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Transfusion Medicine Service Informed Consent

Further Information Is Available By Contacting The Medical Director Of Transfusion Medicine Service: Zbigniew.M.Szczepiorkowski, MD
  1. Written documentation of informed consent will be obtained before all elective transfusions.
    2.

    Transfusions occurring in emergency situations will not require prior written informed consent.

    All elective surgeries requiring a "Type and Screen" or crossmatching preoperatively according to the Surgical Blood Order Schedule, or any procedure in which the physician has ordered blood to be crossmatched, will have a written informed consent for transfusion completed prior to surgery.

  2. Responsibility for explaining risk, benefits and alternatives to the patient and obtaining the consent will be the responsibility of the attending physician performing the procedure. This responsibility may be delegated to another physician caring for the patient.


  3. A consent for transfusion will be valid for:
    4.
    Non-surgical patients: A period of one year, unless previously revoked.

    Surgical patients: The perioperative period and any subsequent treatment in that admission related to the surgical treatment or the condition that required it.

  4. Verification of completion of the informed consent process will be the responsibility of the transfusionist and, in surgical cases, the nurse verifying the completion of the surgical consent form.


  5. A written, standard informed consent document will be used.
    6. Risks

    As of June, 2006, the best estimates of transfusion risks with allogeneic transfusion were:

    Viral Transmission
    HIV 1/2,300,000 units
    HBV 1/200,000
    HCV 1/1,800,000
    HTLV-1/2 1/500,000
    Bacterial Contamination
    Red cell units 1/1,000,000
    Platelets < 1/20,000
    Immunologic Complications
    Death due to acute hemolytic transfusion reaction 1/600,000
    Delayed hemolytic transfusion reaction 1/2,000 - 1/30,000
    Transfusion-related acute lung injury (TRALI) 1/100,000
    Graft versus host disease 1/22,000
    Febrile reaction 1/100
    Urticarial reaction 1/30 - 1/50


    Note that platelet transfusions using platelet concentrate units and cryoprecipitate transfusion involve pooling of multiple units, and thus risks of infectious disease exposure increase with the size of the pool.

    Alternatives

    Preoperative autologous donation is available. If the patient wishes to donate at DHMC, complete the order form (found in all surgical clinics) and refer the patient to the Donor/Apheresis Room (ext. 3-3775). The patient may also donate through the American Red Cross or any hospital that is appropriately accredited or licensed.

    Intraoperative and/or post-operative red cell recovery may also be feasible.

    In certain situations, peri-operative hemodilution may be useful.

    Additional Information

    If you need additional information or assistance in dealing with patient questions, please contact the Transfusion Medicine Service Laboratory (ext. 5-7207) and ask to speak to the pathologist or pathology resident.

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