Prior to transfusion of a red blood cell product the patient must be informed about the procedure, including a discussion of the risks and benefits. Consent must be obtained prior to the transfusion and the patient educated about warning signs of an adverse reaction.


Usually a physician or nurse will discuss the transfusion process with the patient. If the patient is unable to consent (in a coma, demented, small child) then the discussion occurs with a surrogate decision maker (family member, guardian, parent).


Elements of informed consent:

(1) indications for the transfusion (why)

(2) what is going to be done (testing, infusion, number of units, time involved)

(3) benefits and risks

(4) alternative therapeutic options

(5) risks if transfusion is declined

(6) an opportunity for asking questions and clarifications


The decision to continue with transfusion depends on the patient. Consent or refusal should be documented in the medical record. Refusal for transfusion should be reported to the ordering physician.


Potential warning signs for a transfusion reaction that the patient should be encouraged to report:

(1) vague, uneasy feelings

(2) pain (at IV site, back, chest, other)

(3) shortness of breath or chest tightness

(4) fever

(5) chills or flushing

(6) nausea or dizziness

(7) hives or skin rash

(8) dark or red urine


Education about possible adverse reactions is especially important in a person transfused as an outpatient. These patients may be discharged soon after the transfusion, so that some reactions may occur at home.


To read more or access our algorithms and calculators, please log in or register.