Blood Transfusion Consent Form

Need for Blood Transfusion?

Due to decreased dietary intake of iron, many cases of anemia have been reported and the number is increasing day by day. Not only this, reckless driving has led to many road traffic accidents resulting in blood loss. Many chronic illnesses lead to the deficiency of iron in the body. All these patients require a blood transfusion. Few patients need transfusion on a daily basis.

Which Type of Patients Require Blood Transfusion?

There are many indications of blood transfusion, but these are some common ones:

  • Hemoglobin level less than 6g/dl
  • Acute massive blood loss due to trauma, surgery, and post-delivery.
  • Chronic blood loss
  • Exchange transfusion in neonates
  • Blood discrepancies and disorders like Thalassemia/ Hemophilia
  • Cancer patients
  • Shock
  • Burn patients
  • For surgeries

Types of Blood

There are mainly 2 categories defining blood types; the ABO system and the Rhesus system. Types of blood groups present hence type A+, A-, B+, B-, AB+, AB-, O+ and O-. A blood sample from a donor is drawn and then it is cross-matched with the recipient’s blood to avoid reactions.

There are different types of blood and products required by various patients. Some may need whole blood while others may benefit from Packed Red Blood Cells. Other blood products are Fresh Frozen Plasma, Cryoprecipitate, and Platelet Rich Plasma.

Importance of Consent

Informed consent is essential before a blood transfusion. Some sects do not approve of blood transfusion, therefore, it is the responsibility of the doctor to inform his patient about the need for blood transfusion and its consequences. Written documentation is necessary before proceeding with the procedure.

Blood Transfusion Consent Forms

Blood transfusion consent forms need to be detailed about the necessity of the procedure along with the benefits and complications. The layout of the form is:

  • Information about the patient; name, father/ spouse’s name, age, sex, address, and contact number.
  • Diagnosis is based on the patient’s history and clinical examination.
  • Drug history and allergies.
  • History of blood transfusion in past – if yes – reason for transfusion and quantity of blood transfused. History of reaction to blood if any.
  • Name of the doctor who requested the transfusion with his registration number.
  • Description of the method of transfusion and indications.
  • Quantity of blood and type of blood or blood products to be transfused.
  • Name of the hospital/ clinic, date of procedure, and time of the start of blood transfusion.
  • Complications of the procedure. Common consequences include transmission of infections and reaction to blood/ blood products.
  • Measures to be taken, given by the doctor, in case of reaction to blood including the name of drugs, route of administration, and dosage according to the age of the patient.
  • Confidentiality and privacy agreement.
  • Emergency contact/ next of kin person of the patient.
  • Signature of the doctor.
  • Name and signature of the nurse in charge.
  • Full name with the signature of the patient and/or any close relative.
Blood transfusion consent form

Simi Karton

Dr. Simi Karton currently resides in Los Angeles with her husband. This website is a voluntary work of Dr. Karton to provide people with useful health-related information with a straightforward approach.

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