Information for Adult patients who may wish to refuse the use of Blood / Blood Products.

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This leaflet is for adult patients who may wish to decline a blood transfusion at Milton Keynes University Hospital NHS Trust including patients who are admitted to hospital or who are due to have a procedure and do not wish to accept blood or blood components. If you have any further questions, please speak to a doctor, nurse or midwife caring for you.

Can anyone refuse a blood transfusion?

• Yes. We want to be sure that we treat every patient in a way which recognises their individual choices or religious beliefs.
• In all cases hospital staff will respect your right, as an adult patient, to decide what will happen during your treatment.
• If you are a Jehovah’s Witness you will probably be carrying an ‘Advance Decision to Refuse Specified Medical Treatment ‘(ADD), also known as a no blood card’. The information contained in the ADD will be recorded in your medical records.
• Some Jehovah Witness patients also may wish to wear their own ‘No Blood’ wristband supplied by the Jehovah’s Witness Hospital Liaison Committee. The hospital also has a supply of these wristbands. This would be worn in addition to the standard hospital identification wristband.

What should I do if I know I am coming into hospital?
Before you are admitted to hospital you will usually be invited to attend a preoperative assessment clinic where you will be seen by a nurse/midwife and/or a doctor. You should make the nurse/midwife and /or doctor aware that you request that no blood or blood components should be used as part of your treatment. It is very important to tell the hospital staff as soon as possible so they can plan your treatment with this in mind. The consultant in charge of your care will be made aware of your choices; they will openly and fully discuss your care and treatment options
including the possible risks of treating you without using blood or blood components. Your doctor has the right to decide that they are unwilling to perform surgery under these circumstances. In this case you may choose to ask for a referral to a surgeon who is known, in principle, to accept patients who do not accept blood or blood components.

What do I need to bring with me?
If you are one of Jehovah’s Witnesses, please bring your ‘Advance Decision to Refuse Specified Medical Treatment’ also known as a ‘no blood card’ document with you.

What if I am pregnant and refuse a blood transfusion?
As part of your first appointment with your midwife you will be asked whether you have any objections to receiving a blood transfusion or blood components. This could include the Anti-D injection recommended for those who are Rh(D) Negative. If you choose not to receive blood, your midwife or GP will refer you to the antenatal clinic to discuss the management of your pregnancy with a consultant and make a plan of care with you.

Will I be asked to sign a consent form?
Before any operation or procedure takes place you will be asked to sign a consent form. In signing the form you are agreeing only to treatment you are willing to accept and which you have discussed with your doctor. If you decide to refuse blood you will be given the opportunity to discuss your preferences and a checklist will be completed clearly indicating which blood products
you are declining. This will be signed by you, your consultant and a witness and then filed in your health records. This document is valid for this admission only.

Are there any alternatives to blood transfusion?
Red blood cells carry oxygen around the body and their number is measured by testing your haemoglobin. If your haemoglobin is low you have anaemia which may mean your body does not receive enough oxygen causing you to feel tired and short of breath. A blood transfusion can be used to treat this by increasing your haemoglobin with red blood cells from a blood donor. There is currently no alternative to blood transfusion to increase the amount of oxygen in your blood, but there are drugs and other procedures that can help lessen the effects of any blood loss. The use of these drugs will depend on the type of your surgery and your current medical condition. Your doctor will discuss any appropriate alternatives to blood transfusion with you.

Other precautions that may be taken before, during or after your hospital stay
You may have tests to check for any abnormalities relating to your blood – e.g., anaemia, clotting. If you are anaemic, you will be treated appropriately and the cause of the anaemia will be investigated. If you are taking medication that affects the clotting abilities of your blood, e.g., Aspirin, Warfarin, Clopidogrel, Direct Oral Anticoagulants, antibiotics and even some herbal remedies, this will be discussed and you may be advised to change or stop your medication.

What will happen if there is an emergency during my stay?
If an emergency situation arises during your stay in hospital we will respect your wishes whatever the risks if we have an ‘Advance Decision to Refuse Specified Medical Treatment’ for you or you have completed and signed the trust’s ‘Consent form and checklist for all patients refusing blood’.

What if I change my mind?
If you change your mind about refusing a blood transfusion you must tell staff immediately. This decision will be recorded in your health records and your treatment plan will be adapted accordingly.

If you would like to see the MKUH policy related to refusal of blood/blood components, please ask your clinical team for a copy,