1. Purpose and scope 

The purpose of this document is to provide a framework for clinicians prescribing blood products for children at The Royal Children’s Hospital (RCH).

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

2. Definitions 

3. Guideline 

3.1 Consent discussion 

Blood transfusions are used to treat blood loss or to supply blood components that the body cannot make itself and has the potential to be lifesaving. Valid informed consent must be obtained and documented prior to transfusion of blood products and/or plasma-derived blood components.

The decision to transfuse a patient should be a carefully considered decision and involve a discussion with the patient, parent/legal guardian, providing the patient, parent/legal guardian with information and provide them with an opportunity to ask any questions and use an interpreter for non-English speaking families. 

The following should be part of the consent discussion:

• The type of blood product (e.g., red cells)
  
• The clinical indication for the blood product transfusion (e.g., severe anaemia)
  
• The possible benefits of the transfusion
  
• The possible risks associated with a transfusion
  
• The risks of refusing a transfusion
  
• Any alternatives to transfusion 

3.2 Types of blood products and benefits 

3.3 Risks associated with transfusion 

Australia has one of the safest blood supplies in the world and blood transfusions in Australia are usually very safe. Blood donors are voluntary and non-remunerated. Blood donations are obtained, tested, handled and stored very carefully. Each blood donation is test for HIV, Hepatitis B, Hepatitis C, malaria and syphilis.

There is a small chance that some patients experience complications, most side effects experienced and mild and self-limiting e.g. fever or a rash and are easily managed by stopping the transfusion.

See table below for some of the risks related to transfusion:

For further information see Australian Red Cross Lifeblood websites for more information https://www.lifeblood.com.au/health-professionals/clinical-practice/adverse-events/classification-incidence

3.4 Risks of not having a transfusion 

Choosing not to have a blood transfusion may have serious consequences in certain situations including death or disability. Being fully informed about a blood transfusion, includes understanding the consequences of not having the suggested transfusion in the patient’s circumstances. 

3.5 Possible alternatives to transfusion 

3.6 Patient and family information 

Information on blood product transfusion will be offered to the patient, parents/legal guardians.

Provision of information must be documented on the Blood eConsent form or the paper based MR634/A form in the event of an EMR downtime.

3.7 Documentation of blood transfusion consent

Transfusion consent should be sought prospectively prior any blood product transfusion. The only exception is a critical bleeding event where consent should be sought retrospectively.

The RCH records consent for blood transfusion on the Blood eConsent form. In the event of an EMR downtime the paper-based Patient consent to blood products MR634/A should be used. A copy of this paper based form should be kept at the patient’s bedside until they are discharged. The original signed form should be sent to HIS for scanning.  

The RCH surgical consent form does not include a section on transfusion consent and if a blood transfusion may be required during the surgical procedure, the Blood eConsent form must be completed with the family prior to surgery.

The Blood eConsent form should be sighted by medical and nursing clinicians prior to the prescription and administration of blood products.

3.8 Clinical indication for blood transfusion and specific blood products consented 

Record the clinical indication for transfusion on the Blood eConsent form. This may be related to the admission or the specific clinical condition. 

Record the specific blood products the family/patient have consented to receive on the Blood eConsent form. Clinical staff ensure these are included on this form prior to transfusion of any prescribed/ordered blood products. 

The Blood eConsent form requires renewal if the clinical condition changes or the blood product prescribed/ordered is not included on the Blood eConsent form. 

3.8 Duration of blood transfusion consent 

Blood product transfusion consent is valid for 12 months.

3.9 Refusal of blood products 

If the patient, parent/legal guardian indicated that they are not willing to provide consent for transfusions of blood products, please refer to the Blood Refusal – Management of Procedure  

Please document all aspects related to refusal within the patient's medical record.  

3.10 Key aligned documents / resources 

• Australian Red Cross Lifeblood - Informed consent | Lifeblood
• Department of Health - Bloods Matters consumer information - Blood transfusions (health.vic.gov.au)
• South Australia blood transfusion fact sheets in 18 translations - Blood transfusions | SA Health