Management of patients who refuse blood transfusion

The management of patients who refuse blood transfusion presents a unique combination of ethical, legal and medical challenges. Refusal can stem from religious beliefs, such as those held by Jehovah's Witnesses, or other personal reasons, such as fear of transfusion-transmitted infections or being given blood from vaccinated donors. This article presents the principles of respecting patient autonomy while ensuring safe and effective medical care, particularly when life-sustaining treatments are declined. Informed by the UK Mental Capacity Act 2005, which upholds a patient's right to refuse treatment, the article outlines a multidisciplinary approach to patient care that involves identification of the blood refuser, preoperative optimization, intraoperative blood conservation techniques and legal considerations. It also addresses some of the issues in the management of paediatric patients when parents refuse transfusions on behalf of their children. Alternative strategies such as erythropoietin, intravenous iron and cell salvage are discussed. The importance of individualized care plans, early identification, thorough documentation and continuing communication between the multidisciplinary team and the patient or family is emphasized to achieve the best possible outcomes.