Introduction

This article provides a step-by-step approach to consenting patients for a blood transfusion in an OSCE setting. For more
information on prescribing and administering blood products, see the Geeky Medics guide to administering a blood
transfusion.
All patients receiving a blood transfusion need to give fully informed consent. 1,2
documented in their notes.
This can be given verbally but needs to be
Obtaining consent for any procedure involves discussing the bene
Information provided should be tailored to the speci
All organisations which provide blood transfusions should have a local policy or guideline that provides more detail about the
transfusion process, so please refer to these in practice.

Opening the consultation

Wash your hands and don PPE if appropriate.
Introduce yourself, including your name and role.
Con
Explain the purpose of the conversation\:
r e c o m m e n d e d f o r y o u , w o u l d t h i s b e o k ?"
" T o d a y I’ d l i k e t o t a l k t o y o u a b o u t h a v i n g a b l o o d t r a n s f u s i o n t h a t h a s b e e n
Establish rapport and an open line of communication\:
“ F e e l f r e e t o i n t e r r u p t m e i f y o u h a v e a n y q u e s t i o n s a t a n y p o i n t”
.
Make sure to check the patient’s understanding at regular intervals throughout the consultation and provide opportunities to
ask questions (this is often referred to as ‘chunking and checking’).

Ideas, concerns & expectations

Ascertain what the patient already knows about the blood transfusion process. This could be their
have had many before. This will help you provide the patient with information speci
time to check their understanding and if they have any concerns. Some patients might be worried about asking questions, so
reassure them that they can ask as many questions as they need.
Ideas
“ D o y o u k n o w w h y w e h a v e s u g g e s t e d t h a t y o u h a v e a b l o o d t r a n s f u s i o n ?”
“ H a v e y o u o r h a s a n y o n e y o u k n o w h a d a b l o o d t r a n s f u s i o n b e f o r e ?”
“ D o y o u k n o w w h a t h a v i n g a b l o o d t r a n s f u s i o n i n v o l v e s ?”
Concerns
“ I s t h e r e a n y t h i n g t h a t w o r r i e s y o u a b o u t h a v i n g a b l o o d t r a n s f u s i o n ?”
“ I s t h e r e a n y t h i n g t h a t y o u d o n’ t u n d e r s t a n d a b o u t t h e p r o c e s s o f t r a n s f u s i n g b l o o d ?”
Expectations
“ H o w d o y o u h o p e t h a t r e c e i v i n g a b l o o d t r a n s f u s i o n w i l l h e l p y o u ?”
“ D o y o u h a v e a n y p a r t i c u l a r q u e s t i o n s y o u w a n t m e t o c o v e r ?”
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Bene

Potential bene
Receiving a blood transfusion can relieve symptoms caused by anaemia
It can prevent damage caused to organs associated with anaemia
It can allow earlier mobilisation and quicker recovery after an operation, acute illness or injury

Risks

Blood transfusions in the UK are usually very safe. Donated blood is obtained, tested, handled, and stored very carefully.
However, there is a small chance that some patients may face some complications. The chances of these events happening
varies, but the overall risk of a serious problem occurring is less than 1 in 10,000.
3
Some of the risks of receiving a blood transfusion include\:
Identi
cause a severe reaction (this is classi
Reactions during the transfusion such as fever, chills or a rash
Build-up of
Infection, such as bacteria or viruses like hepatitis B or C or HIV. Because of e
(less than 1 in a million).
4
Formation of antibodies, which might make it harder to match blood if patients need another transfusion in the future.
Iron overload can occur in long-term transfusion programmes.
For women of childbearing potential, it is essential to mention that antibodies could cause complications with a future
pregnancy, possibly making their baby anaemic.
Once a patient has received a blood transfusion, they are no longer able to donate blood (mention this if relevant).
When explaining the risks to patients, it is useful to remind them that they will be checked regularly while receiving the blood
and that they should tell a member of sta
Example
" B l o o d t r a n s f u s i o n i s v e r y s a f e , b u t a s i s t h e c a s e w i t h a n y m e d i c a l p r o c e d u r e , t h e r e a r e s o m e r i s k s .
"
" D o n a t e d b l o o d i s c a r e f u l l y t e s t e d a n d p r o c e s s e d , s o t h e r i s k o f i n f e c t i o n d u e t o b a c t e r i a o r v i r u s e s l i k e h e p a t i t i s o r H I V i s
t i n y – l e s s t h a n 1 i n a m i l l i o n . W e h a v e t o c h e c k c a r e f u l l y t h a t w e m a t c h t h e r i gh t b l o o d f o r y o u , s o y o u n e e d t o w e a r a n I D
b a n d a n d y o u w i l l b e a s k e d t o s t a t e y o u r n a m e a n d d a t e o f b i r t h b e f o r e s t a r t i n g . O c c a s i o n a l l y , p e o p l e d e v e l o p a r e a c t i o n
d u r i n g t h e t r a n s f u s i o n , s u c h a s a t e m p e r a t u r e o r a r a s h . R a r e l y , t h e s e c a n b e s e r i o u s . T h e r e i s a s m a l l r i s k t h a t
b u i l d u p i n y o u r c i r c u l a t i o n , m a k i n g y o u f e e l s h o r t o f b r e a t h .
"
" E v e n t s s u c h a s t h e s e a r e u n l i k e l y a n d w e w i l l c h e c k y o u r e g u l a r l y d u r i n g t h e t r a n s f u s i o n . I t i s v e r y i m p o r t a n t t o t e l l a
m e m b e r o f s t a
t r a n s f u s i o n y o u r i m m u n e s y s t e m c a n m a k e a n t i b o d i e s a g a i n s t t h e d o n o r b l o o d c e l l s . T h e s e w o n’ t a
m a k e i t h a r d e r f o r u s t o
"

Potential alternatives

Potential alternatives to blood transfusion may include\:
Iron replacement therapy\: by tablet or intravenous infusion
Cell salvage\: also known as autologous blood transfusion. This can be performed in surgery and is a process in which the
blood lost during or just after the operation is collected,
5
Erythropoietin injections\: the hormone that stimulates the body to make its own red blood cells
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Doing nothing
If it is possible that a patient will need a transfusion (e.g. they are due to have surgery and they are anaemic), they may
sometimes be given medications that can reduce the chance of needing a transfusion. For example\:
Tranexamic acid\: can be used to reduce blood loss during surgery
Iron supplementation\: can correct anaemia in patients with iron de

What does transfusion involve?

Brie
Example
" B e f o r e t h e t r a n s f u s i o n , a s m a l l s a m p l e o f y o u r b l o o d n e e d s t o b e o b t a i n e d t o c h e c k y o u r b l o o d gr o u p . T h i s w i l l b e s e n t t o
a l a b f o r t e s t i n g . A s m a l l n e e d l e c a l l e d a c a n n u l a w i l l b e p u t i n t o a v e i n i n y o u r a r m o r h a n d . Y o u w i l l b e a s k e d t o gi v e y o u r
n a m e a n d d a t e o f b i r t h a n d t h i s w i l l b e c h e c k e d a g a i n s t y o u r I D b a n d a n d t h e d e t a i l s o n t h e b a g o f d o n o r b l o o d s e l e c t e d
f o r y o u .
"
" T h e b l o o d w i l l
t o b e t r a n s f u s e d . Y o u r t e m p e r a t u r e , b l o o d p r e s s u r e a n d p u l s e w i l l b e c h e c k e d b e f o r e , d u r i n g a n d a f t e r t h e t r a n s f u s i o n .
"

How the patient might feel during and after the transfusion

A sharp prick may be felt when the cannula is
transfusion. Some people develop a fever, chills, or a rash. This is usually treated with paracetamol or by slowing down the
transfusion.
The patient’s arm or hand (depending on where the cannula was inserted) may ache and/or have a bruise for a few days after.
Remind the patient that they should contact their GP if they feel unwell, particularly within 24 hours of having a blood
transfusion, but any time in the 2 weeks following the transfusion. This is especially important if they have pain in their chest or
back, any breathing di

Ask if the patient is happy to proceed with the blood transfusion, based on everything you have explained.
Ask if they have any further questions or concerns. If they are unsure, o
allow them to have a discussion with their family.
Check if the patient has any allergies and ask if they have ever been told they need a special type of blood or have been given
an alert card (about antibodies or irradiated blood).

Closing the consultation

Check the patient’s understanding of the information given and ask if they have any questions.
Summarise what you have discussed to emphasise the key points to the patient.
Provide written information on blood transfusion.
Document the discussion in the patient’s notes.
Dispose of PPE and wash your hands.
Patient information lea
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NHS Blood and Transplant provide a range of UK wide patient information lea on blood transfusion and alternatives
to transfusion.

Reviewer

Dr Catherine Booth
Consultant in Haematology and Transfusion Medicine
NHS Blood and Transplant and Barts Health NHS Trust

References

1. NICE Guidelines [NG24]. B l o o d T r a n s f u s i o n . 2015. Available from\: [LINK]
2. Guidelines from the expert advisory committee on the Safety of Blood, Tissues and Organs (SaBTO) on patient consent for
blood transfusion. 2020. Available from\: [LINK]
3. Serious Hazards of Transfusion (SHOT) – the UK Haemovigilance scheme. Available from\: [LINK]
4. Joint UKBTS Professional Advisory Committee (JPAC). T h e e s t i m a t e d r e s i d u a l r i s k t h a t a d o n a t i o n m a d e i n t h e i n f e c t i o u s
w i n d o w p e r i o d i s n o t d e t e c t e d o n t e s t i n g \: r i s k s s p e c i LINK]
5. Klein AA e t a l . A s s o c i a t i o n o f a n a e s t h e t i s t s g u i d e l i n e s \: c e l l s a l v a g e f o r p e r i-o p e r a t i v e b l o o d c o n s e r v a t i o n . 2018. Available [LINK]
from\:
6. NHS Blood and Transplant. Receiving a Blood Transfusion patient information leaLINK]
Source\: geekymedics.com
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