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The approach to the patient who refuses blood transfusion

Kendall P Crookston, MD, PhD
Section Editor
Arthur J Silvergleid, MD
Deputy Editor
Jennifer S Tirnauer, MD


Disagreements arising between patients and their clinicians on the choice of therapy remain a challenge in the practice of modern medicine. Such conflicts can strain the critical clinician/patient relationship [1,2]. Few disagreements have drawn as much attention in the medical, legal, and public spheres as the refusal of blood transfusion [3,4].

Dealing with such patients and their families takes additional time and energy, which may not be available in emergency situations and may not be reimbursed. Nevertheless, clinicians are obliged to provide the best management possible, factoring in the time required to assess the specific preferences of patients and their families. A thorough understanding of these issues, combined with a precise determination of the patient’s wishes, will enable a clinician to outline the most appropriate treatment plan or to refer the patient to an appropriate colleague when clinically possible.

This topic review will present an overview of this subject, often called "bloodless medicine," which is now evolving into the field of "patient blood management" [5]. Given the paucity of specific clinical guidelines, the approach discussed here reflects prevailing concepts generalizable to all medical specialties.  

General discussions of the use of blood for transfusion (ie, red blood cells [RBCs], white blood cells [WBCs], platelets, plasma) as well as the risks of transfusion are presented in separate UpToDate reviews:


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Literature review current through: Nov 2017. | This topic last updated: Aug 11, 2016.
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