Consent and patient info

  • Overview

    This information is intended to provide a framework for clinicians prescribing blood products for children at the Royal Children’s Hospital.

    Please refer to the Blood Transfusion - Fresh Blood  Products Procedure and the Consent – Informed Procedure

    Obtaining transfusion consent

    Blood products have the potential to save lives, and frequently provide considerable benefit to patients when used appropriately. There are significant risks associated with transfusion and the decision to transfuse a patient should be a carefully considered decision and involve a discussion with the patient/parent, with an opportunity for the patient/parent to ask any questions. 

    The following should be part of the consent discussion:

    Indications for blood product transfusion and possible benefits:

    • Red Blood Cells (RBC’s) – increase oxygen carrying capacity 
    • Platelets (PLTS) – used to stop bleeding due to thrombocytopenia
    • Fresh Frozen Plasma (FFP) – used to treat bleeding due to coagulopathy
    • Cryoprecipitate (Cryo)- used to treat bleeding due to hypofibrinogenaemia
    • Albumex 4% and 20% - used as volume replacement in wide variety of instances or albumin deficiency 
    • Intravenous Immunoglobulins (IVIg) - used to either replace immunoglobulins or to help regulate the immune system
    • Human derived fractionated clotting products - used to replace low levels of clotting factors 

    Risks of transfusion:

    • Australia has one of the safest blood supplies in the world. Blood donors are voluntary and unpaid and must satisfactorily complete a pre-donation interview every time they donate.
    • Every blood donation is tested for infections such as HIV, Hepatitis B and C and these must be negative before the blood is released. 
    • However, there still are risks associated with transfusion and the most common reactions reported to occur during transfusion at the RCH are fever and allergic reactions. Most are mild and symptoms subside with simply stopping the transfusion. The majority of reactions require little, if any, treatment. 
    • The Australian Red Cross Blood Service describes the current adverse events of transfusion. 

    Risks of not having the recommended transfusion:

    • Being fully informed about blood transfusion includes having an understanding of the consequences of not having the suggested transfusion.
    • Having an understanding about the different blood components and their function may be helpful in explaining the risks of not having a transfusion.
    • A parent or patient may choose not to have a blood transfusion against medical advice. This may be due to personal or religious reasons. 
    • If a parent/patient refuses a blood transfusion, refer to the Blood Refusal - management of procedure for the management of these patients. 

    Possible alternative treatments

    Some alternatives or processes that may decrease the need for transfusion in specific circumstances are:

    • Oral iron supplementation or intravenous iron infusions for the management of iron deficiency anaemia
    • Erythropoiesis stimulating agents may be considered after discussion with the on call haematologist.
    • Maximising haematinics (B12 and folate)
    • Cell salvage during specific types of surgery
    • Tranexamic acid
    • Specialised management of specific types of medications prior to surgery
    • Blood donation from a family member (This must be referred to a haematologist and is only indicated in specific circumstances, for example a blood group that is rarely found)  

    Patient and family information

    Information on blood product transfusion will be offered to the patient/parents and this will be documented on the Patient consent to blood products MR634/A form

    RCH Kids health info

    The Australian Red Cross Blood Service has transfusion information for parents and children. This includes information in languages other than English.

    They also provide specific Neonatal transfusion information and transfusion fact sheets

    Department of Health Blood Matters program blood transfusion information in language other than English 

    Documenting blood product transfusion consent

    Blood product transfusion consent form

    The RCH has a specific consent form for the transfusion of blood products; Patient consent to blood products MR634/A. Document the consent for the transfusion of blood and blood products on this form.The RCH surgical consent form does not include blood product transfusion consent. If there is a reasonable expectation that a blood product transfusion may be required during a surgical procedure (i.e. a blood group and antibody screen is ordered) the MR634/A consent form should be completed with the patient/family prior to surgery.

    The provision of information to the patient/family must be documented on the MR634/A form. 

    Consent for blood product transfusion remains paper based at the RCH. A copy of the blood product transfusion consent should be kept in the patient’s bedside folder until they are discharged. The original signed form should be sent to HIS for scanning.  

    Once the blood product transfusion consent form has been scanned into EMR, or if the patient has a long standing consent, it can be viewed in chart review section of EMR under the Media tab. Clinicians must sight the consent for blood product transfusion on the MR634/A prior to completing the “prepare” and “transfuse” order in EMR. If this has not been obtained the transfusion will be delayed until consent is obtained. The only exception is a critical bleeding event where consent should be sought retrospectively.

    Duration of consent

    Blood product transfusion consent is valid for the entire current admission, for example is the patient requires multiple blood product transfusion during the admission only one blood product transfusion consent form is required. 

    When a patient needs ongoing transfusion support, consent can be valid for 12 months. The consent form should indicate the expiry date of long term consent. 

    Refusal of blood products?

    Refusal of blood products

    If the patient/parent/guardian does not wish to receive a blood product transfusion see Blood Refusal – Management of Procedure and document this in both the medical record and on the blood transfusion consent form. The FYI flag of the EMR patient should also be completed. The FYI flag will stay valid for the entirety of the patient’s lifetime, across multiple admissions unless it is deactivated due to change of mind or circumstance.