Society for the Advancement of Patient Blood Management

View all recommendations from this society

July 23, 2018

Avoid transfusion, outside of emergencies, when alternative strategies are available as part of informed consent; include a discussion about alternative strategies during the informed consent process.

Informed choice/consent regarding transfusion and effective alternatives should be standardized and consistently delivered. Throughout the world, there is wide variation amongst medical practitioners and hospitals in the delivery of information to patients regarding the risks of and alternatives to transfusion. Outside of the truly emergent clinical situation, transfusion should be avoided or limited when other interventions are available to manage and preserve the patient’s own blood. This promotes patient empowerment and engagement. Alternative strategies to transfusion include, but are not limited to, pharmacologic agents, cell salvage, normovolemic hemodilution, and minimally-invasive surgical techniques. Additionally, transfusions may not be necessary in asymptomatic patients even in the presence of low hemoglobin concentrations.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The Executive Committee and Board of Directors (BOD) of the Society for the Advancement of Patient Blood Management (SABM) had a strong desire to participate in the Choosing Wisely campaign. Participation allows SABM to align with the national Choosing Wisely® team and other specialty societies to further the mission of collaborative physician-patient health care delivery and responsible use of resources.

A Task Force was appointed from within the BOD to draft the initial set of recommendations. Evidence-based recommendations were based on our society’s foundational pillars and structured around published SABM Standards. A critical feature was the review of relevant literature for supporting evidence applicable to each statement. Ultimately, the draft recommendations were submitted to the membership for input via an email survey. This resulted in the final five statements for which evidentiary materials and pertinent references were written. The BOD approved the materials prior to submission. Recent review with updates was undertaken by the SABM Educational Oversight Committee.

Working with this initiative, our selected recommendations and integrated materials were further honed based on subsequent campaign review. This list and supporting material resulted in a publication in a peer-reviewed journal in 2019. SABM will also develop monitors to assess the impact of the initiative for our members and hospital affiliates. We foresee this as a vehicle for outreach to other professional societies, health care providers and patients.


Friedman M, Arja W, Bata R et al. Informed consent for blood transfusion: What do medical residents tell? What do patients understand? Am J Clin Pathol. 2012 Oct;138(4):559-65.

Davis R, Vincent C, and Murphy M Blood transfusion safety: the potential role of the patient. Transfus Med Rev 2011; 25(1) 12-23.

Booth C, Grant-Casey J, Court EL et al. National comparative audit of blood transfusion: report on the 2014 audit of patient information and consent. Transfus Med 2017: 21(3): 183-189.

Vossoughi S, Macauley R, Sazama K, and Fung M Attitudes, practices, and training on informed consent for transfusions and procedures. Amer J Clin Path 2015; 144: 315-321.

Howell CA and Forsythe JLR Patient consent for blood transfusion- recommendations from the SaBTO. Transfus Med 2011. 21: 359-362.

Court EL. Robinson JA, and Hocken DB Informed consent and patient understanding of blood transfusion. Transfus Med 2011; 21: 183-189.

Shander A, Hardy JF, Ozawa S, Farmer SL, Hofmann A, Frank SM, Kor DJ, Faraoni D, Freedman J; Collaborators. A Global Definition of Patient Blood Management. Anesth Analg. 2022 Feb 10. doi: 10.1213/ANE.0000000000005873. Epub ahead of print. PMID: 35147598.