. You will need to tailor your discussion to cover what is important to your individual patient.

Download a printable version of the consent checklist (PDF 264KB).

Important

Before authorising blood components, check whether the patient has any specific transfusion requirements.

▢ Benefits

Red cells

  • Relieve symptoms of anaemia
  • Prevent complications of anaemia (tissue ischaemia, organ damage)
  • Earlier mobilisation/ quicker recovery after illness or surgery

Platelets and plasma

  • Stop or prevent bleeding

▢ Risks

(and actual or potential consequences)

▢ Alternatives

(as relevant/appropriate to the clinical situation)

Red cells

  • Iron therapy (oral/IV)
  • Other haematinic replacement (vitamin B12, folate)
  • Erythropoietin
  • Cell salvage (surgery)

Plasma

  • Factor concentrates, if applicable

Platelets

  • Tranexamic acid

▢ Informed patient

Provide the patient with written information, with sufficient time to read and consider it, and an opportunity to ask questions. If written information is not available, 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 and 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.

Information:

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