Prepare a patient information leaflet about blood transfusion, intended for adult patients scheduled for elective surgery attending a pre-admission clinic approximately 1 month prior to the date of admission.

1. Indications for blood transfusion

• Not always necessary – only if required
• Blood loss – if the amount lost is greater than the body can tolerate

2. Reducing need for transfusion

• Pre-op optimisation of haemoglobin– iron, folate or B12 replacement
• Check your medication - 
• Cell salvage intra op

3. How blood is given

• Intravenous either during the operation or on the day afterwards (may take up to 4 hours per unit) 

4. Symptoms during transfusion

• Most asymptomatic
• Regular observations
• Temperature, chill or rash – paracetamol and slow transfusion
• Severe reactions extremely rare

5. Side effects

• Wrong blood - 2m units transfused each year, only a handful of cases
• Infections HepB (1in 500 000), HIV (1in 5m), Hep C (1 in 30m), bacterial contamination
• vCJD – probably very low
•  Fluid overload
• TRALI 

6. Concerns / contacts

• Doctor on ward 
• Hospital transfusion practitioner
• NBS, national patient safety agency

7. Possibly paragraph for Jehovah's witnesses