Informed Consent

Jessica De Bord, DDS, MSD, MA (Bioethics)

Opportunities to "consent" a patient abound on the wards. The aim of this
section is to provide you with the tools required for the "basic minimum"
as well as providing a more comprehensive picture of the informed
consent process. You will find that the particular circumstances (e.g. the
patient's needs or the procedure) will determine whether a basic or
comprehensive informed consent process is necessary. (See
also Informed Consent in the OR.)
What is informed consent?
Informed consent is the process by which the treating health care
provider discloses appropriate information to a competent patient so that
the patient may make a voluntary choice to accept or refuse treatment.
(Appelbaum, 2007)1 It originates from the legal and ethical right the
patient has to direct what happens to her body and from the ethical duty
of the physician to involve the patient in her health care.
What are the elements of full informed consent?
The most important goal of informed consent is that the patient has an
opportunity to be an informed participant in her health care decisions. It
is generally accepted that informed consent includes a discussion of the
following elements:
The nature of the decision/procedure
Reasonable alternatives to the proposed intervention
The relevant risks, benefits, and uncertainties related to each
alternative
Assessment of patient understanding
The acceptance of the intervention by the patient
In order for the patient's consent to be valid, she must be considered
competent to make the decision at hand and her consent must be
voluntary. It is easy for coercive situations to arise in medicine. Patients
often feel powerless and vulnerable. To encourage voluntariness, the
physician can make clear to the patient that she is participating in a

decision-making process, not merely signing a form. With this

understanding, the informed consent process should be seen as an
invitation for the patient to participate in health care decisions. The
physician is also generally obligated to provide a recommendation and
share his reasoning process with the patient. Comprehension on the part
of the patient is equally as important as the information provided.
Consequently, the discussion should be carried on in layperson's terms
and the patient's understanding should be assessed along the way.
Basic or simple consent entails letting the patient know what you would
like to do; giving basic information about the procedure; and ensuring
that the patient assents or consents to the intervention. Assent refers to a
patients willing acceptance of a treatment, intervention, or clinical care.
Basic consent is appropriate, for example, when drawing blood in a
patient who has given blood before. Sometimes consent to the procedure
is implied (e.g. the patient came in to have blood drawn), but an
explanation of the elements of the procedure remain necessary. Decisions
that merit this sort of basic informed consent process require a low-level
of patient involvement because there is a high-level of community
consensus that the treatment being offered is the only or best option
and/or there is low risk involved in the treatment If a patient does not
consent under the paradigm of basic consent, then a fuller informed
consent discussion is warranted.
How much information is considered "adequate"?
How do you know when you have provided enough information about a
proposed intervention? Most of the literature and law in this area suggest
one of three approaches:
Reasonable physician standard: what would a typical physician
say about this intervention? This standard allows the physician to
determine what information is appropriate to disclose. However, this
standard is often inadequate, since most research shows that the
typical physician tells the patient very little. This standard is also
generally considered inconsistent with the goals of informed
consent, as the focus is on the physician rather than on what the
patient needs to know.
Reasonable patient standard: what would the average patient
need to know in order to be an informed participant in the
decision? This standard focuses on considering what a typical
patient would need to know in order to understand the decision at
hand.

 Subjective standard: what would this particular patient need to

know and understand in order to make an informed decision? This
standard is the most challenging to incorporate into practice, since it
requires tailoring information to each patient.
Most states have legislation or legal cases that determine the required
standard for informed consent. In the state of Washington, we use the
"reasonable patient standard." The best approach to the question of how
much information is enough is one that meets both your professional
obligation to provide the best care and respects the patient as a person,
with the right to a voice in health care decisions. (See also TruthTelling and Law and Medicine.)
What sorts of interventions require informed consent?
All health care interventions require some kind of consent by the patient,
following a discussion of the procedure with a health care provider.
Patients fill out a general consent form when they are admitted or receive
treatment from a health care institution. Most health care institutions,
including UWMC, Harborview, and VAMC also have policies that state
which health interventions require a signed consent form. For example,
surgery, anesthesia, and other invasive procedures are usually in this
category. These signed forms are the culmination of a dialogue required
to foster the patient's informed participation in the clinical decision.
For a wide range of decisions, explicit written consent is neither required
nor needed, but some meaningful discussion is always needed. For
instance, a man contemplating having a prostate-specific antigen screen
for prostate cancer should know the relevant arguments for and against
this screening test, discussed in lay terms. (See also Research Ethics.)
Is it ever acceptable to not have a full informed consent?
Exceptions to full informed consent are:
If the patient does not have decision-making capacity, such as a person
with dementia, in which case a proxy, or surrogate decision-maker, must
be found. (See Surrogate Decision-Making/No Legal Next of Kin.)
A lack of decision-making capacity with inadequate time to find an
appropriate proxy without harming the patient, such as a life-threatening
emergency where the patient is not conscious
When the patient has waived consent.

 When a competent patient designates a trusted loved-one to make

treatment decisions for him or her. In some cultures, family members
make treatment decisions on behalf of their loved-ones. Provided the
patient consents to this arrangement and is assured that any questions
about his/her medical care will be answered, the physician may seek
consent from a family member in lieu of the patient.
When is it appropriate to question a patient's ability to participate in
decision making?
In most cases, it is clear whether or not patients have capacity to make their
own decisions. Occasionally, it is not so clear. Patients are under an unusual
amount of stress during illness and can experience anxiety, fear, and
depression. The stress associated with illness should not necessarily preclude
one from participating in one's own care. However, precautions should be
taken to ensure the patient does have the capacity to make good decisions.
There are several different standards of decision-making capacity. Generally
you should assess the patient's ability to:
Understand his or her situation,
Understand the risks associated with the decision at hand, and
Communicate a decision based on that understanding.
When this is unclear, a psychiatric consultation can be helpful. Of course, just
because a patient refuses a treatment does not in itself mean the patient is
incompetent. Competent patients have the right to refuse treatment, even
those treatments that may be life-saving. Treatment refusal may, however, be
an indication that it is necessary to pause to discuss further the patient's
beliefs and understanding about the decision, as well as your own.
What about the patient whose decision making capacity varies from
day to day?
A patients decision-making capacity is variable as their medications or
underlying disease processes ebb and flow. You should do what you can to
catch a patient in a lucid state - even lightening up on the medications if
necessary and safe - in order to include her in the decision making process.
Delirious patients have waxing and waning abilities to understand information.
However, if a careful assessment is done and documented at each contact, and
during lucid periods the patient consistently and persistently makes the same
decision over time, this may constitute adequate decisional capacity for the
question at hand.
What should occur if the patient cannot give informed consent?

If the patient is determined to be incapacitated/incompetent to make health

care decisions, a surrogate decision maker must speak for her. There is a
specific hierarchy of appropriate decision makers defined by state law (also see
the DNR topic page). If no appropriate surrogate decision maker is available,
the physicians are expected to act in the best interest of the patient until a
surrogate is found or appointed. In rare circumstances, when no surrogate can
be identified, a guardian ad litem may have to be appointed by the court.
Confer with social work and risk management if you have trouble finding a
legal surrogate for the patient.
How does informed consent apply to children?
Children do not have the decision-making capacity to provide informed
consent. Since consent, by definition, is given for an intervention for oneself,
parents cannot provide informed consent on behalf of their children. Instead
they can provide informed permission for treatment. For older children and
adolescents, assent should always be sought in addition to the authorization of
legal surrogates. Adolescents and mature minors are legally and ethically
authorized to provide informed consent if they are emancipated, and in many
states, including Washington, they may provide consent for matters regarding
sexual and reproductive health, mental health, and substance abuse. See your
states legislation regarding mature minors and consent laws.
The primary responsibility of the physician is the well-being of the child.
Therefore, if the parental decision places the child at risk of harm then further
action may be indicated. When there are differences in opinion between the
parents and physicians that cannot be resolved ethics consultation may be
pursued, and legal avenues may be pursued when all other means have failed.
Children should be included in decision-making at a developmentally
appropriate level and assent should be sought when possible. (See Parental
Decision Making.)
Is there such a thing as presumed/implied consent?
The patient's consent should only be "presumed," rather than obtained, in
emergency situations when the patient is unconscious or incompetent and no
surrogate decision maker is available, and the emergency interventions will
prevent death or disability. In general, the patient's presence in the hospital
ward, ICU or clinic does not represent implied consent to all treatment and
procedures. The patient's wishes and values may be quite different from the
values of the physician. While the principle of respect for person obligates you
to do your best to include the patient in the health care decisions that affect
her life and body, the principle of beneficence may require you to act on the
patient's behalf when her life is at stake.
References

1 Appelbaum PS. Assessment of patients competence to consent to

treatment.New England Journal of Medicine. 2007; 357: 1834-1840. [back to
article]
Informed Consent:
Case 1
A 64-year-old woman with MS is hospitalized. The team feels she may need to be
placed on a feeding tube soon to assure adequate nourishment. They ask the patient
about this in the morning and she agrees. However, in the evening (before the tube
has been placed), the patient becomes disoriented and seems confused about her
decision to have the feeding tube placed. She tells the team she doesn't want it in.
They revisit the question in the morning, when the patient is again lucid. Unable to
recall her state of mind from the previous evening, the patient again agrees to the
procedure.
Is this patient competent to decide? Which preference should be honored?

Informed Consent:
Case 1 Discussion
This patient's underlying disease is impairing her decision-making capacity. If her wishes are
consistent during her lucid periods, this choice may be considered her real preference and
followed accordingly. However, as her decision-making capacity is questionable, getting a
surrogate decision maker involved can help determine what her real wishes are.

Informed Consent:
Case 2
A 55-year-old man has a 3-month history of chest pain and fainting spells. You feel
his symptoms merit cardiac catheterization. You explain the risks and potential
benefits to him, and include your assessment of his likely prognosis without the
intervention. He is able to demonstrate that he understands all of this, but refuses
the intervention.
Can he do that, legally? Should you leave it at that?

Informed Consent:
Case 2 Discussion
This patient understands what is at stake with his treatment refusal. As he is
competent to make this decision, you have a duty to respect his choice.
However, you should also be sure to explore his reasons for refusing
treatment and continue to discuss your recommendations. A treatment

refusal should be honored, but it should also not be treated as the end of a
discussion.
PHILIPPINE MEDICAL ASSOCIATION
North Avenue, Quezon City
PHILIPPINE MEDICAL ASSOCIATION DECLARATION
ON
THE RIGHTS AND OBLIGATIONS OF THE PATIENT
INTRODUCTION
The time honored relationship between Filipino physicians, their patients and the community has undergone significant changes in recent times. The physician
should always act according to his conscience, for the best interest of the patient, and must exert equal effort to guarantee patient autonomy, justice and
participation in the decision making. The following Declaration represents some of the principal rights and obligations of the patient which the medical
profession endorses and promotes, Physicians and other persons or bodies involved in the provision of health care have a joint responsibility to recognize and
uphold these rights. Whenever legislation, government action or any other administration or institution denies patients these rights, physicians should pursue
appropriate means to assure or to restore them. On the other hand, legislating these rights will erode the basic foundation that welds the patients and the
physicians together trust and respect, running counter to the best interests of the patients.

RIGHTS
1. Right to Good Quality Health Care and Humane Treatment
a.
Every person has a right to good quality health care without any discrimination and within the limits of the resources available for health and medical care.
b.
In the course of such care, his human dignity, culture, convictions and integrity shall be respected.
c.
If the patient has to wait for care, he shall be informed by the health professionals of the reason for the delay.
d.
The patient shall always be treated in accordance with his best interests. The treatment applied shall be in accordance with generally accepted medical
principles.
e.
The patient has the right of continuity of health care.
f.
An emergency patient who is immediate threat of dying or losing life or limb shall be extended immediate medical care and treatment without any pecuniary
consideration until the emergency situation is over.

2. Right to Dignity
a.
The patient's dignity, culture and value shall be respected at all times in medical care and teaching.
b.
Terminal ill patients are entitled to humane terminal care to make dying asdignified and comfortable as possible.

3. Right to Be Informed of His Rights and Obligations as a Patient

Every person has the right to be informed of his rights and obligations as a patient. The Philippine Medical Association (PMA) in coordination with health care
providers, professionals and civic groups, the medical people's organizations, local government units, and other government agencies and non-governmental
organizations shall conduct a nationwide information and education to make known to people their rights as patients as provided in this Declaration. The
health care institutions shall inform patients of their rights as well as of the institution's rules and regulations that apply to the conduct of the patient while in the
care of such institution.

4. Right to Choose His Physician

a.
The patient is free to avail of the services of a physician or health institution of his choice except when he chooses to be confined in a service ward. In this
case, his attending physician shall be the one who was on duty and who made the admitting orders at the time of admission as appearing in the Doctor's
Order Sheet of the Medical Record.
b.
The patient has the right to seek a second opinion.
c.
The patient has the right to change his physician or other health care provider.

5. Right to Informed Consent

a.
The patient has the right to self-determination, to make free decisions regarding himself. The physician shall inform the patient of the consequences of his
decisions.
b.
Patient who is mentally competent and of legal age or in his incapacity or age of minority his legal representative, has a right to a clear explanation, in
layperson's terms, of all proposed or contemplated procedures whether diagnostic or therapeutic, including the identity and professional circumstances of the
person or persons who will perform the said procedure or procedures.
The explanation shall include that amount of information necessary and indispensable for him to intelligently give his consent which may include, but may not
be limited to the benefits, risk and side effects, and the probability of success or failure, as a possible consequence of said proposed procedure or procedures,
including the implications of withholding consent. In the explanation of the proposed procedure or procedures, the comprehensive ability of the patient shall
also be considered taking into account his level of education, the dialect or language that he speaks and understands and if possible, the use of anatomic
sketch, or otherwise the use of those materials or visual aids that may aid the patient or his legal representative, in fully understanding the proposed
procedure or procedures. The right to informed consent shall likewise consider the voluntariness in which the patient or his legal representative has given his
consent seeing to it that the patient or his legal representative was allowed to ask questions, or that he is given the chance to consult his kins, or to seek
another expert opinion.
c.
The unconscious patient
1)
If the patient is unconscious or unable to express his will, informed consent must be obtained whenever
possible from a legal representative.
2)
When medical intervention is urgently needed, consent of the patient may be presumed.
3)
Physicians should always try to save the life of a patient unconscious due to a suicide attempt.
d.
The legally incompetent patient

1)
If a patient is a minor or legally incompetent the consent of a legally representative is required. Nevertheless the
patient must be involved in the decision making to the fullest extent allowed by his mental capacity.

A patient, who is eighteen years of age and above, shall be considered, for purposes of this declaration, to be of
legal age.
2)
If the legally incompetent patient can make rational decisions, his decisions must be respected, and he has the
right to forbid the disclosure of information to his legally representative.
3)
If the patient's legal representative, forbids treatment but, in the opinion of the physician contrary to the patient's
best interest, the physician may challenge this decision in court. In case of emergency, the physician will act in
the patient's best interest.
e.
In case of emergency, when there is no one who can give consent in his behalf, the physician can perform any emergency diagnostic or treatment procedure
in the best interests of the patient.

6. Right to REFUSE DIAGNOSTIC AND MEDICAL TREATMENT

a.
The patient has the right to refuse diagnostic and medical treatment procedures, provided that the following conditions are satisfied:
1)
He is of age twenty one and above, and mentally competent;
2)
He is informed of the medical consequences of his refusal;
3)
He releases those involved in his care from any obligation relative to the consequences of his decision; and
4)
His refusal will not jeopardize public health and safety.
b.
An adult with a sound mind may execute an advance directive for physicians not to put him on prolonged life support if, in the future, his condition is such that
there is little or no hope of reasonable recovery and the physician shall therefore allow the natural course to happen. The qualifications listed as 1, 2, 3, and 4,
of the preceding provision 6,a., shall be considered as satisfied if a patient whose condition makes him unable to express his will, has executed an advance
directive.

7. Right to Refuse Participation in Medical Research

The patient has the right to be advised of plans to involve him in medical research that may affect the care or treatment of his condition. The proposed
research shall be performed only upon the written informed consent of the patient.

8. Right to Religious Belief and Assistance

The patient has the right to receive spiritual and moral comfort including the help of a minister of his chosen religion.

9. Right to Privacy and Confidentiality

The patient has the right to privacy and protection from unwarranted publicity. This right to privacy shall include the patient's right not to be subjected to
exposure, private or public, either by photography, publications, video-taping, discussion, medical teaching or by any other means that would otherwise tend
to reveal his person and identity and the circumstances under which he was, he is, or he will be, under medical or surgical care or treatment.

a.
All identifiable information about a patient's health status, medical condition, diagnosis, prognosis and treatment and all other information of a personal kind,
must be kept confidential, even after death. Except, in cases when descendants may have a right of access to information that would inform them of their
health risks.
b.
All identifiable patient data must be protected. The protection of the data must be appropriate as to the manner of its storage. Human substance from which
identifiable data can be derived must be likewise protected.
c.
Confidential information can be disclosed in the following cases:
(1)
when his mental or physical condition is in controversy in a court litigation and the court in its discretion orders
him to submit to physical or mental examination by a physician;
(2)
when the public health and safety so demand;
(3)
when the patient or, in his incapacity, his legal representative expressly gives the consent;
(4)
when his medical or surgical condition, without revealing his identity, is discussed in a medical or scientific
forum for expert discussion for his benefit or for the advancement of science and medicine.
(5)
when it is otherwise required by law.

10. Right to Disclosure of, and Access to Information

a.
In the course of his treatment and hospital care, the patient has the right to be informed of the result of the evaluation of the nature and extent of his disease.
Any other additional or further contemplated medical treatment and surgical procedure or procedures.
b.
Disclosure of information maybe withheld if the information to the patient will cause mental suffering or further impair his health. Such disclosure may be
withheld or deferred at some future opportune time upon due consultation with the patient's immediate family.
c.
Information must be given in a way appropriate to the local culture and in waiver the patient can understand.
d.
The patient has the right not to be informed on his explicit request, unless required for the protection of another person's life.
e.
The patient has the right to choose who, if anyone, should be informed on his behalf.
f.
The patient has the right to examine and be given an itemized bill of the hospital and medical services rendered.
g.

The patient or his legal representative, has the right to be informed by the physician or his delegate of his continuing health care requirements following
discharge, including instructions about home medications, diet, physical activity and all other pertinent information.

11. Right to Correspondence and to Receive Visitors

The patient has the right to communicate with relatives and other persons and to receive visitors subject to reasonable limits prescribed by the rules and
regulations of the health care institution.

12. Right to Medical Records

The health care institution and the physician shall ensure and safeguard the integrity and authenticity of the medical records.
a.
Upon the request of patient, the physician shall issue a medical certificate, a clinical abstract to the patient upon discharge from the institution. Any relevant
document that the patient may require for insurance claims shall also be made available to him within a reasonable period of time.
b.
He has the right to view the contents of his medical records with the attending physician explaining contents thereof and at his expense.
c.
The patient may obtain from the health care institution a reproduction of his medical record at his expense.

13. Right to Health Education

Every person has the right to health education that will assist him in making informed choices about personal health and about the available health services.
The education should include information about healthy lifestyles and about methods of prevention and early detection of illnesses. The personal responsibility
of everybody for his own health should be stressed. Physicians should have an obligation to participate actively in educational efforts.

14. Right to Express Grievances

The patient has the right to express only valid complaints and grievances about the care and services received. Patients may express their complaints and
grievances with the Ethics Committee of the Philippine Medical Association through its component societies which shall afford all parties concerned with the
opportunity to settle amicably all grievances.

Societal Rights of Patients

In addition to the individual rights of patients, patients have societal rights which are as follows:

1.
Right to Health The patient has the right to access quality health care and to physicians who are
free to render clinical and ethical judgment without interference or outside pressure. The patient has the
right to regain and/or acquire the highest attainable standard of health, in a non- discriminatory, gender
sensitive, and equal manner, which health authorities and health practitioner must progressively contribute
to realize.

2.
Right to Access to Quality Public Health Care The patient has a right from the
national and local government a comprehensive and integrated health care delivery system, providing the
necessary manpower and facility resources. The patient has the right to functioning public health and health
care facilities, goods and services and programs needed and sufficient quantity. They shall likewise be
provided with health facilities and services with adequate provision of essential drugs, regular screening
program, appropriate treatment of prevalent diseases, illnesses, injuries and disabilities, including provision
of public health insurance. Towards this end, the government shall approximate the international standard
allocation for the health sector as set by the World Health Organization.

3.
Right to Healthy and Safe Workplace The patient has the right to a healthy natural
workplace environment with adequate supply of safe and potable water and basic sanitation, industrial
hygiene, prevention and reduction of exposure to harmful substances, preventive measures for

occupational accidents and diseases, and an environment that discourages abuse of alcohol, tobacco use,
drug use and other harmful substances.

4.
Right to Medical and Education Information and Programs the patient has the
right to prevention, medical information and education programs on immunization, prevention, treatment
and control of diseases, behavior-related concerns, and disaster relief and emergency situations during
epidemics and similar health hazards. The government shall endeavor to provide these information through
lectures, symposia, tri-media, posters and the like.

5.
Right to Participate in Policy Decisions the patient has the right to participate in policy
decisions relating to patient's right to health at the community and national levels.

6.
Right to Access to Health Facilities

The patient has the right to be admitted to any primary, secondary, tertiary and other specialty hospitals
when appropriate and necessary.

7.
Right to Equitable and Economic Use of Resources

The patient has the right to demand that government health facility resources must be equitably distributed
in all regions of the country.

8.
Right to Continuing Health Care

The patient has the right from the national and local government programs to ensure continuity of care in
the form of hospice care, rehabilitation, chemotherapy, and radiotherapy and similar modalities.

9.
Right to Be Provided Quality Health Care in Times of Insolvency

The patients who are paupers have the right from the national and local government provisions for quality
medical care in spite of insolvency. The national and local government must provide for a system of
payment to health care facilities and providers for all the valid and necessary medical expenses of their
poor and marginalized citizens.

Declaration of Obligations
The Obligation of Patients Patients shall at all times fulfill their obligations and responsibilities regarding medical care and their personal
behavior.

1.
Obligation to Know Rights the patient shall ensure that he/she knows and understands what
the patients' rights are and shall exercise those rights responsibly and reasonably.

General Risks of Transfusion

Link to Transfusion Medicine Manual ARCBS
The commonest causes of transfusion reactions seen at The Royal Children's Hospital are fever, chills,
hives and red rashes, these occur in approximately 1% of all blood transfusions. The incidence can
increase to 10% in children who are chronically transfused.
Circulatory overload is a risk for those patients already in a high risk group for circulatory overload, for
example neonates, cardiac patients.
The following information is provided as guidance, in order to provide you with the relevant information
in the event that you are asked questions.
Fractionated blood products derived from human plasma (e.g.. immunoglobulins, albumin) include viral
inactivation steps and therefore the viral risks are much lower. There have been no documented cases
of viral transmission with albumin, and no cases of viral transmission with Australian IVIG.

Description of transfusion related adverse events

Adverse reaction

Risk per unit transfused (unless specified)

Bacterial sepsis

1: 75,000 for platelets

1: 500,000 for red cells
Haemolytic reactions: Acute

1: 12,000 to 77,000
Haemolytic reactions: Delayed

1:2,500 to 11,000

Anaphylaxis - IgA deficiency

1: 20,000 to 50,000
Fluid overload/cardiac failure

Up to 1% of patients receiving transfusions

TRALI

1: 5,000 to 190,000

Transfusion-associated graft vs host disease

Rare

Reference: ARCBS Blood Component Information Booklet 2012.

Risk of transmission of viral infection from blood products

Estimate of residual risk 'per u

Agent and testing standard

Window period
(Days)

HIV (antibody + RNA)

Less than 1 in a 1 million

5.6
HCV (antibody + RNA)

Less than 1 in a 1 million

3.1
HBV (Antibody + NAT)

Less than 1 in a 1 million

23.9
HTLV I & II (antibody)

Less than 1 in a 1 million

51
Variant Creutzfeldt-Jakob Disease (vCJD)
[No testing]

Possible. Not yet reported in Austr

section below.

Malaria (antibody)

Less than 1 in a million

7-14

Notes: vCJD=variant Creutzfeldt-Jakob Disease; (a) The risk estimates for HIV, HCV, HBV are based on
Blood Service data from 1 January 2007 to 31 December 2009. The risk estimate for HTLV 1/2 is based
on data from 1 January 2004 to 31 December 2009.
Reference: ARCBS Blood Component Information Booklet 2012.

The Calman Chart.

(Calman 1996) for explaining risk (UK risk per one year).

Negligible

< 1:1,000,000 e.g. death from a lightning strike

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

Reference: ARCBS Blood Component Information Booklet 2012.

Links

RCH Blood Transfusion Procedure

Kids Health Info, parent info leaflet

Blood transfusion website

A parents guide to transfusion

Voyages Comic

Amazing you

Transfusion Consumer Information in languages other than English

Please remember to read the disclaimer.