Choosing Wisely:

Avoid transfusion, outside of emergencies, when alternative strategies are available as part of informed consent; make discussion of alternatives part of the informed consent process.

Rationale and Comments: Informed choice/consent regarding transfusion and other effective methods should be standardized and consistently delivered. Throughout the world, there is wide variation among medical practitioners and hospitals with regard to medical knowledge about the true risks of transfusion, alternatives to transfusion, and the delivery of this information to patients. Outside of the truly emergent clinical situation, transfusion should be avoided or limited when other interventions are available. Alternative strategies include, but are not limited to pharmacologic agents, cell salvage, normovolemic hemodilution, and minimally-invasive surgical techniques.
Sponsoring Organizations:
  • Society for the Advancement of Blood Management
  • Sources:
  • Expert consensus
  • Disciplines:
  • Hematologic
  • References: • Friedman M, Arja W, Bata R, et al. Informed consent for blood transfusion: What do medical residents tell? What do patients understand? Am J Clin Pathol. 2012;138(4):559-65.
    • Davis R, Vincent C, Murphy M. Blood transfusion safety: the potential role of the patient. Transfus Med Rev. 2011;25(1)12-23.
    • Booth C, Grant-Casey J, Court EL, et al. National comparative audit of blood transfusion: report on the 2014 audit of patient information and consent. Transfus Med. 2017:21(3):183-189.
    • Vossoughi S, Macauley R, Sazama K, Fung M. Attitudes, practices, and training on informed consent for transfusions and procedures. Amer J Clin Path. 2015;144:315-321.
    • Howell CA, Forsythe JLR. Patient consent for blood transfusion- recommendations from the SaBTO. Transfus Med. 2011;21:359-362.
    • Court EL, Robinson JA, Hocken DB. Informed consent and patient understanding of blood transfusion. Transfus Med. 2011;21:183-189.

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