Consent
Consent for transfusion should be obtained and documented. Check your local institutional guidelines.
Always cover the following when gaining consent:
Explain
- Cause/likelihood of bleeding or the low blood count for which transfusion is being considered
- Nature of the proposed transfusion therapy - what is involved
- Benefits expected
- Risks - including both common and rare but serious
- Alternatives including the risk of doing nothing.
Ask
- Is there anything else you would like to know?
- Is there anything you do not understand?
Provide
- Interpreter for non-English speaking patients
- Written information.
Risk
In terms of viral safety, Australia has one of the safest blood supplies in the world.
The following table outlines risks of transfusion transmitted infection calculated on Australian Red Cross Blood Service (ARCBS) data from 1 January 2006 to 31 December 2007.
|
| HIV (antibody + RNA) | 9 | Approximately 1 in 35.2 million |
| HCV (antibody + RNA) | 5.4 | Approximately 1 in 3.2 million |
| HBV (HBsAg) | 38 | Approximately 1 in 1.9 million |
| HTLV I & II (antibody) | 51 | Approximately 1 in 14.7 million |
| Variant Creutzfeldt-Jakob Disease (vCJD) [No testing] | | Possible. Not yet reported in Australia. See section below. |
| Malaria (antibody) | N/A | 1 in 4.9 million to 1 in 10.2 million |
(a) HIV, HCV, HBV risk estimates are based on ARCBS data from 1 January 2006 to 31 December 2007. HTLV risk estimate based on data from 1 January 2004 to 31 December 2007. For other agents refer below.
Viral estimates: Seed, CR, Kiely P and Keller AJ. Residual Risk of Transfusion Transmitted Human Immunodeficiency Virus, Hepatitis B Virus, Hepatitis C Virus and Human T Lymphotrophic Virus. Intern Medicine Journal 2005; 35(10): 592-8.
Malaria: Seed, CR. Residual Risk Estimates for Transfusion Transmitted Malaria (TTM). ARCBS DPARC; November 9/10 2005 meeting.
There have been no reported cases of transmission by transfusion of classical Creutzfeldt-Jakob Disease (cCJD), and retrospective studies suggest that the possibility of such transmission of cCJD is remote.
To date, no Australian has been infected with vCJD. In the UK, there have been a small number of reported cases of putative transfusion transmission since 2004. In Australia, as a precaution, people who have spent a cumulative period of six months in the UK between 1 January 1980 and 31 December 1996 and/or had a transfusion in the UK between 1 January 1980 and the present time are not accepted as blood donors.
These risks are very small compared to risks of everyday living: chance of being killed in a road accident is about 1 in 10,000.
The most common types of reactions are not serious and include, for example, headache, mild fever, itching and hives.
ABO incompatibility remains one of the most common fatal complications of blood transfusion and most are due to avoidable errors (such as patient/sample identification errors).
Other serious risks associated with transfusion - based on overseas estimates - are outlined below (degree of recognition/reporting of events results in variable incidences. Many are underestimated).
|
| Bacterial sepsis (platelets) | 1: 100,000 |
Haemolytic reactions:
Acute
Delayed |
1: 12,000 to 77,000
1: 4,000 to 9,000
|
| Anaphylaxis – IgA deficiency | 1: 20,000 to 170,0000 |
| Fluid overload/cardiac failure | Up to 1% of patients receiving transfusions |
| TRALI | 1: 5,000 to 10,000 |
| Transfusion-associated graft vs host disease | Rare |
Reference: ARCBS Blood Component Information Booklet 2007.
The Calman Chart
(Calman 1996) for explaining risk (UK risk per one year).
|
| Minimal | 1:100,000 – 1:1,000,000 e.g. death from a train accident |
| Very low | 1:10,000 – 1:100,000 e.g. death from an accident at work |
| Low | 1:1000 – 1:10,000 e.g. death from a road accident |
| High | > 1:1000 e.g. transmission of chickenpox to susceptible household contacts |