Blood group misinformation impacting the attendant’s decision-making for a timely blood transfusion to their patient: An ethical dilemma

Abstract

In the third week of November 2024, a critical incident involving the refusal of a blood transfusion was reported at our hospital. The case involved a 65-year-old Indian patient who had been admitted for a proposed stoma closure surgery. Although the healthcare team deemed an urgent blood transfusion necessary as part of the patient’s treatment plan, the transfusion was refused due to misinformation from the patient’s attendants regarding the patient’s original blood type. Their refusal was also driven by a fear of the potential consequences of an erroneous mismatched blood transfusion. The blood transfusion centre (BTC) laboratory confirmed the patient’s blood type as B Rh (D) positive. However, the attendants raised concerns about the accuracy of this blood grouping, citing previous misunderstandings and misinformation that led them to believe the patient was AB Rh (D) positive until that point. Despite receiving multiple assurances and thorough explanations from the attending physician and nursing staff, the attendants remained distrustful of the BTC laboratory results and requested a re-evaluation of the patient’s blood type. As a result, a fresh blood sample was collected for repeat typing. After a one-on-one discussion with our transfusion medicine specialist, the attendants were ultimately convinced of the confirmed blood type. Subsequently, three compatible packs of packed red blood cells (PRBC) of B Rh (D) positive were issued to the patient over the next three consecutive days from our blood centre. This situation underscores the importance of effective communication and education regarding the patient’s actual blood type. Our report further details the incident, its consequences, the associated ethical dilemmas, and recommendations to prevent similar occurrences in future.