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

Please note, this page is printable by selecting the normal print options on your computer.

This leaflet explains more about adult blood transfusion refusal and the Milton Keynes University Hospital NHS Trust policy for patients who are admitted to hospital or who are due to have an operation and do not 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 Witnesses you will probably be carrying an ‘Advance Decision to Refuse Specified Medical Treatment ‘(ADD), also known as ‘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. This would not replace 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 products (if you do not want these to be used) 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 products.

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 products (if you do not want these to be used).

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 document with you. Also known as ‘no blood card’.

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 products. This could include the Anti-D injection.
If you choose to not receive blood, your midwife or GP will refer you to the antenatal clinic to discuss the management of you pregnancy with a consultant and make a plan of care with you.

Will I be asked to sign a consent form?
Yes. 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 asked to sign Consent from and check list for all patients refusing with reference to withholding consent for blood /blood
products clearly identified. The form will also be signed by a member of the medical team witnessed and then filed in your health records.

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 may 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 a bag of 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 methods that can help lessen the effects of your blood loss.
The use of these drugs will depend on the type of your surgery and your current medical condition. Your doctor will discuss with you alternatives to blood transfusion as appropriate. 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, antibiotics and even some herbal remedies, this will be discussed and you may be advised to change or stop your medication.

In an emergency
If you are admitted to hospital in an emergency and we know of your wishes, we will respect and follow them. If your wishes are unknown to the clinical team and an emergency situation arises
then they will act in your best interest, which may include using blood/ blood products.

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 wished whatever the risks.

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 policy relating to Refusal of Blood/Blood products, please ask your clinical team for a copy.