Guidelines for red blood cell and plasma transfusion for adults and children
Informed consent and information disclosure
The EWG had some difficulty reaching consensus on some issues related to obtaining informed consent for red blood cell and plasma transfusion. Members agreed that health care workers should inform patients about the possibility and likelihood of blood transfusion, and solicit and answer any questions the patient might have. Beyond that point, members had difficulty providing guidelines for informed consent that reconcile requirements for full disclosure irrespective of the clinical scenario with a more pragmatic approach that considers disclosing transfusion-related information in light of the patient's clinical situation.
The EWG believes that the risk associated with red blood cell and plasma transfusion must be placed in the context of the overall risk associated with an illness or procedure. Blood transfusion is often given in situations, such as surgery, chemotherapy or critical illness, where the risk from transfusion is small compared with the overall risks. Undue emphasis on the risks from blood transfusion was thought by some to be both unreasonable and imprudent, as it could confuse patients about the absolute and relative risks they are facing. For example, coronary artery bypass grafting has an approximate composite risk of stroke, myocardial infarction and death of 1% to 2%. Is it then necessary or even appropriate to do more than advise patients that they have a 10% to 40% probability of receiving a blood transfusion, with which there are associated remote but real risks, then solicit the patient's response and questions.
The EWG agreed that, where clinically appropriate, patients should be advised that alternatives to allogeneic transfusion exist, but members could not reach consensus on the need to discuss them in detail, given their inconsistent availability and varying effectiveness in averting allogeneic exposure and preventing transmissible diseases.
Finally, the EWG agreed that patients should be informed that they have received red blood cells or plasma as soon as possible following transfusion, but could not reach consensus on who should inform them (e.g., treating physician, prescribing physician, blood bank, hospital administration) or how to ensure that they were informed.
