For me the difficulties surrounding consent in general relate to the definition of consent, what information should be provided , how should it be communicated and what documentation (evidence) confirming that it has been validly achieved. It is interesting that the terms consent and “informed” consent are used as if they are different. The implication is that there is “misinformed” consent. In reality this may well be the case, but consent is consent, but how is this defined? I guess  the only ultimate test of valid consent occurs in medicolegal cases in which a court may or may not be convinced (aka duty to warn). 

Additionally, in view of recent research implicating transfusion of labile blood components as an independent risk factor for adverse clinical outcomes, reconsideration of product information is warranted and wider dissemination of this information is important. I was recently surmising that allogeneic blood transfusion has the widest and most heterogeneous potential hazards, probably greater than any other medical intervention. Evidence for benefit in improving clinical outcomes is thus an increasing challenge and a reassurance patients can reasonably expect.

There are two separate questions here.

The first asks if 'routine' admission forms cover consent for transfusion.  Only the standard forms for elective surgery ask and require specific consent for transfusion.  Neither emergency admission nor medial admission forms make allowance for this, so specific consent for transfusion is required in these circumstances.

Even so, it would be prudent to have a second, transfusion-specific consent form signed in the case of a patient who is over the surgery and has been ordered a 'post-op top-up' transfusion.  Properly informed about the potential risks and benefits, some may decline.

The second question is about a person returning for the same procedure on a regular basis.  NSW Health and the AMA agree that a consent form is valid for a year from the date of signing.  The patient with recurrent anaemia due, say, to a myelodysplastic syndrome comes in, offers their arm for the needle and knows a fair bit about the process already.

Our procedure in these cases, backed by our legal eagles, is to require a new consent form every 12 months or if the blood product changes, such as a platelet transfusion in a patient who has been receiving regular red cell transfusions.

Dr Isbister, doesn't the standard hospital consent form which patient's sign on admission cover this?? Surely we are not expected to get a consent for every transfusion? How do we manage the chronic transfusion population who are having frequent transfusion of blood products??

I would be interested in participants thoughts on the following aspects of consent for blood transfusion:

1. Is a difference between consent and informed consent?
2. In what ways is blood transfusion different from other medical interventions?
3. What information should be provided to patients?